Learning from previous lockdown measures and minimising harmful biopsychosocial consequences as they end: a systematic review
Open accessAbstract
BACKGROUND: Infectious outbreaks, most recently coronavirus disease 2019 (COVID-19), have required pervasive public health strategies, termed lockdown measures, including quarantine, social distancing, and closure of workplaces and educational establishments. Although evidence analysing immediate effects is expanding, repercussions following lockdown measures remain poorly understood. This systematic review aims to analyse biopsychosocial consequences after lockdown measures end according to short, medium, and long-term impacts. METHODS: PubMed, Ovid MEDLINE, Embase, PsycInfo, Web of Science, and Scopus databases were searched from inception to January 12, 2021. Reference lists were manually reviewed. Eligible studies analysed biopsychosocial functioning after lockdown measures secondary to recent infectious outbreaks ended. Lockdown measures were defined as quarantine, isolation, workplace or educational closures, social or physical distancing, and national or local closure of public institutions deemed non-essential. Studies exclusively researching outcomes during lockdown measures, examined infectious participants, or analysed lockdown measures not pertaining to an infectious outbreak were excluded. Two independent reviewers extracted data and assessed bias with a third resolving discrepancies. Data was extracted from published reports with further information requested from authors where necessary. The mixed methods appraisal tool assessed study quality, languages were restricted to English, German, Italian, and French and narrative synthesis was applied. RESULTS: Of 5149 identified studies, 40 were eligible for inclusion. Psychological distress, economic repercussions, social, biological, and behavioural ramifications were observed. Short to medium-term effects comprised reactions relating to early trauma processing whereas medium to long-term repercussions manifested in maladaptive behaviours and mental health deterioration. Increased alcohol intake, stigmatisation, and economic effects were also identified consequences. High-risk groups included health care workers, children, elderly, inpatients, those with pre-existing psychiatric diagnoses, and socially isolated individuals. CONCLUSIONS: Supporting vulnerable groups and offering education, workplace modifications, financial, and social assistance may mitigate negative repercussions. Establishing a rapid and comprehensive evidence base appraising the efficacy of such interventions and identifying areas for development is essential. This review was limited by study heterogeneity and lack of randomisation in available literature. Given the unprecedented nature and progression of COVID-19, the relevance of previous outcomes remains uncertain. PROTOCOL REGISTRATION: PROSPERO registration CRD42020181134.
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Lockdowns should be used temporarily to give national health systems time to strengthen and to allow a more comprehensive set of public health and social measures, so that less disruptive measures like testing, contact tracing, and isolation are ready after lockdown ends.
“The proper use of lockdowns is to serve as a temporary expedient to provide time for national health systems to build up and enable a more comprehensive set of public health and social measures, so that less disruptive measures—such as testing, contact tracing, and isolation—are in place after the lockdown is lifted.30”
From The Lancet Commission on lessons for the future from the COVID-19 pandemic (2022) · cites this paper as [30]
People in marginalised communities with lower socioeconomic status and mental health conditions reported poorer mental health than the general population.
“people living in marginalised communities with lower socioeconomic status and mental health conditions reported poorer mental health than the general population.”
From The Lancet Commission on lessons for the future from the COVID-19 pandemic (2022) · cites this paper as [30]
Pre-existing inequalities in mental health remained during the pandemic.
“Pre-existing inequalities in mental health have remained during the pandemic.”
From The Lancet Commission on lessons for the future from the COVID-19 pandemic (2022) · cites this paper as [30]
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- Authors
- Muehlschlegel, P. A., Parkinson, E. A., Chan, R. Y., Arden, M. A., & Armitage, C. J.
- Affiliations
- Royal Free London NHS Foundation Trust (GB)
- York Teaching Hospital NHS Foundation Trust (GB)
- University of Manchester (GB)
- Sheffield Hallam University (GB)
- Manchester Academic Health Science Centre (GB)
- Corresponding author
- Muehlschlegel, Paula A
- Venue
- Journal of Global Health
- Publisher
- International Global Health Society
- Published
- 2021-05-22
- Volume
- 11
- Pages
- 05008-05008
- ISSN
- 2047-2978 (ISSN-L)
- 2047-2986
- PMC
- PMC8141332
- OpenAlex
- W3143490285
- Cited by
- 31
- References
- 59
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 9 · 2022: 13 · 2021: 2
- FWCI
- 0.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Global Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, cc-by)
- SHURA (Sheffield Hallam University Research Archive) (Sheffield Hallam University) (acceptedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Sociology and Political Science › COVID-19 Prevention and Impact
- Social Sciences › Safety Research › Social impacts of COVID-19
- Keywords
- lockdown measures, COVID-19 pandemic, biopsychosocial consequences, psychological distress, mental health deterioration, economic impact, alcohol consumption, stigmatization, social isolation, vulnerable populations, healthcare workers, children, older adults, maladaptive behavior, post-lockdown recovery
- MeSH terms
- Physical Distancing, COVID-19, Disease Outbreaks, Humans, Public Policy, Quarantine, Schools, Randomized Controlled Trials as Topic, Workplace
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