The impact on the mental health and well-being of unpaid carers affected by social distancing, self-isolation and shielding during the COVID 19 pandemic in England – a systematic review

  1. Tabo Akafekwa
  2. Elizabeth Dalgarno
  3. Arpana Verma

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Abstract

Objective

This study explores the impact of the COVID 19 lockdown measures on the mental health and well-being of unpaid carers, who make up the largest number of the carer population in England.

Study design

A systematic review research protocol was designed and used to conduct the review along with the Enhancing Transparency in Reporting the synthesis of Qualitative Research - ENTREQ statement [43]. Pre-determined inclusion and exclusion criteria were used. EndNote X9 reference management was used and the search process was represented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram [76]. Appraisal of the included research was carried out using the Critical Appraisal Skills Programme (CASP) [57]. Line by line coding was done using inductive thematic synthesis and EPPI Reviewer 4 software [60].

Results

Four themes emerged; immediate worries or fears, adapting to change, post pandemic fears and use of technology.

Conclusion

The measures put in place during the first lockdown period have had detrimental impacts on unpaid carers, putting them at greater risk of burnout. However, use of digital platforms could have a positive impact on well-being. Recommendations for further research are provided.

What is new?

Key findings?

  • Discontinued or reduced access to activities and services during the first lockdown during the pandemic has had a negative impact on both people who require care and their carers.

  • Carers prioritise the mental health and wellbeing needs of the people they care for over their own.

  • Further qualitative research from different groups of carers would be useful to gain a deeper understanding of the impact of the COVID 19 pandemic measures on unpaid carers.

  • Use of digital technology and digital platforms may be useful tools for carers both during the pandemic and after.

What this adds to what is known?

  • There have been very few qualitative studies on the impact of the COVID 19 pandemic on the mental health and wellbeing of unpaid carers, this review has synthesised their findings and will contribute to future research.

  • Unpaid carers are known to be at risk of poor mental health and wellbeing outcomes, this review demonstrates that they are even more at risk due to the increased reliance on them during the pandemic.

What is this implication and what should change?

  • There is limited qualitative data available from a range of different groups of carers for example, spouse carers, parent carers, carers of people who have specific needs or conditions. Therefore, purposeful sample research to determine the needs of groups of carers during the COVID 19 pandemic could be valuable.

  • Unpaid carers who do not have appropriate support are more at risk of poor mental health and wellbeing outcomes. During the pandemic services have had to adapt to the various rules implemented. Digital adaptations to the provision of support to both carers and the people they care for could be beneficial both during and after the pandemic.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2021.08.20.21262375: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Therefore, two papers from the Cochrane Qualitative and Implementation Methods Group guidance series [46, 47]and Noyes et al. [48] chapter on qualitative evidence have also been used.
    Cochrane Qualitative
    suggested: (UCSF Center for AIDS Prevention Studies (CAPS, RRID:SCR_005647)
    2.2 Data sources and search strategy: A range of databases were searched; CINAHL plus [51], Ovid (Embase, MEDLINE,
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)
    APA PsycINFO) [52] and The Cochrane [53] library, to reduce the risk of excluding relevant research [45].
    Cochrane [
    suggested: None
    Google Scholar and more were searched for grey literature, a full list is available in the research protocol (Appendix A).
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    An exploration of MeSH terms in all three databases searched revealed the term ‘caregiver’ was the only term applicable to unpaid carers.
    MeSH
    suggested: (MeSH, RRID:SCR_004750)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.08.20.21262375 on medRxiv