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. 2022 Apr 1;5(4):e227629.
doi: 10.1001/jamanetworkopen.2022.7629.

Psychological Distress Before and During the COVID-19 Pandemic Among Adults in the United Kingdom Based on Coordinated Analyses of 11 Longitudinal Studies

Kishan Patel  1 , Elaine Robertson  2 , Alex S F Kwong  3   4 , Gareth J Griffith  4   5 , Kathryn Willan  6 , Michael J Green  2 , Giorgio Di Gessa  7 , Charlotte F Huggins  8 , Eoin McElroy  9 , Ellen J Thompson  10 , Jane Maddock  1 , Claire L Niedzwiedz  11 , Morag Henderson  12 , Marcus Richards  1 , Andrew Steptoe  7 , George B Ploubidis  12 , Bettina Moltrecht  12 , Charlotte Booth  12 , Emla Fitzsimons  12 , Richard Silverwood  12 , Praveetha Patalay  1   12 , David Porteous  8   13 , Srinivasa Vittal Katikireddi  2
Affiliations

Psychological Distress Before and During the COVID-19 Pandemic Among Adults in the United Kingdom Based on Coordinated Analyses of 11 Longitudinal Studies

Kishan Patel et al. JAMA Netw Open. .

Abstract

Importance: How population mental health has evolved across the COVID-19 pandemic under varied lockdown measures is poorly understood, and the consequences for health inequalities are unclear.

Objective: To investigate changes in mental health and sociodemographic inequalities from before and across the first year of the COVID-19 pandemic in 11 longitudinal studies.

Design, setting, and participants: This cohort study included adult participants from 11 UK longitudinal population-based studies with prepandemic measures of psychological distress. Analyses were coordinated across these studies, and estimates were pooled. Data were collected from 2006 to 2021.

Exposures: Trends in the prevalence of poor mental health were assessed in the prepandemic period (time period 0 [TP 0]) and at 3 pandemic TPs: 1, initial lockdown (March to June 2020); 2, easing of restrictions (July to October 2020); and 3, a subsequent lockdown (November 2020 to March 2021). Analyses were stratified by sex, race and ethnicity, education, age, and UK country.

Main outcomes and measures: Multilevel regression was used to examine changes in psychological distress from the prepandemic period across the first year of the COVID-19 pandemic. Psychological distress was assessed using the 12-item General Health Questionnaire, the Kessler 6, the 9-item Malaise Inventory, the Short Mood and Feelings Questionnaire, the 8-item or 9-item Patient Health Questionnaire, the Hospital Anxiety and Depression Scale, and the Centre for Epidemiological Studies-Depression across different studies.

Results: In total, 49 993 adult participants (12 323 [24.6%] aged 55-64 years; 32 741 [61.2%] women; 4960 [8.7%] racial and ethnic minority) were analyzed. Across the 11 studies, mental health deteriorated from prepandemic scores across all 3 pandemic periods, but there was considerable heterogeneity across the study-specific estimated effect sizes (pooled estimate for TP 1: standardized mean difference [SMD], 0.15; 95% CI, 0.06-0.25; TP 2: SMD, 0.18; 95% CI, 0.09-0.27; TP 3: SMD, 0.21; 95% CI, 0.10-0.32). Changes in psychological distress across the pandemic were higher in women (TP 3: SMD, 0.23; 95% CI, 0.11, 0.35) than men (TP 3: SMD, 0.16; 95% CI, 0.06-0.26) and lower in individuals with below-degree level education at TP 3 (SMD, 0.18; 95% CI, 0.06-0.30) compared with those who held degrees (SMD, 0.26; 95% CI, 0.14-0.38). Increased psychological distress was most prominent among adults aged 25 to 34 years (SMD, 0.49; 95% CI, 0.14-0.84) and 35 to 44 years (SMD, 0.35; 95% CI, 0.10-0.60) compared with other age groups. No evidence of changes in distress differing by race and ethnicity or UK country were observed.

Conclusions and relevance: In this study, the substantial deterioration in mental health seen in the UK during the first lockdown did not reverse when lockdown lifted, and a sustained worsening was observed across the pandemic period. Mental health declines have been unequal across the population, with women, those with higher degrees, and those aged 25 to 44 years more affected than other groups.

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Conflict of interest statement

Conflict of Interest Disclosures: Ms Robertson reported receiving grants from the Medical Research Council (MRC) and the Scottish Government Chief Scientist Office during the conduct of the study. Dr Griffith reports holding a postdoctoral post funded by the MRC and receiving a postdoctoral fellowship from grants from the Economic and Social Research Council (ESRC) during the conduct of the study. Dr Green reported receiving grants from the MRC during the conduct of the study. Dr Huggins reported receiving grants from the Wellcome Trust during the conduct of the study. Dr Niedzwiedz reported receiving grants from the MRC during the conduct of the study and outside the submitted work. Dr Henderson reported grants from ESRC during the conduct of the study. Dr Katikireddi reported receiving grants from the MRC and the Scottish Government Chief Scientist Office during the conduct of the study; serving as cochair of the Scottish Government’s Expert Reference Group on Ethnicity and COVID-19; being a member of the UK Government’s Scientific Advisory Group on Emergencies subgroup on ethnicity; and being a member of the UK Cabinet Office’s International Best Practice Advisory Group. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Trends in Overall and Sex-Stratified Prevalence of High Psychological Distress
Colored boxes indicate the time period groupings, with blue indicating time period 1 (March to June 2020); green, time period 2 (July to October 2020); and gray, time period 3 (November 2020 to March 2021). A, Shaded areas indicate 95% CIs. ALSPAC indicates children in the Avon Longitudinal Study of Parents and Children; BCS70, 1970 British Cohort Study; BiB, Born in Bradford; ELSA, the English Longitudinal Study of Aging; GS, Generation Scotland; MCS, the Millennium Cohort Study; NCDS, 1958 National Child Development Study; NS, Next Steps; NSHD, 1946 National Survey of Health and Development; and USOC, Understanding Society.
Figure 2.
Figure 2.. Changes in Psychological Distress Before and During the Pandemic in Each of 11 Longitudinal UK Studies
Standardized mean differences measure changes across time periods (compared with prepandemic distress) for the continuous psychological distress scores (A), and relative risk measures risk of high distress scores at each time period (B). ALSPAC indicates children in the Avon Longitudinal Study of Parents and Children; BCS70, 1970 British Cohort Study; BiB, Born in Bradford; ELSA, the English Longitudinal Study of Aging; GS, Generation Scotland; MCS, the Millennium Cohort Study; NCDS, 1958 National Child Development Study; NS, Next Steps, formerly the Longitudinal Study of Young People in England; NSHD, 1946 National Survey of Health and Development; TwinsUK, Twins UK; and USOC, Understanding Society.
Figure 3.
Figure 3.. Changes in Psychological Distress Over Time by Sex, Education, Ethnicity, and UK Country
Stratified changes across time periods (compared with prepandemic distress). Each light-colored point represents estimates from a different included study (study-specific estimates appear in eTables 8 and 10-12 in the Supplement).
Figure 4.
Figure 4.. Trends in Prevalence of Psychological Distress by Age Group
Stratified changes across time periods (compared with prepandemic distress).
See this image and copyright information in PMC

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