Understanding inequalities in mental health by family structure during COVID-19 lockdowns: evidence from the UK Household Longitudinal Study.

PURPOSE: The COVID-19 pandemic increased psychiatric distress and impacts differed by family structure. We aimed to identify mechanisms contributing to these inequalities. METHODS: Survey data were from the UK Household Longitudinal Study. Psychiatric distress (GHQ-12) was measured in April 2020 (first UK lockdown; n = 10,516), and January 2021 (lockdown re-introduced following eased restrictions; n = 6,893). Pre-lockdown family structure comprised partner status and presence of children (< 16 years). Mediating mechanisms included: active employment, financial strain, childcare/home-schooling, caring, and loneliness. Monte Carlo g-computation simulations were used to adjust for confounding and estimate total effects and decompositions into: controlled direct effects (effects if the mediator was absent), and portions eliminated (PE; representing differential exposure and vulnerability to the mediator). RESULTS: In January 2021, after adjustment, we estimated increased risk of distress among couples with children compared to couples with no children (RR: 1.48; 95% CI 1.15-1.82), largely because of childcare/home-schooling (PE RR: 1.32; 95% CI 1.00-1.64). Single respondents without children also had increased risk of distress compared to couples with no children (RR: 1.55; 95% CI 1.27-1.83), and the largest PE was for loneliness (RR: 1.16; 95% CI 1.05-1.27), though financial strain contributed (RR: 1.05; 95% CI 0.99-1.12). Single parents demonstrated the highest levels of distress, but confounder adjustment suggested uncertain effects with wide confidence intervals. Findings were similar in April 2020 and when stratified by sex. CONCLUSION: Access to childcare/schooling, financial security and social connection are important mechanisms that need addressing to avoid widening mental health inequalities during public health crises.

Home working and social and mental wellbeing at different stages of the COVID-19 pandemic in the UK: Evidence from 7 longitudinal population surveys.

BACKGROUND: Home working has increased since the Coronavirus Disease 2019 (COVID-19) pandemic's onset with concerns that it may have adverse health implications. We assessed the association between home working and social and mental wellbeing among the employed population aged 16 to 66 through harmonised analyses of 7 UK longitudinal studies. METHODS AND FINDINGS: We estimated associations between home working and measures of psychological distress, low life satisfaction, poor self-rated health, low social contact, and loneliness across 3 different stages of the pandemic (T1 = April to June 2020 -first lockdown, T2 = July to October 2020 -eased restrictions, T3 = November 2020 to March 2021 -second lockdown) using modified Poisson regression and meta-analyses to pool results across studies. We successively adjusted the model for sociodemographic characteristics (e.g., age, sex), job characteristics (e.g., sector of activity, pre-pandemic home working propensities), and pre-pandemic health. Among respectively 10,367, 11,585, and 12,179 participants at T1, T2, and T3, we found higher rates of home working at T1 and T3 compared with T2, reflecting lockdown periods. Home working was not associated with psychological distress at T1 (RR = 0.92, 95% CI = 0.79 to 1.08) or T2 (RR = 0.99, 95% CI = 0.88 to 1.11), but a detrimental association was found with psychological distress at T3 (RR = 1.17, 95% CI = 1.05 to 1.30). Study limitations include the fact that pre-pandemic home working propensities were derived from external sources, no information was collected on home working dosage and possible reverse association between change in wellbeing and home working likelihood. CONCLUSIONS: No clear evidence of an association between home working and mental wellbeing was found, apart from greater risk of psychological distress during the second lockdown, but differences across subgroups (e.g., by sex or level of education) may exist. Longer term shifts to home working might not have adverse impacts on population wellbeing in the absence of pandemic restrictions but further monitoring of health inequalities is required.

Qualitative study to explore UK medical students' and junior doctors' experiences of occupational stress and mental health during the COVID-19 pandemic.

OBJECTIVES: This qualitative study aimed to explore the occupational experiences of medical students and junior doctors working during the COVID-19 pandemic. In particular, the research sought to identify factors which mediated work stress, barriers to disclosing mental health problems and levels of support medical students and junior doctors received during the pandemic. DESIGN: This study was a form of thematic analysis and adopted an inductive, 'bottom-up' approach, in which coded categories were derived from rich, descriptive data. SETTING: Semistructured interviews were conducted online with UK-based medical students and junior doctors. Interviews were recorded, and analysis was done by coding salient quotes into themes. PARTICIPANTS: The final sample consisted of seven junior doctors and eight medical students, during the summer of 2021. RESULTS: High levels of occupational stress were identified, which were exacerbated by COVID-19. A number of organisational difficulties associated with the pandemic compounded participants' experiences of work stress. Participants recognised progress towards promoting and managing mental health within the profession but may still be reluctant to access support services. Barriers to disclosure included fear of stigmatisation, concerns about adding to colleagues' workloads, lack of clarity about career implications and mistrust of occupational health services. CONCLUSIONS: While attitudes towards mental health have improved, medical students and junior doctors may avoid seeking help. Given the immense pressures faced by health services, it is imperative that extra measures are implemented to minimise work-stress, encourage help-seeking behaviours and promote supportive work cultures.

Did trade union presence and membership protect against deteriorating mental health during the Covid-19 pandemic?

BackgroundTrade union membership has massively declined in economically advanced economies. In addition, considerable variation exists between indicators of unionization, including trade union membership or presence rates. However, trade union membership and collective bargaining rates have recently risen in the UK. Yet, studies on the association between collective bargaining and workers’ mental health are sparse and non-existent in the current pandemic context. This study examines whether the impact of the COVID-19 pandemic on UK workers’ mental health is moderated by the presence of trade unions within their industrial sector.MethodsWe used UK Household Longitudinal Study (Understanding Society) data from adults in paid employment, who participated in at least: one pre-COVID-19 Wave (9 or 10/11) and one COVID-19 wave. Primary outcome was probable psychological distress, defined by ‘caseness’ (score≥4) in the General Health Questionnaire-12 (GHQ-12). In model 1, exposure was trade union presence in workplaces, interacting with a variable splitting time between the pre and pandemic periods. In model 2, industry was added to the exposure in model 1 (3-way interaction). We fitted mixed-effects logistic regression models, adjusting for age, gender, ethnicity, UK country of residence and dummy variables for Understanding Society waves.ResultsOur final sample included 69,348 observations across 9,075 individuals. Pre-pandemic, odds of GHQ-12 caseness were almost 11% (OR:1.11 95%CI:0.98,1.26) higher for workers in unionised compared to non-unionised workplaces;however post-pandemic there was no difference between the two groups. Examining changes over the pre- to pandemic period, showed that odds of GHQ-12 caseness for those in non-unionised workplaces increased by 42% (OR:1.42 95%CI:1.23,1.64), whereas for those in unionised workplaces odds increased by 28% (OR:1.28 95%CI:1.11,1.47). Overall, industrial classification did not modify the relationship between trade union presence and GHQ-12 caseness, except for workers in Manufacturing (OR:0.61 95%CI:0.40,0.95) where we found a protective effect but the opposite stands for those in Transportation and Storage (OR:1.89 95%CI:1.18,3.03). Pre-pandemic, odds of GHQ-12 caseness for education sector workers were considerably higher in unionised workplaces (OR:1.70 95%CI:1.15,2.53) but declined during the pandemic period (OR:0.62 95%CI:1.05,2.47).ConclusionTrade union presence appears to have a protective effect for worker mental health during the pandemic. However, apart from Manufacturing, Transportation and Storage and Education, there is no evidence that type of industry modifies this effect. Therefore, policies should be designed to encourage and facilitate trade union presence across industries as they are likely to mitigate adverse mental health effects in times of extreme uncertainty.

Comparing population-level mental health of UK workers before and during the COVID-19 pandemic: a longitudinal study using Understanding Society.

OBJECTIVES: The COVID-19 pandemic has substantially affected workers' mental health. We investigated changes in UK workers' mental health by industry, socioeconomic class and occupation and differential effects by UK country of residence, gender and age. METHODS: We used representative Understanding Society data from 6474 adults (41 207 observations) in paid employment who participated in pre-pandemic (2017-2020) and at least one COVID-19 survey. The outcome was General Health Questionnaire-12 (GHQ-12) caseness (score: ≥4). Exposures were industry, socioeconomic class and occupation and are examined separately. Mixed-effects logistic regression was used to estimate relative (OR) and absolute (%) increases in distress before and during pandemic. Differential effects were investigated for UK countries of residence (non-England/England), gender (male/female) and age (younger/older) using three-way interaction effects. RESULTS: GHQ-12 caseness increased in relative terms most for 'professional, scientific and technical' (OR: 3.15, 95% CI 2.17 to 4.59) industry in the pandemic versus pre-pandemic period. Absolute risk increased most in 'hospitality' (+11.4%). For socioeconomic class, 'small employers/self-employed' were most affected in relative and absolute terms (OR: 3.24, 95% CI 2.28 to 4.63; +10.3%). Across occupations, 'sales and customer service' (OR: 3.01, 95% CI 1.61 to 5.62; +10.7%) had the greatest increase. Analysis with three-way interactions showed considerable gender differences, while for UK country of residence and age results are mixed. CONCLUSIONS: GHQ-12 caseness increases during the pandemic were concentrated among 'professional and technical' and 'hospitality' industries and 'small employers/self-employed' and 'sales and customers service' workers. Female workers often exhibited greater differences in risk by industry and occupation. Policies supporting these industries and groups are needed.

The mental health of UK workers during the COVID-19 pandemic: a longitudinal analysis of differential impacts across industries and social class categories*

BackgroundThe COVID-19 pandemic has substantially affected mental health but its impacts are likely to differ across industries and social class groups. The ‘new normal’ in employment opportunities, patterns and conditions is likely to include a degree of fear, uncertainty, employment instability and job loss. It is imperative we identify and understand how workers have been disadvantaged by the pandemic and current working modes. We aimed to examine the impact of COVID-19 on the mental health of UK workers by industry and social class category and to investigate whether any observed impacts differed by age, gender, and country of residence within the UK.MethodsWe used the UK Household Longitudinal Study (Understanding Society) to analyse data from adults in paid employment, who participated in pre-COVID-19 Waves [9(2017/19) and 10/11(2018/20)] and in at least one COVID-19 wave. Our primary outcome was probable psychological distress, defined by ‘caseness’ (a score of 4+) in the General Health Questionnaire-12 (GHQ-12) and exposures included industrial sectors (classified using the UK Standard Industrial Classification) and social class (using the Eight Class National Statistics Socio-economic Classification). We fitted mixed-effects logistic regression models, adjusting for age, gender, employment type, financial situation and UK country of residence and used inverse probability weights to account for attrition and non-response, to estimate odds ratios (ORs) with 95% confidence intervals (95%CI). Subsequently, we stratified by gender, UK country of residence, and age group.ResultsOur final sample includes 44,500 observations (Pre-pandemic period=13,314, pandemic period=31,186) across 7,075 individuals. GHQ-caseness increased for workers in most industries during the pandemic;especially in ‘Accommodation and Food Services’ (OR:3.2;95%CI:1.9,5.4). Analysis by social class showed that ‘Small employers and own account’ workers were the most affected (OR:2.9;95%CI:2.1,4.0). Our stratified analysis by industry demonstrated the largest increase in GHQ-caseness between the pre and pandemic periods to be by gender in the ‘Accommodation and Food Services’ sector (OR:9.6;95%CI:3.2,29.0 for men;OR:2.0;95%CI:1.2,3.4 for women);whereas by social class the largest increase was observed when stratifying by UK country of residence for ‘Small employers and own account’ workers (non-England: OR:8.8;95%CI:4.1,18.8;England: OR:2.5;95%CI:1.6,3.9).ConclusionOur findings indicate that the pandemic has significantly affected the mental health of UK workers. Policies with a decentralised element are needed, prioritising support to certain industrial sectors and the self-employed/small business owners, as well as for particular demographic groups (e.g. men in the ‘Accommodation and Food Services’ industry) who are in an excessively high risk.

Ethnic and socioeconomic differences in SARS-CoV-2 infection: prospective cohort study using UK Biobank.

BACKGROUND: Understanding of the role of ethnicity and socioeconomic position in the risk of developing SARS-CoV-2 infection is limited. We investigated this in the UK Biobank study. METHODS: The UK Biobank study recruited 40-70-year-olds in 2006-2010 from the general population, collecting information about self-defined ethnicity and socioeconomic variables (including area-level socioeconomic deprivation and educational attainment). SARS-CoV-2 test results from Public Health England were linked to baseline UK Biobank data. Poisson regression with robust standard errors was used to assess risk ratios (RRs) between the exposures and dichotomous variables for being tested, having a positive test and testing positive in hospital. We also investigated whether ethnicity and socioeconomic position were associated with having a positive test amongst those tested. We adjusted for covariates including age, sex, social variables (including healthcare work and household size), behavioural risk factors and baseline health. RESULTS: Amongst 392,116 participants in England, 2658 had been tested for SARS-CoV-2 and 948 tested positive (726 in hospital) between 16 March and 3 May 2020. Black and south Asian groups were more likely to test positive (RR 3.35 (95% CI 2.48-4.53) and RR 2.42 (95% CI 1.75-3.36) respectively), with Pakistani ethnicity at highest risk within the south Asian group (RR 3.24 (95% CI 1.73-6.07)). These ethnic groups were more likely to be hospital cases compared to the white British. Adjustment for baseline health and behavioural risk factors led to little change, with only modest attenuation when accounting for socioeconomic variables. Socioeconomic deprivation and having no qualifications were consistently associated with a higher risk of confirmed infection (RR 2.19 for most deprived quartile vs least (95% CI 1.80-2.66) and RR 2.00 for no qualifications vs degree (95% CI 1.66-2.42)). CONCLUSIONS: Some minority ethnic groups have a higher risk of confirmed SARS-CoV-2 infection in the UK Biobank study, which was not accounted for by differences in socioeconomic conditions, baseline self-reported health or behavioural risk factors. An urgent response to addressing these elevated risks is required.

Remote history of VTE is associated with severe COVID-19 in middle and older age: UK Biobank cohort study.

BACKGROUND: Venous thromboembolism (VTE) is a common, life-threatening complication of COVID-19 infection. COVID-19 risk-prediction models include a history of VTE. However, it is unclear whether remote history (>9 years previously) of VTE also confers increased risk of COVID-19. OBJECTIVES: To investigate possible association between VTE and COVID-19 severity, independent of other risk factors. METHODS: Cohort study of UK Biobank participants recruited between 2006 and 2010. Baseline data, including history of VTE, were linked to COVID-19 test results, COVID-19-related hospital admissions, and COVID-19 deaths. The risk of COVID-19 hospitalization or death was compared for participants with a remote history VTE versus without. Poisson regression models were run univariately then adjusted stepwise for sociodemographic, lifestyle, and comorbid covariates. RESULTS: After adjustment for sociodemographic and lifestyle confounders and comorbid conditions, remote history of VTE was associated with nonfatal community (RR 1.61, 95% CI 1.02-2.54, p = .039), nonfatal hospitalized (RR 1.52, 95% CI 1.06-2.17, p = .024) and severe (hospitalized or fatal) (RR 1.40, 95% CI 1.04-1.89, p = .025) COVID-19. Associations with remote history of VTE were stronger among men (severe COVID-19: RR 1.68, 95% CI 1.14-2.42, p = .009) than for women (severe COVID-19: RR 1.07, 95% CI 0.66-1.74, p = .786). CONCLUSION: Our findings support inclusion of remote history of VTE in COVID-19 risk-prediction scores, and consideration of sex-specific risk scores.

Occupation and risk of severe COVID-19: prospective cohort study of 120 075 UK Biobank participants.

OBJECTIVES: To investigate severe COVID-19 risk by occupational group. METHODS: Baseline UK Biobank data (2006-10) for England were linked to SARS-CoV-2 test results from Public Health England (16 March to 26 July 2020). Included participants were employed or self-employed at baseline, alive and aged <65 years in 2020. Poisson regression models were adjusted sequentially for baseline demographic, socioeconomic, work-related, health, and lifestyle-related risk factors to assess risk ratios (RRs) for testing positive in hospital or death due to COVID-19 by three occupational classification schemes (including Standard Occupation Classification (SOC) 2000). RESULTS: Of 120 075 participants, 271 had severe COVID-19. Relative to non-essential workers, healthcare workers (RR 7.43, 95% CI 5.52 to 10.00), social and education workers (RR 1.84, 95% CI 1.21 to 2.82) and other essential workers (RR 1.60, 95% CI 1.05 to 2.45) had a higher risk of severe COVID-19. Using more detailed groupings, medical support staff (RR 8.70, 95% CI 4.87 to 15.55), social care (RR 2.46, 95% CI 1.47 to 4.14) and transport workers (RR 2.20, 95% CI 1.21 to 4.00) had the highest risk within the broader groups. Compared with white non-essential workers, non-white non-essential workers had a higher risk (RR 3.27, 95% CI 1.90 to 5.62) and non-white essential workers had the highest risk (RR 8.34, 95% CI 5.17 to 13.47). Using SOC 2000 major groups, associate professional and technical occupations, personal service occupations and plant and machine operatives had a higher risk, compared with managers and senior officials. CONCLUSIONS: Essential workers have a higher risk of severe COVID-19. These findings underscore the need for national and organisational policies and practices that protect and support workers with an elevated risk of severe COVID-19.

Mental health and health behaviours before and during the initial phase of the COVID-19 lockdown: longitudinal analyses of the UK Household Longitudinal Study.

BACKGROUND: There are concerns that COVID-19 mitigation measures, including the 'lockdown', may have unintended health consequences. We examined trends in mental health and health behaviours in the UK before and during the initial phase of the COVID-19 lockdown and differences across population subgroups. METHODS: Repeated cross-sectional and longitudinal analysis of the UK Household Longitudinal Study, including representative samples of over 27,000 adults (aged 18+) interviewed in four survey waves between 2015 and 2020. A total of 9748 adults had complete data for longitudinal analyses. Outcomes included psychological distress (General Health Questionnaire-12), loneliness, current cigarette smoking, use of e-cigarettes and alcohol consumption. Cross-sectional prevalence estimates were calculated and multilevel Poisson regression assessed associations between time period and the outcomes of interest, as well as differential associations by age, gender, education level and ethnicity. RESULTS: Psychological distress increased 1 month into lockdown with the prevalence rising from 19.4% (95% CI 18.7% to 20.1%) in 2017-2019 to 30.6% (95% CI 29.1% to 32.3%) in April 2020 (RR=1.3, 95% CI 1.2 to 1.4). Groups most adversely affected included women, young adults, people from an Asian background and those who were degree educated. Loneliness remained stable overall (RR=0.9, 95% CI 0.6 to 1.5). Smoking declined (RR=0.9, 95% CI=0.8,1.0) and the proportion of people drinking four or more times per week increased (RR=1.4, 95% CI 1.3 to 1.5), as did binge drinking (RR=1.5, 95% CI 1.3 to 1.7). CONCLUSIONS: Psychological distress increased 1 month into lockdown, particularly among women and young adults. Smoking declined, but adverse alcohol use generally increased. Effective measures are required to mitigate negative impacts on health.