Reimagining the journey to recovery: The COVID-19 pandemic and global mental health

The editorial addresses how the COVID-19 pandemic affected global mental health and argues for a careful assessment of policies enacted under uncertainty to inform future pandemic preparedness. It highlights the chronic and potentially enduring nature of mental health problems, especially among younger generations, and the socioeconomic adversities exacerbated by the pandemic (e.g., recession, inequality, civil unrest). The Special Issue aimed to document mental health aspects of the pandemic, focusing on vulnerable populations, inequities, health system responses, policy evaluations, and life-course perspectives, to inform policy and practice as societies seek to build back better.

The article synthesizes findings from studies included in a PLOS Medicine Special Issue and other contemporary literature. Cited evidence includes systematic reviews and meta-analyses on mental health symptom prevalence during the pandemic, large-scale cohort studies on psychiatric outcomes following COVID-19 infection, analyses of contextual determinants (e.g., lockdown stringency, national death rates, socioeconomic conditions), and studies from both high-income countries and LMICs. The literature converges on selective increases in mood and anxiety symptoms, mixed findings over time with some transient effects, and the substantial role of social determinants and policy contexts. It also references policy statements and frameworks from WHO and the UN emphasizing mental health and psychosocial support within the pandemic response.

This is an editorial and narrative synthesis. The authors summarize and interpret evidence from studies published in the Special Issue and related literature. No original empirical data collection or formal analytic methodology is presented.

- Increases in mental health problems were primarily concentrated in mood and anxiety disorders; severe mental health problems did not show consistent increases, and some outcomes showed declines or inconclusive patterns (e.g., self-harm linked to self-reported symptoms but not serology-confirmed infection in one study). - Early increases in anxiety/depression symptoms were observed within the first six months of the pandemic, but longer-term trends were less clear and in some cases transient. - Prevalence of mental health problems was strongly associated with contextual factors: lockdown stringency, pandemic severity, and socioeconomic conditions (e.g., agricultural production). Associations with subjective factors (confidence in government/health care, COVID-19 knowledge, personal infection, social support) were generally weaker. - Predictors of poorer mental health shifted over the first two years (e.g., the impact of national death rates and fears about infection/access to essentials waned over time), underscoring the need for agile, context-specific policies. - Working from home showed no sustained adverse mental health effects in a high-income setting, though subgroup variation may exist. - The burden was inequitably distributed, disproportionately affecting women, young people, and low-income groups; healthcare workers showed increased service use, though declines in their mental health were not consistently observed. - People with severe mental disorders faced discriminatory access to life-saving COVID-19 interventions, likely contributing to higher mortality. - LMIC findings include: quality-adjusted life years (QALYs) lost due to morbidities (much of it mental health–related) were 5–11 times greater than those lost to COVID-19 premature mortality; the negative mental health impact of the pandemic was of a similar magnitude to the positive impact of multifaceted anti-poverty programs.

The findings indicate a selective mental health impact of the pandemic, primarily on mood and anxiety disorders, modulated by time-varying contextual factors and pre-existing social determinants. Despite initial concerns, populations displayed notable resilience over time, though substantial inequities persisted and in some cases widened. Contextual differences, especially between high-income settings and LMICs, are important. The evolving nature of predictors highlights the need for responsive, data-driven, and equitable public policies during health crises. The editorial situates the Special Issue within broader mental health science—epidemiology of social determinants, early intervention opportunities, effective psychosocial treatments, and delivery by frontline workers—and emphasizes leveraging increased awareness, telemedicine, and digital innovations to strengthen mental health systems.

The editorial synthesizes evidence showing selective, context-dependent mental health impacts of COVID-19, widespread resilience, and persistent inequities. It calls for reimagined mental health care that integrates policy actions addressing social determinants, scalable evidence-based interventions, and innovations in digital care. Future directions include standardizing outcomes, using digital tools for real-time and electronic health data, developing interventions to reduce disparities, and advancing precision psychiatry to better predict treatment response. The overarching message is one of hope: mobilizing evidence-based, multilevel interventions can support recovery for individuals and societies.

The body of studies summarized is limited by generalizability (notably few LMIC studies), reliance on self-reported outcomes, high attrition and non-participation (exacerbated by pandemic conditions), and heterogeneous mental health measures. Rapidly changing contexts (e.g., return to in-person work, evolving economic conditions, geopolitical events) complicate interpretation over time. As an editorial narrative synthesis, no primary data or formal systematic methods were employed.