The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: a critical review across waves

Abstract

The global public health crisis caused by COVID-19 has lasted longer than many of us would have hoped and expected. With its high uncertainty and limited control, the COVID-19 pandemic has undoubtedly asked a lot from all of us. One important central question is: how resilient have we proved in face of the unprecedented and prolonged coronavirus pandemic? There is a vast and rapidly growing literature that has examined the impact of the pandemic on mental health both on the shorter (2020) and longer (2021) term. This not only concerns pandemic-related effects on resilience in the general population, but also how the pandemic has challenged stress resilience and mental health outcomes across more specific vulnerable population groups: patients with a psychiatric disorder, COVID-19 diagnosed patients, health care workers, children and adolescents, pregnant women, and elderly people. It is challenging to keep up to date with, and interpret this rapidly increasing scientific literature. In this review, we provide a critical overview on how the COVID-19 pandemic has impacted mental health and how human stress resilience has been shaped by the pandemic on the shorter and longer term. The vast literature is dominated by a wealth of data which are, however, not always of the highest quality and heavily depend on online and self-report surveys. Nevertheless, it appears that we have proven surprisingly resilient over time, with fast recovery from COVID-19 measures. Still, vulnerable groups such as adolescents and health care personnel that have been severely impacted by the COVID-19 pandemic do exist. Large interindividual differences exist, and for future pandemics there is a clear need to comprehensively and integratively assess resilience from the start to provide personalized help and interventions tailored to the specific needs for vulnerable groups.

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  The early stages of the COVID-19 pandemic were often associated with increased levels of distress and depressive and anxiety symptoms in the general population.

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  A substantial group of individuals has been either largely unaffected or is even doing better during the pandemic.

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  Longitudinal follow up showed remarkable signs of resilience.

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  Health care workers appear to be at an increased risk of stress-related psychological symptoms.

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  The mental health of children, adolescents, and students has been particularly affected by the pandemic.

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  Elderly people are more vulnerable to the physical effects of COVID-19, but also report lower psychopathology during the pandemic.

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  Individuals with an existing psychiatric disorder are experiencing detrimental impact on their mental health from the COVID-19 pandemic, but do not seem to have further increased symptom severity compared with their pre-pandemic levels.

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  A high risk exists for psychiatric sequelae following a COVID-19 infection.

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  Many methodological shortcomings occur in the current literature which is often cross-sectional and relies on self-report, and it is moreover hard to directly compare results across many of the studies.

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  There is an urgent need for a personalized approach when it comes to identifying individuals at risk or resilient for the stressful effects of the COVID-19 pandemic.

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  The effects of stress and the resilience capacity are dependent on (neuro)biological, psychological, and environmental factors and also are heavily dependent on an individual's unique context.