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The effects of the 1918-19 Spanish influenza pandemic have been seen in the increase in mental health issues such as anxiety and depression among young people.
Echoing those seen among people affected by the 1918 pandemic, young people with depression and anxiety reported high levels of experience and fatigue.
Social stigma and difficulties in addressing the affects of the outbreak are believed to have contributed to the rising mental health issues.
The study, published in the journal BMJ Open, shows that young people in particular were more prone to experiences of low life satisfaction, fatigue and injury.
Overall, the increase in these mental health issues was comparable to the epidemic when other studies had focused on older populations or flu epidemics in the post-war years.
The researchers suggest that the outbreak might have a lasting effect that is detectable decades later.
Spike in serious mental illness
Depression and anxiety have been linked to other major infectious epidemics including tuberculosis, meningitis and beriberi.
However, the report into the 1918-19 Spanish influenza pandemic is the first to consider the mental health effects of a known outbreak.
In 2018, around 2.5 million young people in England are estimated to have been diagnosed with depression and anxiety. The earlier the infection occurs, the better the prognosis.
The authors used survey data collected from 5,664 adults aged between 16 and 64 from 1994.
The study began in response to the issue of mental health among working-age people during the aftermath of the flu pandemic.
What they found was that compared with those who had experienced the 1918 flu epidemic, people who had been affected by the 1918-19 Spanish flu were more likely to feel tired or burn out, with feelings of deep sadness and lack of energy.
They also reported high levels of exhaustion, with 41% reporting this, compared with 27% of those with no illness.
People who had experienced the flu epidemics also reported a greater level of experiencing poor mental health, with more problems with energy and lack of a sense of purpose.
Dr Ruth Longden, a senior lecturer in biomedical psychology at the Institute of Psychiatry, King’s College London, said there had been efforts to address the psychological effects of flu-related illness, but more needs to be done to stop it from becoming mental health issues down the line.
Writing in BMJ Open, she said: “Young people are at risk of living in a mental health crisis caused by physical illnesses, such as the flu. If we can avoid this, the impact of the flu could be reduced in future generations.”
Dr Longden, who led the study, said that the report had shown the “strong correlations” between the mental health issues experienced by people during the 1918 flu and the mental health impacts that might occur as a result of current influenza pandemics.
In future, she said, scientists and policymakers should start taking mental health impact studies into healthcare settings, particularly in relation to young people, with a focus on starting mental health treatment earlier.
A dose of added security
Dr Dawn Addis, lecturer in the School of Sociology at University College London, who was not involved in the study, said: “This is a striking, conclusive and surprising find for a study of mental health issues after a major pandemic.
“With the increasing demand for mental health support as well as the rising flu rates in the UK, we need to be alert to how the epidemic might impact on young people’s mental health, particularly over the winter months.”