Both loneliness and a lack of social integration are associated with serious physical and psychological health issues. One population highly susceptible to social isolation and loneliness are individuals who are homeless, who also experience high rates of mental disorder and relationship breakdown. Despite this, little research has explored how social networks, isolation and loneliness are experienced for those with a history of homelessness. In-depth, semi-structured interviews were used to get a nuanced understanding of how social networks and isolation are experienced and understood by individuals experiencing homelessness. Sixteen participants who were either homeless (n = 11) or previously homeless (n = 5) in Sydney, Australia, completed one-off interviews that were audio-recorded and transcribed. Data were analysed using thematic analysis. Participants constructed their social networks as being both constrained and enabled by marginalisation. They experienced rejection from the non-homeless: the loss of critical network members, including rejection from family and a lack of companionship, and low quality and precarious relationships within the homeless community. These accounts were best conceptualised through loneliness theory. Participant's accounts signal that the homeless will likely continue feeling isolated if mainstream attitudes towards homelessness remain stigmatising and discriminatory.

Increased time spent at home during COVID-19 exposed inequities in Australian housing quality and availability. Many Australians lack sufficient space to carry out activities shifted to their homes and the financial downturn rapidly increased stress around housing affordability. Research demonstrates living in unaffordable or poor-quality housing can negatively impact residents' mental health. This study explores the mechanisms through which housing moderates COVID-19's impact on mental health by analysing 2,065 Australians surveyed in mid-to-late 2020. Hierarchical linear regressions were used to examine associations between housing circumstances, neighbourhood belonging and mental-health outcomes (loneliness, depression, and anxiety), adjusted for demographics. Open-ended responses were analysed using thematic analysis and critical-realist epistemology. Feeling 'trapped' and 'helpless' because of insecure tenure or lack of money to improve housing conditions reduced participants' sense of control. Inadequate space and noise adversely impacted participants' well-being. Participants' housing contextincluding amenities, natural spaces, and social connectionsstrongly impacted their emotional experiences. Safe, secure, and suitable housing is a known determinant of safety and physical health; this study suggests it is also a critical factor for Australians' mental health. To improve mental health among the vulnerably-housed, future housing policy should not compromise on housing affordability, quality, space and access to nearby amenities.

BackgroundThe mental health impacts of the COVID-19 pandemic remain a public health concern. High quality synthesis of extensive global literature is needed to quantify this impact and identify factors associated with adverse outcomes.MethodsWe conducted a rigorous umbrella review with meta-review and present (a) pooled prevalence of probable depression, anxiety, stress, psychological distress, and post-traumatic stress, (b) standardised mean difference in probable depression and anxiety pre-versus-during the pandemic period, and (c) comprehensive narrative synthesis of factors associated with poorer outcomes. Databases searched included Scopus, Embase, PsycINFO, and MEDLINE dated to March 2022. Eligibility criteria included systematic reviews and/or meta-analyses, published post-November 2019, reporting data in English on mental health outcomes during the COVID-19 pandemic.FindingsThree hundred and thirty-eight systematic reviews were included, 158 of which incorporated meta-analyses. Meta-review prevalence of anxiety symptoms ranged from 24.4% (95%CI: 18–31%, I2: 99.98%) for general populations to 41.1% (95%CI: 23–61%, I2: 99.65%) in vulnerable populations. Prevalence of depressive symptoms ranged from 22.9% (95%CI: 17–30%, I2: 99.99%) for general populations to 32.5% (95%CI: 17–52%, I2: 99.35) in vulnerable populations. Prevalence of stress, psychological distress and PTSD/PTSS symptoms were 39.1% (95%CI: 34–44%; I2: 99.91%), 44.2% (95%CI: 32–58%; I2: 99.95%), and 18.8% (95%CI: 15–23%; I2: 99.87%), respectively. Meta-review comparing pre-COVID-19 to during COVID-19 prevalence of probable depression and probable anxiety revealed standard mean differences of 0.20 (95%CI = 0.07–0.33) and 0.29 (95%CI = 0.12–0.45), respectively.ConclusionThis is the first meta-review to synthesise the longitudinal mental health impacts of the pandemic. Findings show that probable depression and anxiety were significantly higher than pre-COVID-19, and provide some evidence that that adolescents, pregnant and postpartum people, and those hospitalised with COVID-19 experienced heightened adverse mental health. Policymakers can modify future pandemic responses accordingly to mitigate the impact of such measures on public mental health.

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