COVID-19 – 2021: How to Be Happier

Dicembre 27, 2020

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So you want to look trimmer, be smarter, and successful next year?

You strive to exercise and call your friends more, and spend less?

You are not alone. New Year’s resolutions are as ubiquitous as they are difficult to keep.

Does it even make sense to set such lofty goals for the new year, hoping anew each January first that this time really is the charm?

Any motivational researcher would have “ambivalent feelings” about New Year’s resolutions, says Richard Ryan, an international expert on motivational research and professor emeritus of psychology at the University of Rochester.

“The evidence shows that most of the time people aren’t successful at them.”

But don’t throw in the towel quite yet. Ryan, who is also a clinical psychologist, says that any occasion that gives us an opportunity to reflect on our lives is ultimately a good thing. It doesn’t have to be on New Year’s. “Whenever that happens, if it’s really a reflective change–something that you put your heart behind–that can be good for people.”

And he has another tip: what proves most satisfying, and may also be what’s most needed as the COVID-19 pandemic rages on, are goals that involve giving to others.

“Think of how you can help,” says Ryan. “There’s a lot of distress out there: If we can set goals that aim to help others, those kinds of goals will, in turn, also add to our own well-being.”

His advice is grounded in decades of research. Together with Edward Deci (also a University of Rochester professor emeritus of psychology) Ryan is the cofounder of self-determination theory (SDT), a broad framework for the study of human motivation and personality.

Developed by the duo over nearly 40 years, the theory has become one of the most widely accepted frameworks of human motivation in contemporary behavioral science. Its starting point is the idea that all humans have the natural–or intrinsic–tendency to behave in effective and healthful ways.

According to Ryan, who is also a professor at the Institute for Positive Psychology and Education at Australian Catholic University, acts of willingly helping others satisfy all three of the basic psychological needs identified in SDT research: the needs for autonomy, competence, and relatedness.

Autonomy in this context means that you can engage in activities in which you feel true volition and find personal value. Competence means feeling effective and having a sense of accomplishment. Finally, relatedness means working with and feeling connected to others.

“If you want to make a New Year’s resolution that really makes you happy, think about the ways in which you can contribute to the world,” says Ryan. “All three of these basic needs are fulfilled. The research shows it’s not just good for the world but also really good for you.”

Q&A: Why New Year’s resolutions (often) don’t work

What’s the problem with most New Year’s resolutions?

The saddest part is that most people don’t succeed at their January 1 resolutions. But that is because most of these midnight resolutions look more like pressure coming from the outside–an attempt to look better, relieve guilt, or meet the standards of others. Losing weight, for example, is one of the most common New Year’s goals and one that people tend to do poorly at.

Part of the reason for that is where it’s coming from: it’s often coming from internal or external pressure–as opposed to a goal that’s something that you might intrinsically value such as having more health or vitality. If the goal is one that is not “authentic” and not really coming from your own values or interests, the energy for it fades fast.

Are any resolutions particularly toxic?

There are many goals that even when achieved will not bring people more happiness. A goal of making more money, for example, may get a person working harder, but may actually leave them less connected to others, or feeling less autonomy on a day-to-day basis. It could make the person less happy. Goals that work are ones where we can find real satisfaction in achieving them.

It’s intuitive that giving to others is satisfying. But how does that work on a psychological level?

We found that when people are focused on giving to others they experience deeper satisfactions than when their goals are more self-oriented. For example, experiments show that doing something benevolent for others, even when you will never meet the beneficiary, increases your positive mood and energy.

Most recently, we published a study [in the Journal of Personality and Social Psychology] about what we call people’s “integrative span.” We discovered that your happiness increases as your focus of concern and care gets wider. If your main concerns and cares are narrow and selfish–just about “me and the people very close to me,” versus about “my family and my community,” versus about “the larger world and everything in it”– the less happy you are prone to be. A broader scope of caring and concern for others, in contrast, predicts a higher well-being.

How do we make any resolution more likely to stick?

Beyond the focus of your goals, there are some key elements to success at any resolution you might make. First, make sure your goal is one you truly embrace–that you are fully behind and care about. An achievable goal is also one that is not abstract, like “improve my health” but concrete–such as “increase my daily step count” or “drink sparkling water rather than sugared soda at lunch.”

These latter goals are clear and achievable in a way that a vague global resolution can never be. Once having a clear aim, the next step is making a realistic plan on how and when it will be implemented.

Just as important, research shows that the more you can make achieving your resolution fun and “intrinsically motivated” the more you’ll persist. For example, a plan to increase your step count might include a walk each day with a good friend–which will both achieve your step goal and satisfy relatedness needs. By finding an activity that both gets you to your goal and that you actually enjoy–or at least don’t find aversive–you’ll be more likely to carry on.

Finally, successful resolutions are usually built upon optimal challenges. Setting the bar too high will feel discouraging and lead to disengagement. Keep in mind that with almost any long-term goal the best strategy is to set small incremental goals–not “I’m going to climb Everest” but rather “I’m going to take these first few steps toward base camp.”

Any special advice for 2021?

The past year has been tough; you can make the new one kinder. Any new goals you set that involve changing habits or lifestyles will inevitably involve some setbacks, lapses, and failures. So when failures happen, remember to be a compassionate self-coach. Forget the harsh judgments and instead take interest in what you can learn from the setback and where you got stuck. And then restart with that much more wisdom in hand.

How do I find the goal I ultimately most care about?

For most of us, if we give ourselves occasional moments of reflection-taking the time to really think about what’s going well in our lives and what really matters-we can usually identify some things we could change. Often that means listening to that little nagging feeling about the things that we know would improve our lives.

It means allowing ourselves to tune into that inner signal in an open, non-defensive way and to consider the possibilities and the choices that you really have. In truth, there are always ways to make life better, but the road upward need not be a painful one–if you are going in the right direction.

Changes in population mental health and wellbeing
There is evidence that self-reported mental health and wellbeing worsened during the first national lockdown of the COVID-19 pandemic. Psychological distress, anxiety and depressive symptoms appeared to peak in April 2020. There is evidence of some recovery since April, but not yet to pre-pandemic levels.

Longitudinal cohort studies return to the same sample of people at regular intervals.

Many studies have analysed data from the UK Household Longitudinal Study (UKHLS). They suggest that, among adults:

average mental distress (measured using GHQ-12) was 8.1% higher in April 2020 than it was between 2017 and 2019[footnote 1]
after accounting for changes since 2014, average mental distress in April 2020 was 0.5 points higher than expected (on the GHQ-12 scale)[footnote 2]
the proportion of people experiencing sleep problems increased from 16% before the pandemic to 25% in April 2020
the proportion of adults who reported a level of psychological distress above a set threshold increased from 24.3% between 2017 and 2019 to 37.8% in April 2020, before dropping to 34.7% in May 2020 and 31.9% in June 2020[footnote 4]

Although not wholly consistent, data from other longitudinal studies broadly corroborate these findings.

A study in southwest England found evidence of an increase in anxiety and low wellbeing during the first national lockdown. However, it found no evidence of a change in depressive symptoms.[footnote 5] On the other hand, a study of people surveyed between July 2019 and March 2020, and then again in June 2020, suggests that the proportion of people reporting depressive symptoms increased and that those symptoms worsened over the period.[footnote 6]

Various new mental health-related longitudinal studies were set up in March 2020. Two have reported that levels of anxiety, depressive symptoms and stress during the first national lockdown were higher than the best available pre-COVID-19 benchmarks.[footnote 7] [footnote 8] NEW: A third suggests that there were significant decreases in anxiety and depressive symptoms between April and August 2020.[footnote 9]

Which population groups appear to be disproportionally affected?

Population measures are useful for understanding overall levels of mental health and wellbeing. However, they can hide variation within the population. There is evidence that the COVID-19 pandemic has had a larger adverse impact on the mental health and wellbeing of particular groups.

The following sections relate specifically to adults. The COVID-19 mental health and wellbeing surveillance report includes a separate chapter dedicated to the experiences of children and young people.

Individual characteristics (age, gender and ethnicity)

Young adults (aged between 18 and 34, depending on the study) and women were more likely to report worse mental health and wellbeing during the first national lockdown than older adults and men. This is similar to pre-pandemic patterns, but the differences may have increased.[footnote 1] [footnote 2] [footnote 4] [footnote 5] [footnote 6] [footnote 7] [footnote 8] [footnote 10] [footnote 11] [footnote 12] [footnote 13] [footnote 14] [footnote 15] [footnote 16]

NEW: There is evidence that women and young adults have since experienced a faster recovery between April and August. This has reduced but not eliminated some of the differences between groups observed in April.[footnote 4] [footnote 9]

NEW: Older adults who were recommended to shield were more likely to report higher levels of depression, anxiety and loneliness in June and July 2020 than people of a similar age but not recommended to shield. Rates were highest in those who were recommended to shield and strictly complied with that guidance.[footnote 17] Each group were also more likely to report lower levels of happiness, life satisfaction and sense of purpose. Another study of the same cohort showed that older adults with multi-morbidities (many of whom were self-isolating) reported higher levels of depression and loneliness than older adults without multi-morbidities.[footnote 18]

Two studies have sought to understand the differences in mental distress between men and women. They show evidence that family and caring responsibilities play a role, as do social factors. Women were more likely to have made larger adjustments to manage housework and childcare during the first lockdown than men. These adjustments were associated with increased distress.[footnote 19] [footnote 20] Women also reported having more close friends and a larger subsequent increase in loneliness than men during the first national lockdown.[footnote 12]

Adults living with children have been more likely to report worse mental health than adults living without children.[footnote 5] [footnote 20] [footnote 21] Lone mothers have been particularly vulnerable.[footnote 20] NEW: One study suggests that while adults living with children have reported higher levels of anxiety, they have also reported lower levels of depressive symptoms.[footnote 9]

One study has found that Black, Asian and Minority Ethnicity (BAME) men (when grouped together) reported a larger deterioration in mental health than White British men during the first national lockdown. The deterioration reported among BAME women was similar to that reported among White British women.

It also found that among BAME adults there was no evidence of variation in mental health deterioration by gender. This suggests that the gender gap reported across a number of studies may be a phenomenon mostly seen within the White British population.[footnote 22]

A second study analysing the same data set supported these findings for both men and women. In addition, it reported that in April and June 2020, Bangladeshi, Indian, Pakistani and White British men had all reported declines in mental health since before the pandemic. Bangladeshi and Pakistani men had reported larger declines than White British men.[footnote 23]

NEW: A third relevant study has analysed data from mothers in Bradford. This is an ethnically diverse area with high levels of deprivation. The study found that clinically significant symptoms of depression and anxiety were more common among White British mothers than mothers of other ethnicities. Clinically significant symptoms were also more common among mothers with more economic insecurity. Participants who provided free text in their survey responses corroborated these findings. They also highlighted high levels of anxiety about becoming ill or dying from COVID-19.[footnote 24]

NEW: A fourth study, looking at changes in anxiety and depression since April 2020, has reported that BAME respondents (when grouped together) have been more likely to report higher levels of depression and anxiety, but that this gap has not changed over time with the pandemic.[footnote 9]

It is important to note that the sample sizes for minority ethnicity respondents in these studies are relatively small. This makes the estimates less precise. In addition, the interaction between ethnicity and potential confounding factors needs further consideration. Potential factors include income, employment as a key worker and family/caring responsibilities. Observations so far can only suggest associations.

Adults with pre-existing mental health problems

Adults with pre-existing mental health conditions have reported higher levels of anxiety, depression and loneliness than adults without pre-existing mental health conditions. However, there is no evidence to suggest that this gap has changed since the start of the first national lockdown.[footnote 9] [footnote 13] [footnote 25]

NEW: A comparatively small but in-depth survey of people using primary and secondary care with severe mental health problems has reported preliminary findings. The majority of respondents so far have reported stable mental health during the pandemic. Around a quarter of people currently receiving support from mental health services said that they would need more support than they had been receiving before the pandemic restrictions, and a further quarter said that they might need additional support.[footnote 26]

Data from the UK Biobank suggests that people with a psychiatric disorder have been more likely to be diagnosed with, hospitalised by and die from COVID-19 than people without a psychiatric disorder.[footnote 27] NEW: An NHS Foundation Trust in London has reported 1109 excess deaths among people with pre-existing mental health disorders between March and June 2020.

This is out of a total of 2561 deaths on their mental health register during the period, and based on a comparison between 2019 and 2020. COVID-19 was recorded as the underlying cause in 64% of this excess. ùThe remainder of the excess was accounted for as either unnatural/as yet unexplained or from neurodegenerative conditions.

The study does not compare excess deaths among adults in contact with, or previously in contact with, mental health services to the general population, or account for the impact of comorbidities.[footnote 28] The trust covers an ethnically diverse and urban catchment, with high levels of deprivation.

They report a higher excess mortality ratio among their Black African, Black Caribbean and Other Ethnicity populations.[footnote 29] High excess mortality among adults with severe mental illness has also been reported in Cambridgeshire and Peterborough, including among adults aged 40 to 60.[footnote 30]

NEW: Evidence points to an association between many health conditions and mortality from COVID-19. A recent study found that serious mental illness was associated with a relatively modest increased risk of dying from COVID-19 (26% for women compared to women with no serious mental illness, and 29% among men).[footnote 31] However, as an illustrative example, type II diabetes was associated with a 529% increased risk for women (compared to women without this diagnosis) and 374% increased risk for men.

NEW: With respect to service use, the NHS Trust in London report that their Community Mental Health Teams saw relatively stable caseloads and total contact numbers between March and May. However, they saw a substantial shift from face-to-face to virtual contacts. Their Home Treatment Teams saw the same shift to virtual contacts but reductions in caseloads and total contacts.[footnote 32] Similar patterns were observed in Cambridgeshire and Peterborough, followed by a return towards volumes comparable to previous years.[footnote 30]

There is survey evidence to suggest that fewer than half of adults affected by abuse, self-harm and thoughts of suicide/self-harm accessed formal or informal support during April 2020[footnote 33], although it is not clear whether this is more or less than before the pandemic.

Employment and income
A greater proportion of adults with low household income or relative socioeconomic position reported symptoms of anxiety and depression than adults with higher household income or socioeconomic position during the first national lockdown.[footnote 7] [footnote 25] One study found that adverse experiences, such as COVID-19 illness, financial difficulties or difficulty accessing food and medicine were having a larger impact on mental health and wellbeing among adults in a lower socioeconomic position.[footnote 34] Two studies found that having a low income was associated with loneliness and increasing levels of loneliness during the lockdown.[footnote 13] [footnote 14]

Adults who were not in employment were more likely to report worse and increasing loneliness than those in work.[footnote 14] [footnote 34] Adults who experienced loss of income early in the lockdown reported higher levels of anxiety[footnote 7] and mental distress.[footnote 19] Having some paid work or continued connection to a job during the pandemic was associated with better mental health than not having any work.[footnote 35]

NEW: This is complemented by research suggesting that disruptions in employment have had a smaller impact on psychological distress where income has been protected through the government’s income support programmes or sick pay. The study goes on to say that the immigrant population have been less likely to have their income protected, and are more likely to experience higher levels of psychological distress following disruptions in employment, whether or not their income is protected.[footnote 36] There is also evidence of increasing mental distress among some employed adults, as well as among adults with more educational qualifications.[footnote 2] [footnote 10]

NEW: Women in a lower socioeconomic position have been more likely than women in higher socioeconomic positions and men, in general, to be furloughed, to be working as a key worker or to be working in a person facing role. Women in lower socioeconomic positions have been slightly more likely to report higher levels of psychological distress than women in higher socioeconomic positions although this study does not find a clear socioeconomic gradient.[footnote 16]

NEW: Two studies have reported on change over time since the end of the first national lockdown – one covers April to June,[footnote 4] the other covers April to August.[footnote 9] Both find that young adults and women, after initial deteriorations, have reported greater subsequent improvements in mental health and wellbeing than older adults and men.

The second study also finds that people with lower levels of education and people living with children reported greater subsequent improvement in depressive symptoms and anxiety – reducing but not eliminating some of the differences reported during the first lockdown. This study found no evidence that the rates of initial deterioration or subsequent improvement have been related to ethnicity, household income or pre-existing mental health conditions.[footnote 9]

There is mixed or limited evidence for several other associations with mental health and wellbeing during the pandemic, which make drawing conclusions on these characteristics difficult. A summary of this is presented below.

NEW: Adults who report greater use of problem-focused coping (active coping, planning), avoidant coping (behavioural disengagement, denial, substance use), and supportive coping (emotional support, instrumental support, and venting) reported higher levels of mental ill health.

Greater use of emotion-focused coping (positive reframing, acceptance, humour, religion) was associated with lower levels of mental ill health. Symptoms decreased over time for all coping strategies, but they decreased faster among those who reported use of supportive coping mechanisms. This may indicate a protective effect of social support on psychological distress.[footnote 37]

A second study of the same data found that COVID-19 related adversities were associated with less socially supported coping strategies.[footnote 38] People living with others were more likely to draw on support strategies, as were people who felt lonely, who lived in urban areas, and who had a diagnosed mental health condition. Avoidant coping strategies were more commonly used by women, younger adults, people in a lower socio-economic position, people living with others, people with mental health conditions and people who reported higher levels of loneliness.

One study found evidence that key workers experienced worse mental health and wellbeing in April 2020 than non-key workers.[footnote 39] A second study found evidence of the opposite,[footnote 25] and two further studies found no evidence of a difference.[footnote 2] [footnote 5]

NEW: One study has found that caregivers were more likely to report depressive symptoms than non-caregivers, both before and during the pandemic, and that this was increased when the caregiver also felt lonely.[footnote 40]

One study found that adults with long term physical health conditions reported worse levels of depressive symptoms than adults without long term physical health conditions.[footnote 25]

NEW: A study specifically looking at adults with asthma found that they were more likely to report higher levels of anxiety and depression during the pandemic, particularly among young adults.[footnote 41]

One study found that adults living in urban areas report worse and increasing loneliness.[footnote 13] Another study found no evidence of a difference in depression and anxiety between urban and rural areas.[footnote 7]

One study found that adults who have had COVID-19-related symptoms were more likely to report high levels of mental distress and loneliness than adults who had not had such symptoms.[footnote 11] But, another study found no evidence of this after controlling for other factors.[footnote 19]

Source: University of Rochester

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