ABSTRACT
Disruptions to economic activity such as job loss can impact substance use behaviours. During the COVID-19 pandemic many countries implemented a furlough scheme to prevent job loss. We examine how furlough was associated with respondents' substance use behaviours in the initial stages of the pandemic in the UK. Data were from over 27,000 participants in eight adult longitudinal surveys. Participants self-reported economic activity (furlough or job loss vs stable employment) and smoking (any current), vaping (any current) and drinking alcohol (>4 days/week or 5+ drinks per typical occasion) both before and during the initial stages of the pandemic. Changes in frequency/quantity of substance use were also examined. Risk ratios were estimated within each study using modified Poisson regression, adjusting for a range of potential confounders, including pre-pandemic behaviour (though this was excluded in analyses of behaviour change). Findings were synthesised using a random effects meta-analysis. Compared to stable employment, participation in the furlough scheme was associated with smoking (risk ratio: 1.24 [95% CI: 1.08-1.42];I2=0%) while job loss was associated with vaping (1.72 [1.10-2.71];I2=25%) and heavier drinking (1.21 [1.02-1.43];I2=2%), but these associations were largely accounted for by confounders (adjusted risk ratios: smoking: 1.06 [0.96-1.16];I2=8%;vaping: 1.55 [0.93-2.56];I2=42%;and drinking: 1.03 [0.89-1.20];I2=35%). Furlough was associated with drinking more than before the pandemic (adjusted risk ratio: 1.15 [1.00-1.33];I2=70%), and with increases in vaping behaviour (1.54 [1.14-2.07];I2=0%). Increased drinking associated with furlough is concerning, while increased vaping likely represents moves to reduce smoking and may be positive.
ABSTRACT
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.