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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

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


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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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@ucl.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.

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