Changes to mental health were relatively small during the first 15 months of the COVID-19 pandemic, according to results published in The Lancet Public Health.

This study was a longitudinal analysis of data from the Imperial College London COVID-19 Behaviour Tracker Global Survey and the Oxford COVID-19 Government Response Tracker (OxCGRT). From April 2020, adults residing in 15 countries were invited to participate every 2 weeks in an online survey. A total of 432,642 individuals, or an average of 14,918 every 2 weeks, responded to questions about their mental health. Trends in mental health effects were related with the governmental health policies for the country in which they resided.

Countries that implemented early and targeted COVID-19 action had lower levels of virus circulation and therefore had lower average policy stringency overall.

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Fewer COVID-19 deaths were observed for countries that used an elimination strategy (β, -0.202).

Unadjusted mental health measures increased over time for countries that used a mitigation strategy and decreased over time for countries using an elimination strategy. Life evaluations followed a similar pattern for counties using a mitigation strategy, deteriorating over time. For countries using an elimination strategy, the change over time was not significant.

After controlling for confounders, the association between policy stringency and psychological distress was significant (β, 0.142), indicating that increased stringency was associated with a 0.11-unit increase in distress. The relationship between stringency and mental health remained significant after controlling for deaths (β, 0.088) and cases (β, 0.110). Life evaluations were also related with policy stringency (β, -0.222), remaining significant after controlling for deaths (β, -0.136) and cases (β, -0.161).

Stratified by specific restrictions, greater effects to psychological distress and poorer life evaluations were associated with restrictions on social gatherings, stay at home requirements and international travel but not for school, work, cancelation of public events, and domestic travel or public transportation restrictions.

The number of consecutive accumulated days under high- or low-stringency policies had no effect on mental health.

In general, associations were stronger among women for psychological distress and the negative effects of stringency on life evaluations were dependent on age and gender, more greatly affecting women aged over 60 years.

The limitations of this study included access to the survey, in which these findings likely did not represent individuals who were severely ill with COVID-19 or some marginalized groups.

The study authors concluded, “Our results suggest that that timely use of testing and contact tracing, as part of an elimination strategy, can minimize deaths without requiring greater average policy stringency. COVID-19 policy stringency is associated with lower mental health to the extent that people heed physical distancing protocols, possibly because these protocols impede familiar and meaningful forms of social connection. Governments could prioritize policies that reduce virus transmission but impose fewer restrictions on daily life. […] Even in settings where governments were slow to respond and have consequently brought in restrictive policies such as stay-at-home orders, mental health has gradually declined only slightly, implying that policymakers should be largely reassured by people’s aggregate capacity to cope.”


Aknin LB, Andretti B, Goldszmidt R, et al. Policy stringency and mental health during the COVID-19 pandemic: a longitudinal analysis of data from 15 countries. Lancet Public Health. 2022;7(5):e417-e426. doi:10.1016/S2468-2667(22)00060-3