Depression, anxiety and PTSD symptoms before and during the COVID-19 pandemic in the UK.

BACKGROUND: The impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health is still being unravelled. It is important to identify which individuals are at greatest risk of worsening symptoms. This study aimed to examine changes in depression, anxiety and post-traumatic stress disorder (PTSD) symptoms using prospective and retrospective symptom change assessments, and to find and examine the effect of key risk factors. METHOD: Online questionnaires were administered to 34 465 individuals (aged 16 years or above) in April/May 2020 in the UK, recruited from existing cohorts or via social media. Around one-third (n = 12 718) of included participants had prior diagnoses of depression or anxiety and had completed pre-pandemic mental health assessments (between September 2018 and February 2020), allowing prospective investigation of symptom change. RESULTS: Prospective symptom analyses showed small decreases in depression (PHQ-9: -0.43 points) and anxiety [generalised anxiety disorder scale - 7 items (GAD)-7: -0.33 points] and increases in PTSD (PCL-6: 0.22 points). Conversely, retrospective symptom analyses demonstrated significant large increases (PHQ-9: 2.40; GAD-7 = 1.97), with 55% reported worsening mental health since the beginning of the pandemic on a global change rating. Across both prospective and retrospective measures of symptom change, worsening depression, anxiety and PTSD symptoms were associated with prior mental health diagnoses, female gender, young age and unemployed/student status. CONCLUSIONS: We highlight the effect of prior mental health diagnoses on worsening mental health during the pandemic and confirm previously reported sociodemographic risk factors. Discrepancies between prospective and retrospective measures of changes in mental health may be related to recall bias-related underestimation of prior symptom severity.

Digital Cognitive Behavioural Therapy for Insomnia (dCBT-I) and emotion regulation as early intervention for employees in the workplace

Insomnia is a serious public health concern and has been linked to impaired work productivity. Studies show a link between poor sleep and aspects of occupational functioning such as absenteeism, reduced productivity and low work satisfaction. One in every three workers in the UK are affected by sleep problems costing the economy around £36 billion/year due to loss of productivity in the workplace. This results in around 200,000 working days lost every year, and it is estimated that the cost to industry will rise steadily to £44 billion by 2030 if nothing is done about it. Few studies have evaluated the effectiveness of CBT-I in workplaces, and have found improvements in severity of insomnia and quality of sleep, and slight improvements in productivity and presenteeism, but not in absenteeism. While most interventions for insomnia are focused on the treatment of those above clinical thresholds, there is crucial need for early intervention/prevention of insomnia. This has been further exacerbated during the Covid-19 pandemic due to isolation, financial insecurities, loss of loved ones and fear of infection, causing extensive sleep problems as well as stress, anxiety and depressive symptoms. This study will examine the efficacy of a new hybrid dCBT-I for mild to severe insomnia and symptoms of depression and anxiety delivered to employees in the workplace. This trial tests the efficacy of implementing a hybrid dCBT-I + emotion regulation (ER) in the workplace in a mixed methods evaluation with a two-arm randomised waitlist control (WLC) design. The dCBT-I+ER intervention is 8-weeks long and delivered via self-guided online platform and four videoconferencing therapy sessions. Primary outcomes are the Insomnia Severity Index, the Patient Health Questionnaire and the Generalised Anxiety Disorder. Secondary outcomes are job productivity, job satisfaction, well-being, quality of life, self-reported (sleep diary data) and objective (actigraphy) sleep parameters. We recruited 163 workers with sleep and emotion regulation problems ranging from subclinical to clinical levels not engaged in treatment at the time of the trial. Due to the study design, analyses for the primary hypotheses will be done when the last enrolled participant provides post-intervention follow-up (1-month) outcome measures. We hypothesise that participants randomly allocated to dCBT-I+ER will demonstrate significantly greater improvements on the primary outcomes compared to WLCs post-intervention. They will also demonstrate significantly greater improvements on objective (actigraphy) and self-reported (sleep diary) sleep parameters. Exploratory analyses will also indicate the impact of the dCBT-I+ER on work productivity, job satisfaction, wellbeing, and quality of life. Evaluation of an early intervention for workers with mild to severe symptoms of insomnia and emotion regulation difficulties will contribute to the understanding of benefits of early interventions in the workplace, and its impact on mental health and productivity. The mixed methods evaluation will provide insight into the application of intervention and help us understand people’s experiences of the intervention and what helped or hindered its use. This pilot study forms the basis of what could become a larger nationwide service delivery programme of mental health interventions for insomnia in the workplace.