Since the arrival of the novel coronavirus (COVID-19) in Singapore, the country has dealt with multiple waves of infection and community mitigation strategies, reconfiguring daily life and social cohesion within neighborhoods. For residents in the local community this has meant having to navigate the dynamic nature of infection and ensuing restrictions. Empirical studies on infectious disease outbreaks and other influenza pandemics (i.e., SARS, H1N1, MERS) have shown variability in adaptation strategies (Chew et al., 2020; Javed and Parveen, 2021; Kavčič et al., 2022).

As the COVID-19 pandemic developed, systematic reviews and community research studies across multiple settings have demonstrated growing mental health concerns, specifically the rising trend in depression and anxiety (Brooks et al., 2020; Xiong et al., 2020; Wong L. P. et al., 2021; Castellano-Tejedor et al., 2022) associated with periods of heightened restrictions. However, a finding of greater concern is the persistence of these in the long term (Brooks et al., 2020). For instance, even during later stages of the pandemic (i.e., September 2020), where restrictions were lessened, a recent study found that more than half the sampled population were experiencing symptoms related to either anxiety or depression (Wong L. P. et al., 2021).

In this paper we define mental health as a state of well-being where an individual capitalizes on their abilities to work productively and cope with daily stressors to contribute meaningfully to their community (World Health Organization, 2018). More broadly, health is conceptualized as relying on the ability to gain homeostasis, returning to levels of usual functioning be this physiological or psychosocial (Huber et al., 2016) when facing stressors or external threats to adaptation. We take the stance that such resilient processes are underpinned by having the ability to obtain and mobilize both internal and external protection in the face of concomitant adversity (Egeland et al., 1993; Yates et al., 2003; Hildon et al., 2018). These processes are exemplified in a recent study of healthcare workers facing the early disruptions and fears raised by the pandemic (Chan et al., 2022), further described below. The forthcoming quantitative analysis based on self-administered online survey data, takes a similar approach, seeking to identify what protects the community, enabling better than expected mental health outcomes as their exposure to adversity mounts.

Resilience research on adaptation during COVID-19 (Vinkers et al., 2020; Xiao et al., 2020; Blanc et al., 2021; Zhang et al., 2022) has been considered in various ways. Proponents of this approach tend to build on the long-standing traditions of resilience studies originally based on at-risk children in Hawaii (Werner and Smith, 1982; Gallo et al., 2009; Keyes, 2009; Zhang et al., 2022). These early waves of research helped define resilience as being able to do better than expected, even flourish despite adversity (Werner and Smith, 1979). The following paper defines and operationalizes resilience, accordingly, building on several waves of resilience research (Richardson, 2002), and taking a broad multi-disciplinary, theory-based perspective. Current studies on resilient responses to the pandemic tend to focus on providing evidence and recommendations for stress reduction and enablement of resilient outcomes. Resilient processes and types of protection that kick-in when things are likely to be “really bad” have been less considered.

The Loads-Levers-Lifts model (Hildon et al., 2018; Chan et al., 2022) proposes resilience as a dynamic and modifiable process (see Figure 1). The process is conceived with adversity exposure as the starting point. Such exposure represents risk (i.e., loads), especially as these accumulate and become more challenging to overcome. In response, identifying protection that are needed to offset these effects (i.e., lifts), as well as the types of interventions (i.e., levers) to use will be central to understanding resilient mechanisms.

Therefore, resilience, though intuitive to some, or as Masten and colleagues have called it “ordinary magic” (Masten, 2001; Masten, 2015) is also a phenomenon that can be supported and engineered. This can be achieved by reducing loads or leveraging lifts. Identifying what these are and when lifts “kick in” when loads are high is the purpose of our forthcoming analyses.

Accordingly, we aim to understand how to adapt and thrive under multiple, potentially ongoing, community restrictions and adversities experienced during COVID-19 to inform their effects on the wider community’s mental health. More specifically, the study objectives are to identify:

In summary, we examine three related research question – (1) What typifies adversity related to living with on–off COVID-19 restrictions? (2) Who are the resilient? (3) How are negative effects of adversity attenuated?

In this paper we consider effects of community restrictions on mental health and the role of risk and resilience. This was carried out by examining mental health, adversity and protective exposures during Singapore’s Phase 2 Heightened Alert. Resilience, as we defined it, was observed in around 20% of those exposed to the selected adversities. Adversities were identified both from existing literature (Xiong et al., 2020; Castellano-Tejedor et al., 2022) and empirically verified in the present analyses. Our study has also demonstrated that for significant effects to present on mental health outcomes multiple adversities will need to be detected, and that as adversities mount so can their effects on mental health. Our findings echo longstanding traditions of resilience research (Werner and Smith, 1979; Werner and Smith, 1982; Masten, 2001; Gallo et al., 2009; Keyes, 2009; Masten, 2015; Hildon et al., 2018; Chan et al., 2022; Zhang et al., 2022) and support the central hypothesis that risk is cumulative and exposure to minimal amounts of adversity can be insufficient to trigger certain protective mechanisms (Cicchetti, 2010; Malhi et al., 2019).

Our work also demonstrates the notion of the Loads-Levers-Lifts model, which acknowledges that protection itself is multi-faceted and merits to be studied in relation to specific contexts and degrees of adversity exposure. Correspondingly during periods of intermittent community restrictions and lockdown, the present analysis showed that is catalyzed mental health Loads, measured as cumulative adversities herein. It was demonstrated that harmonious living situations will Lift and offset higher levels of adversity and help enable resilience to depression. In addition, coping by believing that dealing with difficult situations can lead to growth in positive ways shown to be central to Lifting outcomes related both to depression and anxiety. Those with resilient outcomes were found to be more likely to have access to these and other forms of protection. Notably, aligning with the alternative model of existential positive psychology (Wong P. T. P. et al., 2021), where adversity is understood as an important element that allows people to ultimately flourish. Indeed, long-term wellbeing is attained through the understanding that suffering will occur, but also a myriad of ways of overcoming it will be present. Therefore, our study proposes that Levers, such as proactive therapeutic initiatives that enable resilience should tap into this mode of coping. For instance, building resilient capabilities, cultivating inner agency, and addressing anxiety and feelings of uncertainty through Cognitive Behavioral Therapy (CBT; Wong et al., 2006; Lusk and Meinyk, 2013; Van Orden et al., 2021). Furthermore, resilience informed counseling and social work should plan to leverage a focus on achieving better harmony at home and in relationships.

During periods such as Singapore’s Phase 2 Heightened Alert, where movement restrictions are being applied intermittently, above mentionned interventions should be adaptable. These can be enabled in person, if restrictions allow, but also virtually through digital platforms when not. Evidence has shown that CBT delivered online can aid in mitigating health problems (Cuijpers et al., 2008) and that digital platforms can effectively treat depression and anxiety during COVID-19 (Aminoff et al., 2021; Mahoney et al., 2021; Song et al., 2021). Moreover, digital channels have been shown to be critical in aiding people to maintain a “sense of connectedness” to sustain relationship with their loved ones, providing the means for people to maintain and repair relationships during the pandemic (Genc et al., 2022) and beyond. More generally, it is important to note that since resilience will hinge on avoiding multiple adversities (Peek, 2008; Hildon et al., 2010) as well as acquiring sufficient protective buffering to tip the scales back into one’s favor if needed, any intervention that seeks to engage these mechanisms (Cho et al., 2022; Marciano et al., 2022; Silveira et al., 2022; Waters et al., 2022) will be invoking resilient processes.

Our study has its limitations. For instance, while we were able to detect many protective factors more generally, detecting those specific to higher levels of adversity was limited by low power, and some skewness in the data. However, we were still able to capture clear and consistent evidence of resilient characteristics in sub-group analysis as well as some stable interaction effects relating to higher exposure to adversity and corresponding lifts. That said, our present analysis is unable to drill down into those unaffected by COVID-19 restrictions, for example “hardy” personality types (Kobasa et al., 1982; Florian et al., 1995; Magai et al., 2003) or chart bouncing back (Netuveli et al., 2008) over time as such distinctions are best analyzed longitudinally, and we used cross-sectional data. Moreover, quantitative approaches do not allow for reflexive and retrospective analysis, qualitative approaches designed to reduce recall bias and explore lived experiences need to be used to address these issues.

Nevertheless, the current results provide insights into the mental fatigue faced by the community after undergoing multiple waves of COVID-19 restrictions. Future studies are needed to better explore and use longitudinal approaches to capture long-term effects, and fluctuations of living with COVID-19 over time.

In conclusion, early identification of loads, i.e., cumulative adversities which burden mental health and lifts, i.e., protective factors which offset these is fundamental to addressing the effects of the pandemic on our communities. It is also crucial that theory and methods of studying and engaging in resilience become mainstream. The importance of this phenomenon should be emphasized both to public health practitioners and the public as we navigate unprecedented social changes in how we relate and interact.

The data presented in this article are not readily available due to the sensitive nature of the study, and to preserve anonymity of the participants, as per the study team’s commitment during institutional ethical review. Requests to access the datasets should be directed to Zhildon@nus.edu.sg.

This study involved humans and was approved by the National Healthcare Group Domain Specific Review Board, Singapore (Reference No. is 2018/01203). The study was conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to take part.

ZJ-LH conceptualized the study design. AYC, AMSES, MI-CC, and ZJ-LH contributed to the data collection. AYC conducted the data analysis under the guidance of CST. AYC drafted the manuscript with contributions from FJHC and editorial from ZJ-LH. All authors contributed to editing the manuscript and approved the publication.