Elimination COVID-19 Strategies Limited mental health impact, reduced COVID-19 transmissions and deaths

According to the results published in , changes in mental health have been relatively small over the first 15 months of the COVID-19 pandemic The Lancet Public Health.

This study was a longitudinal analysis of data from the Imperial College London-c COVID-19 Behavior Tracker Global Survey and the Oxford COVID-19 Government Response Tracker (OxCGRT). As of April 2020, adults residing in 15 countries were invited to complete an online survey every 2 weeks. A total of 432,642 people, or an average of 14,918 every 2 weeks, answered questions about their mental health. Trends in mental health impacts were related to the national health policy of the country in which they lived.

Countries that took early and targeted COVID-19 measures had lower virus circulation and therefore had lower average overall policy severity.

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Fewer COVID-19 deaths were observed in countries using an elimination strategy (β, -0.202).

Inappropriate mental health interventions increased over time for countries using a mitigation strategy and decreased over time for countries using an elimination strategy. Lifespan ratings followed a similar pattern for counties using a mitigation strategy and deteriorated over time. For countries using an elimination strategy, the change over time was not significant.

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

Strategically by specific limitations, greater impacts on psychological distress and poorer life ratings were associated with limitations in social gatherings, stay-at-home requirements and international travel but not for school, work, cancellation of public events, and limitations in domestic travel or public transport.

The number of consecutive cumulative days under high- or low-strength guidelines had no effect on mental health.

In general, associations for mental distress were stronger in women, and the negative impact of stringency on life assessments was age- and gender-dependent, with women over 60 years of age being more affected.

Limitations of this study included access to the survey, where these results likely did not represent people who were critically ill with COVID-19 or some marginalized groups.

The study authors concluded: “Our findings suggest that the timely use of testing and contact tracing as part of an elimination strategy can minimize deaths without requiring greater average political rigour. The severity of COVID-19 policies is linked to lower levels of mental health to the extent that people are observing physical distancing protocols, possibly because those protocols hinder familiar and meaningful forms of social connection. Governments could prioritize measures that reduce virus transmission but are less restrictive of daily life. […] Even in settings where governments have been slow to respond and consequently implement restrictive measures like lockdowns, mental health has gradually deteriorated only slightly, meaning policymakers should be largely reassured by people’s overall ability to cope. “


Aknin LB, Andretti B, Goldszmidt R, et al. Political 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

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