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      COVID-19 policies in the UK and consequences for mental health

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      The Lancet. Psychiatry
      Elsevier Ltd.

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          Abstract

          The lockdown to “flatten the curve” of COVID-19 has caused harm to many people globally. Over the past 6 months it has been nearly impossible to discern what the UK government strategy is in relation to the virus: suppression, or following of the model used in Sweden to foster community immunity? In mid-September, things became clearer: the UK is on a course for suppression until a vaccine or effective mass testing is in place. For good measure, UK residents have all been punished by new limits to the number of people socialising together, and have been warned that further restrictions could be imposed unless their supposedly reckless social behaviour improves. Frightening graphs depicting scenarios rather than predictions have been used to terrify people about the resurgence of the virus. However, it might be years before a safe vaccine is available, and the mass testing proposal dubbed moonshot is scientifically unsound and could do more harm than good. 1 There is another way. One which takes account of the fact that COVID-19 does not have equal effects across age groups: for young people the risk of COVID-19 seems to be very low but the mental health of young people has been disproportionately affected during this crisis. 2 We should allow young people to go about their lives normally and protect those who are older and more susceptible in a humane and compassionate manner; 3 infectious diseases specialists have good ideas about implementing this suggestion. However, in late September, hundreds of healthy, young students in Scotland and Manchester, UK, have been locked down, banned from visiting home and family, and threatened that they might not be able to go home for Christmas. It is hard to see how this policy is within the bounds of human rights and I am deeply concerned about the impact of such measures on mental health and wellbeing. Many people have highlighted the need not to medicalise natural reactions to the global crisis that the global community is facing as a mental illness. However, the global community cannot, and should not, ignore the evidence amassing to suggest that people of all ages are struggling. Increases in suicidal ideation and self-harm have been observed among young people in China before and after lockdown according to prospective studies that were able to collect cohort data. 4 It is clear that young children have been badly affected by lockdown. Moving forward, nations should prioritise young people. They have suffered immensely in this crisis and sacrificed a lot. Moreover, the economic devastation will have an enormous impact on young people who will bear this burden for years to come. The association between economic downturn and suicide has been shown repeatedly across the globe. Services and support for those in distress should now be prioritised and made easily accessible, in the virtual and real world. Mental health should not be left behind in this crisis. For young people, whole-school approaches involving mental health awareness have been shown to reduce suicidal ideation and behaviour. 5 Such evidence-based mental-health interventions should be implemented, urgently, at scale in the community.

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          Most cited references4

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          Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population

          Summary Background The potential impact of the COVID-19 pandemic on population mental health is of increasing global concern. We examine changes in adult mental health in the UK population before and during the lockdown. Methods In this secondary analysis of a national, longitudinal cohort study, households that took part in Waves 8 or 9 of the UK Household Longitudinal Study (UKHLS) panel, including all members aged 16 or older in April, 2020, were invited to complete the COVID-19 web survey on April 23–30, 2020. Participants who were unable to make an informed decision as a result of incapacity, or who had unknown postal addresses or addresses abroad were excluded. Mental health was assessed using the 12-item General Health Questionnaire (GHQ-12). Repeated cross-sectional analyses were done to examine temporal trends. Fixed-effects regression models were fitted to identify within-person change compared with preceding trends. Findings Waves 6–9 of the UKHLS had 53 351 participants. Eligible participants for the COVID-19 web survey were from households that took part in Waves 8 or 9, and 17 452 (41·2%) of 42 330 eligible people participated in the web survey. Population prevalence of clinically significant levels of mental distress rose from 18·9% (95% CI 17·8–20·0) in 2018–19 to 27·3% (26·3–28·2) in April, 2020, one month into UK lockdown. Mean GHQ-12 score also increased over this time, from 11·5 (95% CI 11·3–11·6) in 2018–19, to 12·6 (12·5–12·8) in April, 2020. This was 0·48 (95% CI 0·07–0·90) points higher than expected when accounting for previous upward trends between 2014 and 2018. Comparing GHQ-12 scores within individuals, adjusting for time trends and significant predictors of change, increases were greatest in 18–24-year-olds (2·69 points, 95% CI 1·89–3·48), 25–34-year-olds (1·57, 0·96–2·18), women (0·92, 0·50–1·35), and people living with young children (1·45, 0·79–2·12). People employed before the pandemic also averaged a notable increase in GHQ-12 score (0·63, 95% CI 0·20–1·06). Interpretation By late April, 2020, mental health in the UK had deteriorated compared with pre-COVID-19 trends. Policies emphasising the needs of women, young people, and those with preschool aged children are likely to play an important part in preventing future mental illness. Funding None.
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            School-based suicide prevention programmes: the SEYLE cluster-randomised, controlled trial.

            Suicidal behaviours in adolescents are a major public health problem and evidence-based prevention programmes are greatly needed. We aimed to investigate the efficacy of school-based preventive interventions of suicidal behaviours.
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              Is Open Access

              Assessment of Mental Health of Chinese Primary School Students Before and After School Closing and Opening During the COVID-19 Pandemic

              The cohort study assesses the association of school closings during the COVID-19 pandemic with the mental health of primary school students in China.
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                Author and article information

                Journal
                Lancet Psychiatry
                Lancet Psychiatry
                The Lancet. Psychiatry
                Elsevier Ltd.
                2215-0366
                2215-0374
                15 October 2020
                15 October 2020
                Affiliations
                [a ]Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham NG7 2RD, UK
                Article
                S2215-0366(20)30457-0
                10.1016/S2215-0366(20)30457-0
                7561293
                33069273
                009e2b8a-44df-417e-aedd-ff48af003e73
                © 2020 Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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