Mental health self-care during the COVID-19 pandemic: a prospective cohort study in Australia

Our findings demonstrate that informal forms of mental health self-care during the COVID-19 pandemic were much more common than the use of formal mental health services such as psychologist or psychiatrist consultations and calls to COVID-19 telephone support lines. Most people reported at least one form of mental health self-care such as meditation or mindfulness, activities to distract themselves, or speaking to a family member or friend about their mental health concerns during the prior month. Despite the heightened use of telephone helplines during the early stages of the pandemic [19], this was the least common action reported to manage mental health concerns within our sample of working-age Australians. Our findings broadly align with the WHO framework for organisation of services for mental health, describing a higher prevalence of informal service use compared to formal service use [20], and our analyses add further value by quantifying more specific informal actions taken to manage mental health. Furthermore, our findings clearly demonstrate the extent to which strategies to manage mental health concerns differ by individuals’ pre-existing and current mental health status, employment, age and gender. The prevalence of actions taken by people in distress suggests that those in most need of help made changes to their lives to support their mental health, and were more likely to seek help. However, people experiencing moderate to high levels of distress also more commonly increased their consumption of alcohol or drug use, which can lead to poorer health or may contribute towards harmful forms of substance abuse in some circumstances [21].

Physical health and mental health are closely interrelated, and exercise was commonly reported as an approach to manage mental health concerns during the pandemic. For some people physical activity during the pandemic acted as a motivator for anxiety relief, whereas those with mental health deteriorations have reported increased sedentary behaviour overall [22]. Physical health interventions, that result in long duration physical activity, may offer the most mental health benefits to men [23], who were identified as having potential barriers to mental health self-care in terms of making changes to their exercise or diet. Furthermore, men may also benefit from employer-based education on mental health supports to reduce negative attitudes of psychological openness to tackle the under-utilisation of mental health services [24], and to benefit from the mental health support of family and friends [25].

The strength of this national cohort study lies within the diverse forms of mental health self-care evaluated, which were investigated by pre-existing health factors, in addition to employment status, age and gender. Findings uncover personal characteristics associated with potential barriers to engagement with mental health supports, and self-care, during an economic crisis. One limitation is that the study findings fall exclusively within the COVID-19 pandemic context, without reference to the degree of mental health self-care prior to the pandemic. However, given the declined mental health observed in this group compared to pre-pandemic reference levels [8, 9], mental health self-care would be anticipated to be less common before the pandemic when taking into context the study findings. Whilst our dataset consists of working-age Australians that are an overrepresented sample of people that experienced pandemic-related work loss, findings are valid within the context of the early stages of the pandemic in Australia, during a heightened period of work loss [26], although they may differ based on changes in public health orders over time, and their relevance for the workforce. Within the category of formal forms of mental healthcare, the heightened use of mental health services in Australia has been ongoing since the start of the COVID-19 pandemic [27], demonstrating the longer-term need for such services. Analogous information on mental health self-care over longer time periods since the start of the pandemic remains a challenge to quantify. Longitudinal research studies, over several years, will uncover changes in informal forms of mental health self-care following periods of crisis. In many nations, stringent pandemic measures have since lifted, and unenforced recommendations remain in community settings which may promote good mental health as observed following the release of lockdown measures [10]. However, some workplaces remain high infection risk settings such as in the health and care industry, and mental health consequences of pandemic-related changes in work may differ from industries with fewer ongoing pandemic-related measures or changes in workload. Employers are uniquely placed to develop relevant mental health supports and policies during changes to the workplace and the nature of work resulting from the pandemic.

The elevated use of online mental health resources and lifestyle changes among furloughed or newly unemployed individuals suggests that these individuals may be more receptive to self-directed mental health interventions. This highlights the potential for online resources and lifestyle modifications to serve as valuable tools for promoting mental well-being during periods of unemployment or furlough. Further research is warranted to understand the long-term effects of these interventions and to identify strategies for promoting their uptake among this vulnerable population, whilst overcoming known barriers to mental health self-care [28].