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Levels of Severity of Depressive Symptoms Among At-Risk Groups in the UK During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Are sociodemographic, psychosocial, and health-related factors associated with risk of poor mental health during the COVID-19 pandemic in the UK?

Findings  This cohort study using data from a large panel study including 51 417 adults found that the risks of moderate and severe depressive symptom trajectories were significantly higher among people experiencing abuse or low social support, individuals with low socioeconomic position, and those with preexisting mental and physical health conditions.

Meaning  These findings suggest that mental health and socioeconomic interventions in the current or future pandemics should be targeted toward people with these risk factors.


Importance  An immediate research priority is to investigate and monitor the psychological well-being among high-risk groups during the coronavirus disease 2019 (COVID-19) pandemic.

Objective  To examine levels of severity of depressive symptoms over time among individuals with high risk in the UK during the COVID-19 pandemic.

Design, Setting, and Participants  This cohort study is part of an ongoing large panel study of adults aged 18 years and older residing in the UK, the COVID-19 Social Study, established on March 21, 2020. Data analysis was conducted in May 2020.

Exposures  Sociodemographic risk factors included belonging to the Black, Asian, and minority racial/ethnic communities, low socioeconomic position (SEP), and essential worker roles (eg, workers in health and social care, education, childcare, or key public services). Health-related and psychosocial risk factors included preexisting physical and mental health conditions, experience of psychological or physical abuse, and low social support.

Main Outcomes and Measures  Depressive symptoms were measured on 7 occasions from March 21 to April 2, 2020, using the 9-item Patient Health Questionnaire (PHQ-9). Group-based depressive symptom trajectories were derived using latent growth mixture modeling.

Results  The analytical sample comprised 51 417 adults aged 18 years and older (mean [SD] age, 48.8 [16.8] years; 26 276 [51.1%] women; 6145 members [12.0%] of Black, Asian, and minority racial/ethnic communities). Among these, 17 143 participants (33.3%) were in the lowest SEP quartile, and 11 342 participants (22.1%) were classified as essential workers. Three levels of severity of depressive symptoms were identified: low (30 850 participants [60.0%]), moderate (14 911 participants [29.0%]), and severe (5656 participants [11.0%]). After adjusting for covariates, experiences of physical or psychological abuse (odds ratio [OR], 13.16; 95% CI, 12.95-13.37; P < .001), preexisting mental health conditions (OR, 12.99; 95% CI, 12.87-13.11; P < .001), preexisting physical health conditions (OR, 3.41; 95% CI, 3.29-3.54; P < .001), low social support (OR, 12.72; 95% CI, 12.57-12.86; P < .001), and low SEP (OR, 5.22; 95% CI, 5.08-5.36; P < .001) were significantly associated with severe depressive symptoms. No significant association was found for race/ethnicity (OR, 1.07; 95% CI, 0.85-1.28; P = .56). Participants with essential worker roles were less likely to experience severe depressive symptoms (OR, 0.66; 95% CI, 0.53-0.80; P < .001). Similar patterns of associations were found for the group of participants with moderate depressive symptoms (abuse: OR, 5.34; 95% CI, 5.15-5.54; P < .001; mental health condition: OR, 4.24; 95% CI, 4.24-4.24; P < .001; physical health condition: OR, 1.89; 95% CI, 1.80-1.98; P < .001; low social support: OR, 4.71; 95% CI, 4.60-4.82; P < .001; low SEP: OR, 1.97; 95% CI, 1.87-2.08; P < .001).

Conclusions and Relevance  In this cohort study of UK adults participating in the COVID-19 Social Study, people with psychosocial and health-related risk factors, as well as those with low SEP, were at the most risk of experiencing moderate or severe depressive symptoms during the COVID-19 pandemic.

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Article Information

Accepted for Publication: September 24, 2020.

Published: October 26, 2020. doi:10.1001/jamanetworkopen.2020.26064

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Iob E et al. JAMA Network Open.

Corresponding Author: Eleonora Iob, MSc, Research Department of Behavioural Science and Health, University College London, 1-19 Torrington Pl, London WC1E 7HB, United Kingdom (eleonora.iob.17@ucl.ac.uk).

Author Contributions: Ms Iob and Mr Frank 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. Ms Iob and Mr Frank are co–first authors.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Iob, Frank, Fancourt.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Iob, Frank, Fancourt.

Obtained funding: Fancourt.

Administrative, technical, or material support: Steptoe, Fancourt.

Supervision: Steptoe, Fancourt.

Conflict of Interest Disclosures: None reported.

Funding/Support: The COVID-19 Social Study was funded by grant No. WEL/FR-000022583 from the Nuffield Foundation. The study was also supported by the MARCH Mental Health Network funded by the Cross-Disciplinary Mental Health Network Plus initiative supported by UK Research and Innovation (grant No. ES/S002588/1), and by the Wellcome Trust (grant No. 221400/Z/20/Z). Dr Fancourt was funded by grant No. 205407/Z/16/Z from the Wellcome Trust. The UKRI Mental Health Networks, Find Out Now, UCL BioResource, HealthWise Wales, SEO Works, FieldworkHub, and Optimal Workshop provided support in recruitment efforts.

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.

Disclaimer: The views expressed are those of the authors and not necessarily the Nuffield Foundation.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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