Background
In 2020, the outbreak and spread of COVID-19 led many governments around the world to adopt suppression measures, including lockdowns, bans on public events, and social distancing. Such measures, although effective in containing the spread of the virus [
1], may have had unintended consequences for the mental health of the population. Brooks and colleagues performed a rapid review of the literature on the psychological impact of quarantine in previous viral outbreaks and reported several negative psychological outcomes [
2]. Three main pathways were involved. First, continuous reports of information about outbreaks in the press and social media were likely to increase stress, anxiety, and fear of the disease and its consequences among the population. The confinement period due to COVID-19 occurred in the context of an unprecedented pandemic, a crisis affecting the entire world [
3]. Anxiety may have been further increased by the dissemination of verified and unverified information about the consequences and spread of the outbreak [
4‐
6]. Anxiety and stress were likely to be even greater among those affected by the disease at home, those at risk of being affected, and those who had a relative or a close friend outside the home who was affected [
3].
Second, the suppression measures deliberately led to a reduction in social contact, social activity, and social support, dramatically changing the social lives of individuals. Limiting social contact affects negatively the mental health of the general population, as evidenced in previous studies [
7,
8]. Such limitations have various possible consequences; confinement is likely to increase feelings of stress among individuals by limiting both access to public and open spaces and contact with people outside the home [
9,
10]. Confinement also lead to greater social exclusion, loneliness, reduced social support, and an increase in alcohol and substance use, all of which are key risk factors for poor mental health and suicidal behaviour [
11‐
15].
Third, the spread of COVID-19 and suppression measures may increase stress by affecting labour conditions [
16]. The workload of some, who were not employed in essential sectors, decreased, while the workload of others, such as health care professionals, increased [
17,
18]. There was also an increase in teleworking for many people employed in services [
19]. The closure of schools also led to children being stuck at home with their parents. Children were particularly vulnerable to confinement [
20], while parents had to combine the management of their professional activities with coping with children at home [
21,
22]. Many people also feared possible long-term consequences of the reduction in activity, particularly for employment and for their income [
23].
Finally, the COVID-19 outbreak and subsequent policy measures may not affect all sociodemographic groups in the same way. They were likely to affect the social and mental health of some groups of the population which are more vulnerable to the three pathways mentioned above, including women [
7,
24] and people who were already physically, mentally, or socially vulnerable prior to the outbreak [
25‐
27]. The main aim of this paper, therefore, was to investigate the risk of psychological distress that may be associated with the COVID-19 pandemic and subsequent confinement measures, particularly during the early days of confinement, in order to measure the short-term effects of the pandemic and the subsequent measures. In light of the previous results reported in the literature, three main research questions were addressed: (a) How did the level of psychological distress at the start of the lockdown period compare with the level of psychological distress usually measured in the general population? (b) Which health, social, and economic conditions predicted psychological distress at the beginning of the confinement period? (c) Was the risk of psychological distress associated with the duration of the lockdown?
Our study complements previous studies in several ways: we compare our results to a dataset from a pre-COVID19 national survey, helping to shed light on the changes, at populational level, associated with the pandemic and the accompanying measures. We also attempt to disentangle the different pathways involved and we compare the level of different symptoms in a pre-COVID19 period with the level of symptoms at the beginning of the lockdown. Finally, Belgium is an interesting case study as it has been among the countries worst hit by the COVID-19 pandemic (see below).
Conclusions
The short-term health, social, and economic conditions related to the COVID-19 pandemic and subsequent lockdown measures were associated with a worsening of the mental health of the general population in Belgium. The effects were measurable from the very first days of lockdown. The risk of psychological distress increased in accordance with increases in exposure to COVID-19 and duration of confinement. This was one of the first assessments of the mental health effects of the COVID-19 pandemic and confinement measures in Europe to be based on a large population sample. The findings indicate that, from the point of view of mental health, the authorities should limit the duration of lockdown and social distancing measures to a minimum. The authorities should also pay attention to those groups of the population that are most at risk of psychological distress, e.g. women, young people, people who are experiencing changes in their occupational status, and people who are feeling lonely or socially isolated. There might be intergenerational tension, as the mental health burden of lockdown seems to fall most heavily on younger people, even though the elderly are more at risk from COVID-19. Mitigating the impact of lockdown on people’s social and professional lives might be an effective strategy for coping with long periods of lockdown. Further research is needed, however, to evaluate whether the mental effects of COVID-19 and lockdown are sustained over longer periods. Likewise, further research should assess whether these effects are similar, in nature and size, in different countries, particularly by taking into account differences in the intensity of the outbreak and the diversity of the suppression measures implemented in the different countries affected.
Acknowledgements
This research was supported by a grant from the A.B. Fund managed by the King Baudouin Foundation, grant number: 2020-J1812640-216406.
We thank Sciensano for the access to the BE.HIS2018 survey data.
We thank the two reviewers for their helpful comments and suggestions.
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