Implementation and sustainability of public health approaches for mental health and wellbeing in schools

Aims: With increasing prevalence of emotional difficulties in children and young people in England, there is a growing emphasis on prevention programs delivered in school settings. The Education for Wellbeing program is working with around 400 schools in England to evaluate five universal mental health and wellbeing interventions Here, we present an overview of the Education for Wellbeing program and describe patterns across different school settings in barriers and facilitators to sustaining intervention delivery Methods: This study draws on interviews with staff and pupils from eight schools over multiple timepoints, including during the COVID- 19 pandemic. Qualitative methods were used to cluster schools with similar 'journeys' over a three-year period in terms of staff members' experiences of intervention delivery and perceived barriers and facilitators to sustaining delivery Results: The analysis demonstrated patterns in schools' journeys over time, each underpinned by a range of barriers and facilitators to the sustainability of the interventions. Four clusters of schools were identified each representing one overarching pattern: 'Spreading and embedding', 'Trialled and moved on', 'Everything's changed', and 'Built into the curriculum for now' Conclusion(s): The variety in schools' experiences highlights the complexity of both school settings and the process of implementing and sustaining interventions. These findings suggest that the environment and conditions into which a public health intervention is placed may be as, if not more, important than the intervention itself, and provoke important questions regarding future research and intervention development.

Association between psychological distress trajectories from adolescence to midlife and mental health during the pandemic: evidence from two British birth cohorts.

BACKGROUND: This paper examined whether distinct life-course trajectories of psychological distress from adolescence to midlife were associated with poorer mental health outcomes during the pandemic. METHODS: We present a secondary analysis of two nationally representative British birth cohorts, the 1958 National Child Development Study (NCDS) and 1970 British Cohort Study (BCS70). We used latent variable mixture models to identify pre-pandemic longitudinal trajectories of psychological distress and a modified Poisson model with robust standard errors to estimate associations with psychological distress, life satisfaction and loneliness at different points during the pandemic. RESULTS: Our analysis identified five distinct pre-pandemic trajectories of psychological distress in both cohorts. All trajectories with prior symptoms of psychological distress irrespective of age of onset, severity and chronicity were associated with a greater relative risk of poorer mental health outcomes during the pandemic and the probability of poorer mental health associated with psychological distress trajectories remained fairly constant. The relationship was not fully attenuated when most recent pre-pandemic psychological distress and other midlife factors were controlled for. CONCLUSIONS: Whilst life-course trajectories with any prior symptoms of psychological distress put individuals at greater risk of poor mental health outcomes during the pandemic, those with chronic and more recent occurrences were at highest risk. In addition, prior poor mental health during the adult life-course may mean individuals are less resilient to shocks, such as pandemics. Our findings show the importance of considering heterogeneous mental health trajectories across the life-course in the general population in addition to population average trends.

Researching adolescent mental health during a pandemic: A registered report of a natural experiment within two pragmatic school-based trials

Aims: Research on the impact of the pandemic on adolescent mental health is limited by several methodological factors, such as the lack of pre-pandemic scores for comparison, control for developmental change, and wider geographic and social representation. Empirical evidence which can potentially causally attribute changes to the pandemic remains therefore limited. The presentation will focus on how a natural experiment within two ongoing school-based cluster randomised pragmatic trials was used to overcome such challenges to investigate whether and to which degree differences in adolescents' mental health could be attributable to the pandemic. Method(s): The multi-partner structure of the trials separated relevant aspects of the data collection from the research team, therefore the analyses could be prospectively registered. The necessity of two recruitment cohorts led to one cohort of schools being assessed in Sept-Oct 2018 (baseline) and Jan-Mar 2020 (1-year follow-up);and the other cohort in Sept-Oct 2019 and Feb-Apr 2021, respectively. Participants in the first cohort (90 schools, N = 6419) acted as unexposed controls, and participants in the second cohort (88 schools, N = 5031) were exposed to the COVID-19 pandemic between assessments. The outcomes were depressive symptoms (Short Mood and Feelings Questionnaire, primary outcome), externalising difficulties (Me and My Feelings questionnaire), and life satisfaction (Huebner Life Satisfaction Scale). Analyses were conducted with random intercept regression models with exposure to the COVID-19 pandemic as focal predictor while controlling for baseline scores and individual-and school-level covariates. Result(s): The primary outcome analysis showed higher levels of depressive symptoms (adjusted d = 0.11). For the secondary outcomes, life satisfaction scores were lower (adjusted d = 0.12), and no differences were detected for externalising difficulties (adjusted d = 0.01). The analyses further indicated potential differential effects based on socio-economic background and gender. The results were robust in sensitivity analyses exploring the impact of missing data, drop-out, and comparability of participants in both cohorts. Conclusion(s): A multi-site and interdisciplinary approach to trial planning laid the foundation for a responsive research structure that in addition to work on high-quality evidence for school-based universal interventions provided evidence that the COVID-19 pandemic increased adolescent depressive symptoms and potentially decreased life satisfaction.

Inequalities in psychological distress before and during the COVID-19 pandemic among UK adults : Kishan Patel

Background Evidence about how population mental health has evolved from before and over the COVID-19 pandemic remains mixed, with impacts on mental health inequalities being unclear. We investigated changes in mental health and sociodemographic inequalities from before and across the first year of the pandemic. Methods Data from 11 UK longitudinal population-based studies with pre-pandemic measures of psychological distress were analysed, estimates pooled, and stratified by age, sex, ethnicity, country and lone household status. Trends in the prevalence of poor mental health were assessed before the pandemic (TP0) and across the pandemic at three time periods (initial lockdown (TP1), easing of restrictions (TP2), and a subsequent lockdown (TP3)). Results In total, 49,993 adult participants were analysed across the 11 cohort studies. There was an overall worsening in mental health from pre-pandemic scores across all three pandemic timepoints, (TP1 Standardised Mean Difference: 0.15 (95% CI: 0.06 - 0.25);TP2 SMD: 0.18 (0.09 - 0.27);TP3 SMD: 0.21 (0.10 - 0.32)) with no evidence of improvement during the period of eased lockdown restrictions in summer 2020. Changes from pre-pandemic psychological distress were higher in females during the pandemic (TP3 SMD: 0.23 (0.11 - 0.35)), amongst those with degree-level education (TP3 SMD: 0.26 (0.14 - 0.38)), and adults aged 25-44 years. We did not find evidence of changes in distress differing by ethnicity, lone household status or UK nation. Conclusions 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. Mental health declines have been unequal across the population and these results have implications for policy, including the need for specific investment for support for those most affected to mitigate the effects of the pandemic and measures to reduce inequalities within these specific groups. Key messages • A sustained deterioration in mental health was observed from before the start of the COVID-19 pandemic, and did not recover when social restrictions were eased. • Deterioration in mental health varied by sociodemographic factors, namely age, sex, and education, and highlights a need for improved mental health care provision to minimise widening inequalities.

Mental health inequalities in disruptions across multiple domains during COVID -19: an investigation in 12 population-based longitudinal studies

Disruptions related to the COVID-19 pandemic and its associated virus suppression measures have affected many worldwide but those already suffering from psychological distress may have been especially vulnerable. We investigated associations between pre-pandemic psychological distress and disruptions to healthcare, economic activity, housing, and cumulative disruptions. Data were from 59,482 participants in 12 UK longitudinal adult population surveys with both pre-pandemic and COVID-19 surveys. Participants self-reported disruptions since the start of the pandemic to: healthcare (medication access, procedures, or appointments);economic activity (negative changes in employment, income or working hours);and housing (change of address or household composition). Logistic regression models were used to estimate associations between pre-pandemic standardised psychological distress scores and disruption outcomes. Findings were synthesised using a random effects meta-analysis with restricted maximum likelihood. Approximately one to two thirds of study participants experienced some form of disruption during the pandemic. One standard deviation higher pre-pandemic psychological distress was associated with: increased odds of any healthcare disruption (odds ratio: 1.30 [95% CI: 1.20-1.40];I2: 65%);increased odds of experiencing any economic disruption (1.11 [1.03-1.16];I2: 61%);no associations with housing disruptions;and increased likelihood of experiencing a disruption in at least two domains (1.25 [1.18-1.32];I2: 38%) or one domain (1.11 [1.07-1.16];I2: 32%) compared to no disruptions. Associations did not differ by sex, ethnicity, education, or age. Individuals suffering from psychological distress pre-pandemic may need additional support to manage stressful life disruptions. Considering mental ill-health was already unequally distributed in the UK population, this may exacerbate existing inequalities related to sex, ethnicity, education and age.