The UK Biobank mental health enhancement 2022: Methods and results

Abstract

Background: This paper introduces the UK Biobank (UKB) second mental health questionnaire (MHQ2), describes its design, the respondents and some notable findings. UKB is a large cohort study with over 500,000 volunteer participants aged 40-69 years when recruited in 2006-2010. It is an important resource of extensive health, genetic and biomarker data. Enhancements to UKB enrich the data available. MHQ2 is an enhancement designed to enable and facilitate research with psychosocial and mental health aspects.

Methods: UKB sent participants a link to MHQ2 by email in October-November 2022. The MHQ2 was designed by a multi-institutional consortium to build on MHQ1. It characterises lifetime depression further, adds data on panic disorder and eating disorders, repeats 'current' mental health measures and updates information about social circumstances. It includes established measures, such as the PHQ-9 for current depression and CIDI-SF for lifetime panic, as well as bespoke questions. Algorithms and R code were developed to facilitate analysis.

Results: At the time of analysis, MHQ2 results were available for 169,253 UKB participants, of whom 111,275 had also completed the earlier MHQ1. Characteristics of respondents and the whole UKB cohort are compared. The major phenotypes are lifetime: depression (18%); panic disorder (4.0%); a specific eating disorder (2.8%); and bipolar affective disorder I (0.4%). All mental disorders are found less with older age and also seem to be related to selected social factors. In those participants who answered both MHQ1 (2016) and MHQ2 (2022), current mental health measure showed that fewer respondents have harmful alcohol use than in 2016 (relative risk 0.84), but current depression (RR 1.07) and anxiety (RR 0.98) have not fallen, as might have been expected given the relationship with age. We also compare lifetime concepts for test-retest reliability.

Conclusions: There are some drawbacks to UKB due to its lack of population representativeness, but where the research question does not depend on this, it offers exceptional resources that any researcher can apply to access. This paper has just scratched the surface of the results from MHQ2 and how this can be combined with other tranches of UKB data, but we predict it will enable many future discoveries about mental health and health in general.

Fig 1. Summary of the topics included in the UK Biobank MHQ1 and MHQ2, illustrating the overlap.

Fig 2. Number of UKB participants invited, starting and completing the MHQ2 questionnaire, as a proportion of those eligible for the questionnaire. UKB scientific team numbers (n = 165,262). Participants could participate in questionnaire without being invited. Started qnn = all respondents who completed at least one module on MHQ2; Completed qnn = respondents who completed all mental health modules in MHQ2.

Fig 3. The flow of participants illustrating those completing the first and second mental health questionnaires, the cross-over and participants who have died or withdrawn.

UKB scientific team numbers. Completed MHQ2 = completed all 12 mental health modules; Not completed MHQ2 = available but didn’t start MHQ2, started but didn’t finish, or failed their identity check; Not available = died or withdrew from the cohort prior to MHQ1/ MHQ2, or withdrew with no further access between MHQ2 and data access.

Fig 4. Proportion in each age group (at completion of relevant questionnaire) with harmful alcohol use according to AUDIT by sex and wave, restricted to those who completed both MHQ1 ≈ 2016 and MHQ2 ≈ 2022 (n = 111,275).

Fig 5. Proportion in each age group (at completion of relevant questionnaire) with ‘PHQ-9-derived current depression’ outcome by sex and wave, restricted to those who completed both MHQ1 ≈ 2016 and MHQ2 ≈ 2022 (n = 111,275).

Fig 6. Proportion in each age group (at completion of relevant questionnaire) with generalised anxiety disorder according to ‘GAD-7-derived current anxiety’ by sex and wave, restricted to those who completed both MHQ1 ≈ 2016 and MHQ2 ≈ 2022 (n = 111,275).