The survey, conducted by Sapien Labs, was conducted in eight English-speaking countries and included 49,000 adults. It showed that 57% of respondents experienced some COVID-19-related adversity or trauma.
Roughly one-quarter showed clinical signs of, or were at risk for, a mood disorder, and only 40% described themselves as "succeeding or thriving."
Those who reported the poorest mental health were young adults and individuals who experienced financial adversity or were unable to receive care for other medical conditions. Not getting enough sleep, exercise, or face-to-face socialization also increased the risk for poorer mental well-being.
"The data suggest that there will be long-term fallout from the pandemic on the mental health front," Tara Thiagarajan, PhD, Sapien Labs founder and chief scientist, said in a press release.
The survey, which is part of the company's Mental Health Million project, is an ongoing research initiative that makes data freely available to other researchers.
The investigators developed a "free and anonymous assessment tool," the Mental Health Quotient (MHQ), which "encompasses a comprehensive view of our emotional, social, and cognitive function and capability," said Thiagarajan.
The MHQ consists of 47 "elements of mental well-being." Respondents' MHQ scores ranged from -100 to +200. Negative scores indicate poorer mental well-being. Respondents were categorized as clinical, at-risk, enduring, managing, succeeding, and thriving.
MHQ scores were computed for six "broad dimensions" of mental health. These included core cognition, complex cognition, mood and outlook, drive and motivation, social self, and mind-body connection.
Participants were recruited through advertising on Google and Facebook in eight English-speaking countries – Canada, the United States, the United Kingdom, South Africa, Singapore, Australia, New Zealand, and India. The researchers collected demographic information, including age, education, and gender.
The assessment was completed by 48,808 respondents between April 8 and December 31, 2020.
A smaller sample of 2,000 people from the same countries polled in 2019 was used as a comparator.
Taken together, the overall mental well-being score for 2020 was 8% lower than 2019 from the same countries, and the percentage of respondents who fell into the "clinical" category increased from 14% in 2009 to 26% in 2020.
Residents of Singapore had the highest MHQ score followed, by residents of the United States. At the other extreme, respondents from the United Kingdom and South Africa had the poorest scores.
"It is important to keep in mind that the English-speaking, Internet-enabled populace is not necessarily representative of each country as a whole," the authors note.
Youth Hardest Hit
The decline in mental well-being was "most pronounced" in the youngest age category (18–24 years), whose average MHQ score was 29% lower than those those 65 and over..
Worldwide, 70% of respondents 65 and over fell into the categories of "succeeding" or "thriving," compared with just 17% of those age 18 to 24.
"We saw a massive trend of diminishing mental well-being in younger individuals, suggesting that some societal force is at play that we need to get to the bottom of," said Thiagarajan.
"Young people are still learning how to calibrate themselves in the world, and with age comes maturity," she said.
Highest Risk Group
Mental well-being was poorest among nonbinary/third-gender respondents. Among them, more than 50% were classified as being at clinical risk, compared to males and females combined, and their MHQ scores were about 47 points lower.
Nonbinary individuals "are universally doing very poorly, relative to males or females," said Thiagarajan. "This is a demographic at very high risk with a lot of suicidal thoughts."
Respondents who were not getting enough sleep, who lacked social interaction, and whose level of exercise was insufficient had lower MHQ scores of an "unexpected magnitude," compared to their counterparts who had enough sleep, more social interaction, and more exercise (a discrepancy of 82, 66, and 46 points, respectively).
Creative, Generous Approach
Commenting on the survey results for Medscape, Ken Duckworth, MD, clinical professor at Harvard University Medical School, , and chief medical officer of the National Alliance of Mental Illness noted the findings were similar to studies conducted in the United States, which showed disproportionately higher rates of mental health problems in younger people. Duckworth was not involved with the survey.
"The idea that this is an international phenomenon and the broad-stroke finding that younger people are suffering across nations is compelling and important for policymakers to look at," he said.
Duckworth noted that although the findings are not "representative" of entire populations in a given country, the report is a "first step in a long journey."
He described the report as "extremely brilliant, creative, and generous, allowing any academician to get access to the data."
He sees it "less as a definitive report and more as a directionally informative survey that will yield great fruit over time."
Also commenting for Medscape, Joshua Morganstein, MD, chair of the American Psychiatric Association’s Committee on the Psychiatric Dimensions of Disaster, said, "One of the important things a document like this highlights is the importance of understanding more where risk [for mental health disorders] is concentrated and what things have occurred or might occur that can buffer against that risk or protect us from it. We see that each nation has similar, but also different challenges."