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

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          Key Points

          Question

          How has the mental health of the UK population changed from before to during the COVID-19 pandemic?

          Findings

          This cohort study of 49 993 participants in 11 longitudinal studies found that mental health has deteriorated from before the start of the COVID-19 pandemic, and this deterioration was sustained across the first year of the pandemic. Deterioration in mental health varied by sociodemographic factors, namely age, sex, and education, and did not recover when social restrictions were eased.

          Meaning

          The substantial deterioration in mental health during the ongoing COVID-19 pandemic observed in this study highlights the need for improved mental health care provision and broader support to minimize the risk of longer-term mental health consequences and widening health inequalities.

          Abstract

          This cohort study investigates changes in mental health and sociodemographic inequalities from before and across the first year of the COVID-19 pandemic in 11 longitudinal studies in the United Kingdom.

          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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          Most cited references54

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Robert L Spitzer, Kurt Kroenke, Janet B W Williams … (2006)
          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            The PHQ-9: validity of a brief depression severity measure.

            K Kroenke, R L Spitzer, J. Williams (2001)
            While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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              Quantifying heterogeneity in a meta-analysis.

              Julian P T Higgins, Simon G Thompson (2002)
              The extent of heterogeneity in a meta-analysis partly determines the difficulty in drawing overall conclusions. This extent may be measured by estimating a between-study variance, but interpretation is then specific to a particular treatment effect metric. A test for the existence of heterogeneity exists, but depends on the number of studies in the meta-analysis. We develop measures of the impact of heterogeneity on a meta-analysis, from mathematical criteria, that are independent of the number of studies and the treatment effect metric. We derive and propose three suitable statistics: H is the square root of the chi2 heterogeneity statistic divided by its degrees of freedom; R is the ratio of the standard error of the underlying mean from a random effects meta-analysis to the standard error of a fixed effect meta-analytic estimate, and I2 is a transformation of (H) that describes the proportion of total variation in study estimates that is due to heterogeneity. We discuss interpretation, interval estimates and other properties of these measures and examine them in five example data sets showing different amounts of heterogeneity. We conclude that H and I2, which can usually be calculated for published meta-analyses, are particularly useful summaries of the impact of heterogeneity. One or both should be presented in published meta-analyses in preference to the test for heterogeneity. Copyright 2002 John Wiley & Sons, Ltd.
              Article 0 comments Cited 5577 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): JAMA Netw Open
                Journal ID (iso-abbrev): JAMA Netw Open
                Title: JAMA Network Open
                Publisher: American Medical Association
                ISSN (Electronic): 2574-3805
                Publication date (Electronic): 22 April 2022
                Publication date Collection: April 2022
                Publication date PMC-release: 22 April 2022
                Volume: 5
                Issue: 4
                Electronic Location Identifier: e227629
                Affiliations
                [1 ]MRC Unit for Lifelong Health and Ageing, University College London, London, England, United Kingdom
                [2 ]MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
                [3 ]Division of Psychiatry, University of Edinburgh, Edinburgh, Scotland
                [4 ]MRC Integrative Epidemiology Unit, University of Bristol, Bristol, England
                [5 ]Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
                [6 ]Bradford Institute for Health Research, United Kingdom
                [7 ]Department of Epidemiology and Public Health, University College London, London, England, United Kingdom
                [8 ]Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland
                [9 ]Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, England
                [10 ]Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Sciences, King’s College London, London, England
                [11 ]Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
                [12 ]Centre for Longitudinal Studies, University College London, London, England, United Kingdom
                [13 ]Centre for Medical Information, University of Edinburgh, Edinburgh, Scotland
                Author notes
                Article Information
                Accepted for Publication: February 28, 2022.
                Published: April 22, 2022. doi:10.1001/jamanetworkopen.2022.7629
                Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Patel K et al. JAMA Network Open.
                Corresponding Author: Praveetha Patalay, PhD, MRC Unit for Lifelong Health and Ageing, UCL, 1-19 Torrington Place, Floor 5, London, WC1E 7HB ( p.patalay@ 123456ucl.ac.uk ).
                Author Contributions: Drs Patalay and Katikireddi had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Patel, Kwong, Griffith, and Green and Mss Robertson and Willan are joint first authors. Drs Patalay, Porteous, and Katikireddi are joint last authors.
                Concept and design: Patel, Kwong, Griffith, Green, McElroy, Maddock, Niedzwiedz, Henderson, Richards, Ploubidis, Fitzsimons, Patalay, Katikireddi.
                Acquisition, analysis, or interpretation of data: Patel, Robertson, Kwong, Griffith, Willan, Green, Di Gessa, Huggins, McElroy, Thompson, Henderson, Richards, Steptoe, Ploubidis, Moltrecht, Booth, Silverwood, Patalay, Porteous, Katikireddi.
                Drafting of the manuscript: Patel, Robertson, Kwong, Griffith, Willan, Green, Henderson, Richards, Moltrecht, Patalay, Katikireddi.
                Critical revision of the manuscript for important intellectual content: Patel, Kwong, Griffith, Green, Di Gessa, Huggins, McElroy, Thompson, Maddock, Niedzwiedz, Richards, Steptoe, Ploubidis, Moltrecht, Booth, Fitzsimons, Silverwood, Patalay, Porteous, Katikireddi.
                Statistical analysis: Patel, Kwong, Griffith, Willan, Green, Di Gessa, Huggins, McElroy, Thompson, Silverwood.
                Obtained funding: Henderson, Steptoe, Ploubidis, Fitzsimons, Patalay, Porteous, Katikireddi.
                Administrative, technical, or material support: Robertson, Kwong, Griffith, McElroy, Thompson, Niedzwiedz, Steptoe, Booth.
                Supervision: Steptoe, Patalay, Porteous, Katikireddi.
                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.
                Funding/Support: This work was supported by the National Core Studies, an initiative funded by UK Research and Innovation, the National Institute for Health Research, and the Health and Safety Executive. The COVID-19 Longitudinal Health and Wellbeing National Core Study was funded by the MRC (MC PC 20059). Full funding acknowledgements for each individual study can be found as part of eAppendix 6 in the Supplement.
                Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
                Additional Contributions: The contributing studies have been made possible because of the tireless dedication, commitment and enthusiasm of the many people who have taken part. We would like to thank the participants and the numerous team members involved in the studies including interviewers, technicians, researchers, administrators, managers, health professionals, and volunteers. We are additionally grateful to our funders for their financial input and support in making this research happen. Specifically, we thank Claire Steves, Ruth C. E. Bowyer, Deborah Hart, María Paz García, and Rachel Horsfall (Twins UK); Nicholas J. Timpson, Kate Northstone, and Rebecca M. Pearson (Avon Longitudinal Study of Parents and Children; more information in eAppendix 7 in the Supplement); Drew Altschul, Chloe Fawns-Ritchie, Archie Campbell, and Robin Flaig (Generation Scotland); Michaela Benzeval (Understanding Society); Andrew Wong, Maria Popham, Karen MacKinnon, Imran Shah, and Philip Curran (1946 National Survey of Health and Development); our colleagues in survey, data, and cohort maintenance teams (the Millennium Cohort Study, Next Steps, 1970 British Cohort Study, National Child Development Study); John Wright and Dan Mason and other colleagues in cohort, survey, data maintenance teams (Born in Bradford).
                Additional Information: Dr McElroy had full access to the Millenium Cohort Study, Next Steps, the 1970 British Cohort Study, and the National Child Development Study; Dr Patel, 1946 National Survey of Health and Development; Dr Kwong, Avon Longitudinal Study of Parents and Children; Dr Green, Understanding Society; Dr Di Gessa, English Longitudinal Study of Ageing; Dr Huggins, Generation Scotland; Ellen Thompson, Twins UK; and Ms Willan, Born in Bradford.
                Article
                Publisher ID: zoi220240
                DOI: 10.1001/jamanetworkopen.2022.7629
                PMC ID: 9034408
                PubMed ID: 35452109
                SO-VID: 236005ca-4e84-47bd-a272-faa697be24b7
                Copyright © Copyright 2022 Patel K et al. JAMA Network Open.
                License:

                This is an open access article distributed under the terms of the CC-BY License.

                History
                Date received : 9 December 2021
                Date accepted : 28 February 2022
                Categories
                Subject: Research
                Subject: Original Investigation
                Subject: Online Only
                Subject: Psychiatry

                Data availability:

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