Some takeaway messages from WP2 – Identifying risk and resilience groups – were:
Global increase in symptoms of anxiety and depression in the general population
During the COVID-19 pandemic, a significant rise in symptoms of anxiety and depression has been observed among the general population, revealing disparities in mental health based on gender and age. Women consistently reported heightened mental health challenges, while young adults faced an increased risk of depression, particularly impacting students. Additionally, individuals with pre-existing mental health disorders were more susceptible to experiencing elevated levels of anxiety and depressive symptoms.
Amidst these challenges, loneliness emerged as a significant risk factor during this period, exacerbating existing mental health conditions. Coping mechanisms like catastrophizing, neuroticism, and insufficient instrumental support played a role in further amplifying these challenges. Moreover, economic, and work-related difficulties, such as unemployment and financial strain, were predictive of symptoms of anxiety or depression. The pandemic also revealed an increase in social inequalities, particularly in smoking rates.
Furthermore, vulnerable populations, including those facing socioeconomic disadvantage, migrants, and individuals experiencing homelessness, encountered heightened mental health difficulties during this time. Healthcare workers, essential to the pandemic response, continued to grapple with poor mental health outcomes. Perceived discrimination emerged as a modifiable factor influencing their mental well-being, suggesting the need for targeted interventions and support measures.
Individual participant data meta-analyses of mental health and resilience in the COVID pandemic (CO-RESPOND)
The aim of CO-RESPOND is to establish a sustainable network of longitudinal studies by retroactively harmonizing datasets. This involves implementing a federated network for distributed and remote data analyses (FND) alongside publishing the harmonized cohort datasets and products in a FAIR manner —ensuring they are Findable, Accessible, Interoperable, and Reusable.
Resilience methodology
Resilience emerges as a crucial concept, inherently tied to adversity. It is defined as the ability to maintain or swiftly regain mental well-being following exposure to challenges. Operationalizing this concept involves recognizing the unpredictable and highly variable nature of adversity. Resilience, then, becomes the result of ongoing dynamic processes of adaptation over time. Achieving this understanding necessitates regular assessments of stressors and the implementation of longitudinal studies to track these evolving responses to adversity.
Register studies on the long-term mental health consequences of the pandemic
Several manuscripts are currently in development regarding mental health in Sweden. One manuscript, focusing on the incidence rates of suicide attempts and suicides, has been submitted to Lancet Psychiatry and is awaiting feedback. Another manuscript delves into the utilization of specialized psychiatric care for common mental disorders and is currently under review by co-authors. Additionally, a separate manuscript examines the issue of long-term sickness absence due to common mental disorders.
In Italy, preliminary findings shed light on the impact of the pandemic on suicide behaviour rates among COVID-infected individuals. Contrary to expectations, there has been no observed increase in suicide rates, although these results are yet to be published. Additionally, a study reveals the risk reduction of highly adhering to recommended healthcare practices among patients with severe mental illness compared to those without. Notably, lower adherence rates are found among patients with severe mental illness, and this pattern remains unchanged before and after the pandemic.
Finally, preliminary analysis is in progress to determine whether patients with mental health disorders in Spain are at an elevated risk of SARS-COV-2 infection.
Key insights from WP3 – Health system preparedness:
In the RESPOND project, WP3 objectives are focused on addressing the mental health and wellbeing challenges posed by the COVID-19 pandemic across Europe. The main goals are to analyse and compare the policies and measures implemented in various European countries to tackle mental health issues among both the general population and vulnerable groups. This includes ongoing assessments of the mental health impacts of country responses to COVID-19 and an examination of how these responses are influenced by health system factors.
A significant aspect of the project is the exploration of how scaling-up remote-delivered stepped-care interventions, as recommended by the World Health Organization, can support the responsiveness of healthcare systems in dealing with mental health challenges during the pandemic.
To achieve these objectives, a mixed methods approach has been adopted. This involves reviewing and analysing policy documentation related to mental health, including evidence inquiries. Challenges of assessing policies at both national and regional levels are being addressed. The project also makes use of available datasets such as coronanet and the Coronavirus Government Response Tracker.
Additionally, in-depth interviews with various stakeholders are being conducted, aiming to understand the trade-offs between actions taken to protect mental health and their broader impacts on the economy. Insights gleaned from these interviews indicate that during the initial stages of the pandemic, mental health was not a primary concern. It gained greater concern later, seen as a double-edged sword for reopening the economy. The lack of emphasis on mental health in prior pandemic preparedness plans was highlighted, alongside the observation that coping with uncertainties could potentially be more detrimental than the pandemic itself. Moreover, it was noted that the level of financial income protection measures, the more positive the outcomes for mental health and wellbeing. As we navigate these challenges, it remains crucial to prioritize the protection of high-risk groups, highlighting the necessity of maintaining, rather than reducing, financial support programs.
The WP3 also carried out a discrete choice experiment (DCE), examining the preferences of both the population and stakeholders regarding four well-being attributes (physical health, mental health, employment, and liberty) during a pandemic. The aim was to uncover the core values guiding mitigation policies comparing the perspective of the decision-maker with the one of the general population. This study revealed divergent preferences between stakeholders and the general population regarding mental health and civil liberties restrictions, providing insights into essential considerations for shaping effective mitigation policies. In particular, the study showed that stakeholders, in comparison with the general population, were more sensitive to mental health and less so to liberty.
The ongoing mental health impact assessments conducted indicate a range of effects stemming from pandemic response measures. These include both positive and negative impacts. Positive outcomes observed include increased participation in exercise, children experiencing less bullying at school, and improved financial stability due to measures such as rent protection and financial support. However, there are also adverse effects noted, particularly in the context of home schooling.
The project also sheds light on the widening socio-economic and mental health inequalities experienced by marginalized population groups. It aims to address long-term impacts on daily life, providing opportunities for mental health and wellbeing reform in the aftermath of the pandemic.
Through these comprehensive efforts, the project aims to provide valuable insights for effective policymaking and interventions to support mental health and wellbeing during the ongoing COVID-19 pandemic across Europe.
WP4 – Health and care workers:
Implementation trial analyses are in preparation. This type of study aims to evaluate real-world conditions for implementing and disseminating an intervention, identifying key elements for its upscale and integration into routine practice. This involves assessing five indicators: needs, appropriateness, acceptability, feasibility, and adoption.
The needs assessment revealed that health and care workers felt misunderstood and encountered stress, burnout, anxiety, powerlessness, and distress. Although interventions were proposed to address these needs, there was a general reluctance among workers to participate, with managers displaying a greater interest in supporting the staff.
Regarding acceptability, timing emerged as a critical factor. During peak crisis periods, there is often a sentiment of “no time for mental distress”. Conversely, after crisis waves subside, individuals showed reluctance to engage with mental health interventions again. Acceptability rates tended to increase among those with prior exposure to and knowledge of psychotherapy and mindfulness. Additionally, misinformation from social media, such as high vaccine hesitancy, influenced many nursing auxiliaries.
In terms of feasibility, several challenges have emerged. Finding appropriate helpers, especially in nursing homes, proved to be difficult. The lack of external resources also posed a significant hurdle. The training process itself demanded considerable resources, including time, personnel, and materials. Moreover, managing intervention times proved problematic, with numerous missed appointments having repercussions for the entire process. Minor technical issues, such as translation problems and website usability on smartphones, also required attention.
Finally, in terms of adoption, the study encountered challenges due to the low number participants. However, those who did participate reported a significant realization of the severity of their condition with the assistance of the intervention.
To facilitate scalability and enhance the effectiveness of the interventions, several recommendations have been proposed. Firstly, a robust campaign focusing on the dissemination of information and knowledge about the principles and mechanisms of the interventions, along with highlighting the significance of mental health, is essential. Building trust and confidence with the participants is another crucial step, emphasizing the importance of building supportive relationships throughout the intervention process. Careful selection and thorough training of helpers play a significant role in ensuring the success of the interventions. Collaboration with leaders and securing leadership support within the services is also vital for sustained effectiveness. Furthermore, allowing flexibility in the intervention process to accommodate variations in session duration and pace can enhance participant engagement and outcomes. Finally, preparing helpers and managers to offer continued care and support post-intervention is crucial for long-term success.
Alongside these recommendations, preparations are underway for resilience analysis, process evaluation, and economic analysis, contributing to a comprehensive understanding of the interventions’ impact and scalability.
WP5 – Vulnerable groups – takeaway messages:
The objectives of WP5 encompassed three main goals. Firstly, to assess the needs of stakeholders and end-users regarding the implementation and scaling-up of the stepped care DWM/ PM+ programs for vulnerable groups. Secondly, executing and evaluating the implementation of the expanded programs within these vulnerable populations. This evaluation includes an examination of various factors such as psychological symptoms, resilience, wellbeing, other mental health outcomes, health inequalities, and the financial impacts on health systems. Lastly, to identify the specific barriers and facilitators that impact the successful scaling-up and execution of the stepped care DWM/ PM+ programs for vulnerable groups. This involves a comprehensive process evaluation to understand the complexities involved in these contexts.
Within WP5, Italy, France, and the Netherlands are conducting randomized controlled trials (RCTs) as part of their research. They began with a qualitative study in to understand the needs of different population groups. Moving to the second phase, they’re conducting three RCTs, with two already completed and one nearing completion. Beginning the third phase, they are now focusing on identifying the specific challenges and factors that impact vulnerable populations.
WP6 – Communication, dissemination and knowledge transfer:
The RESPOND final dissemination event will take place in Barcelona on May 16, 2024.The participants at the event will include RESPOND contributors, officials from the European Commission (EC), World Health Organization (WHO), and others speakers. Additionally, representatives from wider stakeholder groups such as health worker professional associations, individuals with lived experience, academics, and public health emergency leaders/experts will also be present.
Additionally, updates were provided on WP1 – Management and Coordination, and WP7 – Ethics Requirements.
PowerPoint presentations from the meeting are now available for partners in the shared space on the RESPOND website.
To find out more about the latest RESPOND results, please visit our Resources page.