The impact of the initial COVID-19 outbreak on young adults' mental health: a longitudinal study of risk and resilience factors

Abstract

Few studies assessing the effects of COVID-19 on mental health include prospective markers of risk and resilience necessary to understand and mitigate the combined impacts of the pandemic, lockdowns, and other societal responses. This population-based study of young adults includes individuals from the Neuroscience in Psychiatry Network (n = 2403) recruited from English primary care services and schools in 2012-2013 when aged 14-24. Participants were followed up three times thereafter, most recently during the initial outbreak of the COVID-19 outbreak when they were aged between 19 and 34. Repeated measures of psychological distress (K6) and mental wellbeing (SWEMWBS) were supplemented at the latest assessment by clinical measures of depression (PHQ-9) and anxiety (GAD-7). A total of 1000 participants, 42% of the original cohort, returned to take part in the COVID-19 follow-up; 737 completed all four assessments [mean age (SD), 25.6 (3.2) years; 65.4% female; 79.1% White]. Our findings show that the pandemic led to pronounced deviations from existing mental health-related trajectories compared to expected levels over approximately seven years. About three-in-ten young adults reported clinically significant depression (28.8%) or anxiety (27.6%) under current NHS guidelines; two-in-ten met clinical cut-offs for both. About 9% reported levels of psychological distress likely to be associated with serious functional impairments that substantially interfere with major life activities; an increase by 3% compared to pre-pandemic levels. Deviations from personal trajectories were not necessarily restricted to conventional risk factors; however, individuals with pre-existing health conditions suffered disproportionately during the initial outbreak of the COVID-19 pandemic. Resilience factors known to support mental health, particularly in response to adverse events, were at best mildly protective of individual psychological responses to the pandemic. Our findings underline the importance of monitoring the long-term effects of the ongoing pandemic on young adults' mental health, an age group at particular risk for the emergence of psychopathologies. Our findings further suggest that maintaining access to mental health care services during future waves, or potential new pandemics, is particularly crucial for those with pre-existing health conditions. Even though resilience factors known to support mental health were only mildly protective during the initial outbreak of the COVID-19 pandemic, it remains to be seen whether these factors facilitate mental health in the long term.

Figure 1

STROBE diagram illustrating the recruitment stages of the NSPN 2400 cohort; adapted from Kiddle et al. (2018). Eol  expression of interest, HQP  home questionnaire pack; superscript a: 36 practices in Cambridgeshire and Peterborough Primary Care Trust (PCT), 8 in Barnet PCT, 3 in Camden PCT and 3 in Islington PCT; superscript b: schools in Barnet (2), Camden (4), Islington, Tower Hamlets, Haringey, Lambeth and Redbridge (all 1 each), and colleges in Cambridgeshire and Peterborough (6) and Islington (1); superscript c: excluded due to current age beyond scope; superscript d: Assessment 4 was designed as an online survey for which all baseline participants who (a) had a valid email address, and (b) had not withdrawn consent in previous assessments, have been invited (note that for previous assessments only participants who took part in the preceding assessment were invited); superscript e: excluded due to uncertainty of survey responder identity.

Figure 2

Illustration of latent growth curve modelling and computation of extended residuals; these have been computed for both primary outcome measures separately. Please note we used the exact time point of each assessment as latent slope loadings to account for the length of individual trajectories (cf. Fig. 1 for assessment periods).

Figure 3

Density distributions for pre-pandemic data collection periods and data collected mid-pandemic for both primary outcome measures; the Kessler Psychological Distress Scale (A) and the Short Warwick-Edinburgh Mental Wellbeing Scale (B).

Figure 4

Extended residual scores for both primary outcome measures; the Kessler Psychological Distress Scale (A; n = 632) and the Short Warwick-Edinburgh Mental Wellbeing Scale (B; n = 620).

Figure 5

Unstandardised beta coefficients and their 95% confidence intervals for linear models assessing sociodemographic as well as pandemic-related risk factors for both primary outcome measures; the Kessler Psychological Distress Scale (A) and the Short Warwick-Edinburgh Mental Wellbeing Scale (B). The left panel shows coefficients for the observed scores at Assessment 4 whilst the right panel shows extended residual scores which take into account individual pre-pandemic trajectories.

Figure 6

Resilience networks including extended residuals for both primary outcome measures, the Kessler Psychological Distress Scale (A; n = 632) and the Short Warwick-Edinburgh Mental Wellbeing Scale (B; n = 620). Extended residuals take into account individual pre-pandemic trajectories, reflecting the deviation from expected mental health whereas greater extended residuals of psychological distress (dst) relate to higher-than-expected distress, and lower extended residuals of mental wellbeing (wlb) relate to lower-than-expected wellbeing. Please note that the network layout has been averaged to ease comparison.