Background:
The potential impact of the COVID-19 pandemic on population mental health is of increasing global concern. We examine changes in adult mental health in the UK population before and during the lockdown.
Methods:
In this secondary analysis of a national, longitudinal cohort study, households that took part in Waves 8 or 9 of the UK Household Longitudinal Study (UKHLS) panel, including all members aged 16 or older in April, 2020, were invited to complete the COVID-19 web survey on April 23–30, 2020. Participants who were unable to make an informed decision as a result of incapacity, or who had unknown postal addresses or addresses abroad were excluded. Mental health was assessed using the 12-item General Health Questionnaire (GHQ-12). Repeated cross-sectional analyses were done to examine temporal trends. Fixed-effects regression models were fitted to identify within-person change compared with preceding trends.
Findings:
Waves 6–9 of the UKHLS had 53 351 participants. Eligible participants for the COVID-19 web survey were from households that took part in Waves 8 or 9, and 17 452 (41·2%) of 42 330 eligible people participated in the web survey. Population prevalence of clinically significant levels of mental distress rose from 18·9% (95% CI 17·8–20·0) in 2018–19 to 27·3% (26·3–28·2) in April, 2020, one month into UK lockdown. Mean GHQ-12 score also increased over this time, from 11·5 (95% CI 11·3–11·6) in 2018–19, to 12·6 (12·5–12·8) in April, 2020. This was 0·48 (95% CI 0·07–0·90) points higher than expected when accounting for previous upward trends between 2014 and 2018. Comparing GHQ-12 scores within individuals, adjusting for time trends and significant predictors of change, increases were greatest in 18–24-year-olds (2·69 points, 95% CI 1·89–3·48), 25–34-year-olds (1·57, 0·96–2·18), women (0·92, 0·50–1·35), and people living with young children (1·45, 0·79–2·12). People employed before the pandemic also averaged a notable increase in GHQ-12 score (0·63, 95% CI 0·20–1·06).
Interpretation:
By late April, 2020, mental health in the UK had deteriorated compared with pre-COVID-19 trends. Policies emphasising the needs of women, young people, and those with preschool aged children are likely to play an important part in preventing future mental illness.
Conclusion:
This study identifies groups in the population that had a high prevalence of psychological distress before the pandemic. As the economic consequences of lockdown develop, when furloughs turn to redundancies, mortgage holidays expire, and recession takes effect, we believe it is reasonable to expect not only sustained distress and clinically significant deterioration in mental health for some people, but emergence of well described long-term effects of economic recession on mental health including increasing suicide rates and hospital admissions for mental illness.
Women, young people, and those with preschool aged children are experiencing the greatest increase in mental distress. This supports results of previous reports of high prevalence of common mental disorder and self-harm in girls and women aged 16–24 years; while Marmot made a pressing case for tackling health inequalities for women in poverty.
The COVID-19 pandemic has produced many new challenges for health research, policy, and service provision. The problems for mental health from COVID-19 and governmental responses to the pandemic are not necessarily new; instead, pre-existing mental health inequalities could become more entrenched and tackling them might be even more challenging. The pandemic has brought people’s differing life circumstances into stark contrast: access to outside and inside space, household crowding, lack of school provision and childcare, food insecurity, domestic violence, addiction, access to internet and maintenance of social connectivity, as well as economic reserves are all relevant to mental health. An appropriate, proportionate response to mitigate and manage additional needs requires more high-quality information to be included in public health messaging about mental health during the pandemic, alongside adequately resourced services.
For access to the full article: Lancet Psychiatry 2020
https://doi.org/10.1016/ S2215-0366(20)30308-4
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