🦠 How the Pandemic Hit Your Mental Health

Have lifestyle changes during the COVID-19 pandemic left an enduring mark on your wellbeing?

Like most things in life, our behavioral changes during the COVID-19 pandemic may come with some unfortunate tradeoffs. National lockdowns and restrictions of social activity have helped to curb the number of virus-related deaths en route to the highly effective vaccines available to us today. But have they also left a dent in our mental health along the way?

Here’s a look at some of the latest research examining how our daily behavior has changed over the course of the pandemic, and how those changes are continuing to impact our well-being, even as pandemic restrictions are becoming less severe.

Comic from Skeleton Claw Comics

🔀 The Great Behavioral Shift

In a paper published in February 2021, a group of US researchers investigated how the early course of the COVID-19 pandemic affected people’s daily habits. They analyzed data from a wellness study on college students that ran from February 2019 to July 2020. This timeframe allowed them to examine student wellbeing before the onset of the pandemic and compare it to wellbeing after lockdowns began in March 2020.

Data came from surveys and Fitbits. Surveys collected feedback on daily habits and changing lifestyles. The wearables added some objective wellness indicators to the mix, especially in relation to physical activity and sleep quality.

The critical time period the researchers analyzed was the 3-month semester from February to April in 2020. They found that the average number of steps people took per day declined more than 50% from the start of February to the end of April, dropping from ~10,000 steps to ~4600 steps. Physical activity more generally dropped from 4.4 hours to 2.9 hours per day but came with a nice counterbalance of an extra 30 mins of sleep each night.

Unsurprisingly, social contact suffered right after pandemic onset with people reporting ~30 mins a day of social activity; a decline of almost two-thirds. People also reported a twofold increase in the amount of time they spent looking at a screen outside of school or work activities.

All of these behavioral changes contributed to an increased risk for clinical depression. At the beginning of the semester in February, 32% of the study sample were at risk of depression. Just 2 months later, this had increased to 61%.

Both the changes in depression and the changes in behavioral habits were clearly abnormal for the time of year. The same semester in 2019 didn’t show these worrying patterns identified in 2020, and the pandemic was the most obvious explanation for the dramatic changes. In their analysis, the researchers identified the drop in physical exercise as the primary risk factor for the increased depression risk.

The researchers continued their analysis into July 2020 and did find some reassuring evidence of recovery. By July, steps had increased to ~6400 per day and the proportion of students at risk of depression dropped to ~50%.

But how might things look today? In December 2021, the same researchers published a new paper looking at behavioral patterns one year into the pandemic. During this later research timeline, people were getting vaccinated and lockdown measures were relaxing in the US. By the last month of their analysis in May 2021, 95% of the student sample had received at least one dose of a vaccine and 85% were fully vaccinated.

Unfortunately, in May 2021, behavioral habits didn’t look much healthier than they looked in July 2020. People were still averaging ~6400 steps per day and physical activity was stuck at around 3.7 hours a day. Recreational screen time substantially decreased from the pandemic peak of 5.2 hours per day to 3.2 hours per day but didn’t quite reach pre-pandemic levels of 2.2 hours per day. Perhaps the saddest news of all in May 2021 was that people even lost the small wellbeing advantage they gained during the pandemic: their extra 30 mins of sleep.

The most positive signs came from social interaction numbers. People returned to pre-pandemic socializing of around 1.5 hours per day. However, this note of optimism wasn’t enough to improve depression stats. Depression rates plateaued after the small July 2020 recovery and there was no change even a year later in May 2021, with 50% of students remaining at risk of clinical depression.

All in all, it’s no surprise that the pandemic completely disrupted our regular lives, but it should be surprising that this lifestyle deterioration is so persistent. As vaccination rates increase and lockdown measures ease, lifestyle trajectories should be improving, even if they’re not yet back to pre-pandemic levels. But in mid-2021 for a large sample of US students, that positive trajectory wasn’t visible, and it isn’t certain today.

Habits are difficult to change and there’s an inertia to them once they’re established. Lockdowns mandated by the government effectively forced our habits to change once the pandemic started. But of course, there’s no mandate now to return to healthier lifestyles. That responsibility lies entirely with our own will, and our new routines aren’t going to make it easy.

⭐️ Takeaway tips

• What’s changed for you? There may be some post-pandemic behavioral changes you want to hold on to. Many people enjoy the greater flexibility of working from home and some people enjoy extra time with their immediate family. But we all need to explicitly assess how our behavior has changed so that we’re conscious of both the good and the bad. If you simply run with inertia, any negative habits will stick with you, just like they did with the students in the studies above. Make a list of the things you like and dislike about your lifestyle since the pandemic began so you can clearly see what has changed and what it means to you.

• Come up with a plan: Once you’re aware of any negative lifestyle changes, commit to a plan that can alleviate them. Are there friends you haven’t made dinner plans with in a while? Is there a way to get closer to your preferred balance of at-home vs out-of-home work? Have you been putting off travel plans that might be reasonable now?

• Keep an eye on your mental health: Mental health awareness is far better than it was a decade ago, but we still don’t pay as much attention to the health of our minds as we do to the health of our bodies. We have gyms, parks, and sports for keeping physically fit. But when it comes to mental fitness, we tend to speak to therapists only once things have already gone too far. Your depression risk today may be higher than it was before the pandemic, so pay attention to what makes you happy and unhappy. Experiment with changing your screen time habits, spending more time outdoors, meeting up with people more often, and improving your sleep schedules. It’s unlikely that any of us have the perfect balance of these activities, so ongoing exploration and optimization can be productive.

💡 A final quote

“With your talents and industry, with science, and that stedfast honesty which eternally pursues right, regardless of consequences, you may promise yourself every thing—but health, without which there is no happiness. An attention to health then should take place of every other object. The time necessary to secure this by active exercises, should be devoted to it in preference to every other pursuit.”

~ Thomas Jefferson

Also, here’s a quick bonus quote I came across this week that has little to do with this newsletter but made me chuckle:

“I am pretty sure that, if you will be quite honest, you will admit that a good rousing sneeze, one that tears open your collar and throws your hair into your eyes, is really one of life's sensational pleasures.”

~ Robert Benchley

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👋 Until next time,

Erman Misirlisoy, PhD

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