Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study

Abstract

Background: There is major concern about the impact of the global COVID-19 outbreak on mental health. Several studies suggest that mental health deteriorated in many countries before and during enforced isolation (ie, lockdown), but it remains unknown how mental health has changed week by week over the course of the COVID-19 pandemic. This study aimed to explore the trajectories of anxiety and depression over the 20 weeks after lockdown was announced in England, and compare the growth trajectories by individual characteristics.

Methods: In this prospective longitudinal observational study, we analysed data from the UCL COVID-19 Social Study, a panel study weighted to population proportions, which collects information on anxiety (using the Generalised Anxiety Disorder assessment) and depressive symptoms (using the Patient Health Questionnaire) weekly in the UK since March 21, 2020. We included data from adults living in England who had at least three repeated measures between March 23 and Aug 9, 2020. Analyses were done using latent growth models, which were fitted to account for sociodemographic and health covariates.

Findings: Between March 23, and Aug 9, data from over 70 000 adults were collected in the UCL COVID-19 Social Study. When including participants living in England with three follow-up measures and no missing values, our analytic sample consisted of 36 520 participants. The average depression score was 6·6 (SD=6·0, range 0-27) and the average anxiety score 5·7 (SD=5·6, range 0-21) in week 1. Anxiety and depression levels both declined across the first 20 weeks following the introduction of lockdown in England (b=-1·93, SE=0·26, p<0·0001 for anxiety; b=-2·52, SE=0·28, p<0·0001 for depressive symptoms). The fastest decreases were seen across the strict lockdown period (between weeks 2 and 5), with symptoms plateauing as further lockdown easing measures were introduced (between weeks 16 and 20). Being a woman or younger, having lower educational attainment, lower income, or pre-existing mental health conditions, and living alone or with children were all risk factors for higher levels of anxiety and depression at the start of lockdown. Many of these inequalities in experiences were reduced as lockdown continued, but differences were still evident 20 weeks after the start of lockdown.

Interpretation: These data suggest that the highest levels of depression and anxiety occurred in the early stages of lockdown but declined fairly rapidly, possibly because individuals adapted to circumstances. Our findings emphasise the importance of supporting individuals in the lead-up to future lockdowns to try to reduce distress, and highlight that groups already at risk for poor mental health before the pandemic have remained at risk throughout lockdown and its aftermath.

Funding: Nuffield Foundation, UK Research and Innovation, Wellcome Trust.

Figure 1

Predicted growth trajectories of estimated mean anxiety and depressive symptom scores Scores on anxiety were measured using the Generalised Anxiety Disorder assessment (range of scores: 0–21) and scores on depressive symptoms were measured using the Patient Health Questionnaire (range of scores: 0–27). On March 23, the first lockdown commenced in England. On May 10, it was announced that strict lowdown was being eased. On June 15, non-essential retail was reopened. On July 4, further public amenities were reopened.

Figure 2

Predicted growth trajectories of mean anxiety scores by individual characteristics Scores on anxiety were measured using the Generalised Anxiety Disorder assessment (range of scores: 0–21). Graphs for anxiety scores by other individual characteristics are shown in the appendix (p 2).

Figure 3

Predicted growth trajectories of mean depressive symptom scores by individual characteristics Scores on depressive symptoms were measured using the Patient Health Questionnaire (range of scores: 0–27). Graphs for depressive symptoms scores by other individual characteristics are shown in the appendix (p 2).