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Immediate and Longer-Term Changes in the Mental Health and Well-being of Older Adults in England During the COVID-19 Pandemic

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Key Points

Question  How have the mental health and well-being of older adults in England changed during the COVID-19 pandemic compared with prepandemic levels?

Findings  This cohort study including 5146 older adults participating in the English Longitudinal Study of Ageing found that levels of depression, loneliness, and poor quality of life increased significantly during June and July 2020 compared with prepandemic levels and continued to deteriorate during the second national lockdown in November and December 2020, with further increases in anxiety symptoms from June and July 2020 to November and December 2020. Inequalities in experiences of mental ill health during the COVID-19 pandemic were evident, with women, individuals living alone, and those with less wealth being particularly vulnerable.

Meaning  Older individuals did not adapt well to the new psychosocial stressors introduced by the pandemic; policies should be in place for the immediate provision of targeted psychological interventions to support older people, and access to digital mental health services should be improved.


Importance  Despite the emphasis placed on the psychological impact of the COVID-19 pandemic, evidence from representative studies of older adults including pre–COVID-19 data and repeated assessments during the pandemic is scarce.

Objective  To examine changes in mental health and well-being before and during the initial and later phases of the COVID-19 pandemic and test whether patterns varied with sociodemographic characteristics in a representative sample of older adults living in England.

Design, Setting, and Participants  This longitudinal cohort study analyzed data from 5146 older adults participating in the English Longitudinal Study of Ageing who provided data before the COVID-19 pandemic (2018 and 2019) and at 2 occasions in 2020 (June or July as well as November or December).

Exposures  The COVID-19 pandemic and sociodemographic characteristics, including sex, age, partnership status, and socioeconomic position.

Main Outcomes and Measures  Changes in depression (8-item Centre for Epidemiological Studies Depression scale), anxiety (7-item Generalized Anxiety Disorder scale), quality of life (12-item Control, Autonomy, Self-realization, and Pleasure scale), and loneliness (3-item Revised University of California, Los Angeles, loneliness scale) were tested before and during the COVID-19 pandemic using fixed-effects regression models.

Results  Of 5146 included participants, 2723 (52.9%) were women, 4773 (92.8%) were White, and the mean (SD) age was 67.7 (10.6) years. The prevalence of clinically significant depressive symptoms increased from 12.5% (95% CI, 11.5-13.4) before the COVID-19 pandemic to 22.6% (95% CI, 21.6-23.6) in June and July 2020, with a further rise to 28.5% (95% CI, 27.6-29.5) in November and December 2020. This was accompanied by increased loneliness and deterioration in quality of life. The prevalence of anxiety rose from 9.4% (95% CI, 8.8-9.9) to 10.9% (95% CI, 10.3-11.5) from June and July 2020 to November and December 2020. Women and nonpartnered people experienced worse changes in mental health. Participants with less wealth had the lowest levels of mental health before and during the COVID-19 pandemic. Higher socioeconomic groups had better mental health overall but responded to the COVID-19 pandemic with more negative changes.

Conclusions and Relevance  In this longitudinal cohort study of older adults living in England, mental health and well-being continued to worsen as the COVID-19 pandemic progressed, and socioeconomic inequalities persisted. Women and nonpartnered people experienced greater deterioration in mental health.

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Article Information

Accepted for Publication: November 1, 2021.

Published Online: December 22, 2021. doi:10.1001/jamapsychiatry.2021.3749

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Zaninotto P et al. JAMA Psychiatry.

Corresponding Author: Paola Zaninotto, PhD, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom (

Author Contributions: Drs Zaninotto and Iob 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 Zaninotto and Iob are joint first authors. Drs Zaninotto, Iob, and Steptoe contributed equally to this work.

Study concept and design: Zaninotto, Iob, Steptoe.

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

Drafting of the manuscript: Zaninotto, Iob.

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

Statistical analysis: Iob.

Obtained funding: Zaninotto, Steptoe.

Study supervision: Zaninotto, Steptoe.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was funded by the Economic and Social Research Council/UK Research and Innovation, National Institute on Aging, and UK government departments coordinated by the National Institute for Health Research.

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.

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