Living alone and mental health: parallel analyses in UK longitudinal population surveys and electronic health records prior to and during the COVID-19 pandemic

Abstract

Background: People who live alone experience greater levels of mental illness; however, it is unclear whether the COVID-19 pandemic had a disproportionately negative impact on this demographic.

Objective: To describe the mental health gap between those who live alone and with others in the UK prior to and during the COVID-19 pandemic.

Methods: Self-reported psychological distress and life satisfaction in 10 prospective longitudinal population surveys (LPSs) assessed in the nearest pre-pandemic sweep and three periods during the pandemic. Recorded diagnosis of common and severe mental illnesses between March 2018 and January 2022 in electronic healthcare records (EHRs) within the OpenSAFELY-TPP.

Findings: In 37 544 LPS participants, pooled models showed greater psychological distress (standardised mean difference (SMD): 0.09 (95% CI: 0.04; 0.14); relative risk: 1.25 (95% CI: 1.12; 1.39)) and lower life satisfaction (SMD: -0.22 (95% CI: -0.30; -0.15)) for those living alone pre-pandemic. This gap did not change during the pandemic. In the EHR analysis of c.16 million records, mental health conditions were more common in those who lived alone (eg, depression 26 (95% CI: 18 to 33) and severe mental illness 58 (95% CI: 54 to 62) more cases more per 100 000). For common mental health disorders, the gap in recorded cases in EHRs narrowed during the pandemic.

Conclusions: People living alone have poorer mental health and lower life satisfaction. During the pandemic, this gap in self-reported distress remained; however, there was a narrowing of the gap in service use.

Clinical implications: Greater mental health need and potentially greater barriers to mental healthcare access for those who live alone need to be considered in healthcare planning.

Keywords: COVID-19; anxiety disorders; psychiatry.

Figure 1

Regression estimates comparing those living alone with those living with others at each time point for each longitudinal study and the pooled estimate for the continuous standardised distress scores (left panel) and the binary score (right panel). ALSPAC (G0), Avon Longitudinal Study of Parents and Children-Generation 0 (Parents); ALSPAC (G1), Avon Longitudinal Study of Parents and Children-Generation 1; BCS, British Cohort Study; ELSA, English Longitudinal Study of Ageing; GS, Generation Scotland: the Scottish Family Health Study; NCDS, National Child Development Study; NS, Next Steps; NSHD, National Survey of Health and Development; TwinsUK, the UK Adult Twin Registry; USoc, Understanding Society: the UK Household Longitudinal Survey.

Figure 2

Period prevalence per 100 000 patients by mental health outcome from March 2018 to January 2022 in OpenSAFELY-TPP. Solid red lines indicate the introduction of the first lockdown in England in March 2020. Dotted green lines represent subsequent restrictive measures. All regression estimates can be found under ‘main effects’ in online supplemental file 3.

Figure 3

Interrupted time series marginal effects of pre-pandemic versus pandemic periods on outcome measures per 100 000 patients in OpenSAFELY-TPP. Blue lines represent people living alone while red lines are people living with others. Whiskers illustrate 95% CI.