Trends in Psychological Distress Among Adults in England, 2020-2022

Abstract

Importance: In the last 3 years, people in England have lived through a pandemic and cost-of-living and health care crises, all of which may have contributed to worsening mental health in the population.

Objective: To estimate trends in psychological distress among adults over this period and to examine differences by key potential moderators.

Design, setting, and participants: A monthly cross-sectional, nationally representative household survey of adults aged 18 years or older was conducted in England between April 2020 and December 2022.

Main outcomes and measures: Past-month distress was assessed with the Kessler Psychological Distress Scale. Time trends in any distress (moderate to severe, scores ≥5) and severe distress (scores ≥13) were modeled, and interactions with age, gender, occupational social grade, children in the household, smoking status, and drinking risk status were tested.

Results: Data were collected from 51 861 adults (weighted mean [SD] age, 48.6 [18.5] years; 26 609 women [51.3%]). There was little overall change in the proportion of respondents reporting any distress (from 34.5% to 32.0%; prevalence ratio [PR], 0.93; 95% CI, 0.87-0.99), but the proportion reporting severe distress increased by 46%, from 5.7% to 8.3% (PR, 1.46; 95% CI, 1.21-1.76). Although trends differed by sociodemographic characteristics, smoking, and drinking, the increase in severe distress was observed across all subgroups (with PR estimates ranging from 1.17 to 2.16), with the exception of those aged 65 years and older (PR, 0.79; 95% CI, 0.43-1.38); the increase was particularly pronounced since late 2021 among those younger than 25 years (increasing from 13.6% in December 2021 to 20.2% in December 2022).

Conclusions and relevance: In this survey study of adults in England, the proportion reporting any psychological distress was similar in December 2022 to that in April 2020 (an extremely difficult and uncertain moment of the COVID-19 pandemic), but the proportion reporting severe distress was 46% higher. These findings provide evidence of a growing mental health crisis in England and underscore an urgent need to address its cause and to adequately fund mental health services.

Figure 1.. Time Trends in the Proportion of Adults in England Reporting Any Psychological Distress (Moderate or Severe) and Severe Psychological Distress, April 2020 to December 2022

Lines represent modeled weighted prevalence by survey month, modeled nonlinearly using restricted cubic splines (5 knots). Shaded bands represent SEs. Points represent observed weighted prevalence by month.

Figure 2.. Time Trends in the Proportion of Adults in England Reporting Any Psychological Distress (Moderate or Severe), April 2020 to December 2022

Graphs show trends by age (A), gender (B), social grade (C), children in the household (D), smoking status (E), and drinking risk status (F). Lines represent modeled weighted prevalence by survey month, modeled nonlinearly using restricted cubic splines (5 knots). Shaded bands represent SEs. Points represent observed weighted prevalence by month.

Figure 3.. Time Trends in the Proportion of Adults in England Reporting Severe Psychological Distress, April 2020 to December 2022

Graphs show trends by age (A), gender (B), social grade (C), children in the household (D), smoking status (E), and drinking risk status (F). Lines represent modeled weighted prevalence by survey month, modeled nonlinearly using restricted cubic splines (5 knots). Shaded bands represent SEs. Points represent observed weighted prevalence by month.