Perceived accessibility and mental health consequences of COVID-19 containment policies

Background: Individuals have experienced various degrees of accessibility loss during the COVID-19 pandemic, which may consequently have influenced their mental health. Although efforts have been made to understand the mental health consequences of the pandemic and corresponding containment measures, the impacts of accessibility loss remain underexplored. Methods: Based on 186 family interviews, a 569-respondent panel survey was designed and distributed monthly from February to October 2020 in Kunming, China. A 3-wave cross-lagged panel model was developed to understand the causal relationship between mental health and perceived accessibility of daily necessities, key services, and social activities. Results: Goodness-of-fit indicators imply that the hypothesised model fits the observed data well: χ2/df = 2.221, AGFI = 0.910, NFI = 0.907, CFI = 0.933, RMSEA = 0.052. The results indicate that perceived accessibility of daily necessities and social activities had lagged effects on mental health status. The within-wave effects show that perceived accessibility of daily necessities (0.619, p < 0.01) and social activities (0.545, p < 0.01) significantly influenced respondents' mental health during the peak of the pandemic whilst perceived accessibility of social activities dominantly influenced their mental health after restrictions were lifted (0.779, p < 0.01). Perceived accessibility of public services such as healthcare did not significantly influence respondents’ mental health in any wave. COVID-19 containment policies had different mental outcomes across population groups. Disadvantaged people experienced mental health issues due to accessibility loss for daily necessities and social activities until the lifting of compulsory QR-code-for-buses, whilst better-off populations had better mental health during the early phase of the outbreak and rapidly recovered their mental health after mobility restrictions eased. Conclusion: Reduced perceived accessibility of daily necessities and social activities may be an underlying cause of mental health problems. Relative accessibility deprivation exacerbated mental health inequities during the COVID-19 pandemic.