Kavita Vedhara, professor of health psychology at the University of Nottingham discusses her latest research that explores the impact of psychological distress on the risk of contracting COVID-19.
It is well-documented that psychological distress such as anxiety and depression can increase susceptibility to viral respiratory illnesses. When faced with the first pandemic in over 10 years, how did COVID-19, a once relatively unknown viral illness, affect individuals’ mental wellbeing and infection vulnerability?
Monet Bailey, Digital Editor at Health Europa spoke with Professor Vedhara about her recent research into psychological distress and the heightened susceptibility to COVID-19 infection.
Historically, what do we know about the ways in which psychological distress can impact individuals’ susceptibility to viral respiratory illnesses?
Three key pieces of evidence have highlighted the impact of psychological distress on susceptibility to viral respiratory illnesses and this evidence has a long history, scaling as far back as 40-50 years ago.
The first key evidence piece comes from latent viral studies. There are viruses such as Epstein Barr Virus, which causes glandular fever and once you are infected with such viruses, you are infected for life. This means that your immune system during your lifespan tries to contain that viral infection, so you do not experience relapses or recurrences. However, with a viral infection like glandular fever, people do experience relapses and there have been various studies looking at why the immune system loses control of the virus at various times. A previous study has shown fairly reliably that psychological distress can be one of the factors associated with relapses and recurrences of viral infections such as Epstein Barr Virus and herpes simplex virus. To elaborate further, there are viruses that once you have become infected, they become dormant, but stress appears to be involved in the immune system losing control over its containment.
Other studies often considered the gold standard, because of how they are performed, are viral challenge studies. Participants are challenged with a range of different viruses and quarantined for a period. The type of study is designed utilising young, healthy people and administering viruses up their nose. The researchers measure the antibodies and the symptoms to see who gets infected which, as a result, gives an insight into the immune system response. Viral challenge studies highlight two things – who becomes infected after exposure to a virus and unsurprisingly, the infection rate is high, standing at around 70-80% of people exposed and who shows symptoms of viral infection. These studies have proven to be interesting, especially in the context of COVID-19 where we have seen some people become infected but remain symptom-free and some people who experienced severe symptoms. These studies have shown time and time again the impact of stress and other social factors on viral infection susceptibility. Factors such as stress levels, lifestyle choices and sociability all appear to be associated with susceptibility to viral infections and whether you are symptomatic or not. These are wonderful studies because there is control over the participants and no pre-existing viral infections are present. Once the participants are infected with viruses, they quarantine for around one to two weeks where researchers will wait to see who develops the disease and to an extent, this is a tight model of what has happened during the COVID-19 pandemic.
The third type of study is vaccine challenge studies. The reason these studies are relevant and what sparked my interest in this field many years ago was how vaccines, which are designed to protect you against disease, have huge variability in how well they work within people. These types of studies provide a controlled model of what your body does during exposure to a virus without making you ill unless it is a live vaccine which is rarely the case. What we observe in these studies, is that people who experience reduced psychological distress produce more antibodies in response to a vaccine, suggesting that if they are exposed to the disease, they are more likely to be protected. Importantly, these studies highlight those vaccines work more effectively in people like that.
Research has highlighted how humans respond to viruses is not just a relationship between the virus and their immune system, but that psychological and social factors are influential and play their part in determining how well the immune system responds.
Can you outline some of the observations you made regarding individuals’ mental wellbeing during the pandemic and the common symptoms that were reported as part of your observational study? Were there particular demographics who were more affected than others?
We observed increased levels of stress, anxiety, depression, and general worries about COVID. Interestingly, from the beginning of the pandemic and during our study period, psychological distress improved marginally as restrictions changed. As restrictions reduced, we saw a modest improvement in anxiety and depression but not the kind of improvement that policymakers suggested we would have seen. One of the biggest arguments for removing restrictions was the impact on mental health and the reconnection with social interactions but, removing restrictions without a secure plan to keep society safe would evidently not improve mental health. When people were infected with the virus and required to isolate, it can become distressing when the emotional and practical support you would normally expect when you were unwell is taken away.
Our study also revealed that individuals who were the most distressed early on in the pandemic (those reporting the most anxiety, depression, stress, and least positive moods and who then subsequently reported a COVID infection) appeared to report a large number of more severe symptoms.
The groups most affected appeared to be younger people and predominately women. With the younger demographic, they are more likely to have a less robust financial and social situation. Suddenly, you are faced with a pandemic that could mean your career is disrupted, you are unable to socialise and there is the risk of contracting an infectious illness. Additionally, we investigated how healthcare workers were impacted mentally during the COVID-19 pandemic but surprisingly, did not find any evidence that healthcare workers had worse mental health than non-healthcare workers. However, there will be variations in our study’s findings and other research institutes’ data depending on when and where you were able to get data from people.
How should future health policies reflect the impact psychological disorders and distress has on viral illnesses?
One of the things that this country has done brilliantly, and probably better than almost anywhere else in the world, is having a surveillance system to monitor COVID-19. This system provided the world with data on COVID-19, which we would not have had otherwise. We have been able to see and track when it changes and how it changes. I think to maximise the benefit of the knowledge we have compiled during the pandemic we need a comparable surveillance system on the mental health and social interactions of the public. Until we are doing both of those things, we are viewing the virus as the only part of the equation that can make a difference, but unless the virus has somebody to infect, it is a non-entity. Unless you also understand the person that the virus is infecting, you are losing some of the puzzle.
If we truly want to have a joined-up, robust plan for future epidemics and pandemics, where we know they are viral and infectious in nature, then given everything we already know about how psychological and social factors impinge on the impact of viruses; we should have a surveillance system for the public. If we put both the viral and mental health surveillance systems together, you may be able to anticipate with greater precision, increases in infection rates. For example, you can monitor infections in schools with greater accuracy. This model would require behavioural scientists, epidemiologists, public health professionals and infectious disease modellers to work together to achieve a 360 degree understanding.
Currently, studies like the ones we have published, certainly give us an insight into what might be occurring, but they are not the most robust because they are opportunistic. For example, the people in our studies were self-selected and we had to rely on self-reported COVID. However, if we had that surveillance system in place, there are so many more questions that could be answered with greater certainty.
We need to think about if we require the introduction of public health measures to contain a disease and what the mitigating health measures are so that the unintended consequences, like the impact on mental health, do not emerge in the same way we have experienced during the COVID-19 pandemic.
Professor of Health Psychology,
University of Nottingham
This article is from issue 21 of Health Europa Quarterly. Click here to get your free subscription today.