ABSTRACT
Abstract Importance: Predictive models can help identify SARS-CoV-2 patients at greatest risk of post-COVID sequelae and direct them towards appropriate care. Objective: To develop and internally validate a model to predict children and young people most likely to experience at least one impairing physical symptom 3 months after a SARS-CoV-2 PCR-test and to determine whether the impact of these predictors differed by SARS-CoV-2 infection status. Design: Potential pre-specified predictors included: SARS-CoV-2 status, sex, age, ethnicity, deprivation, quality of life/functioning (5 EQ-5D-Y items), physical and mental health, and loneliness (all prior to SARS-CoV-2 testing), and number of physical symptoms at testing. Logistic regression was used to develop the model. Model performance was assessed using calibration and discrimination measures; internal validation was performed via bootstrapping; the final model was adjusted for overfitting. Setting: National cohort study of SARS-CoV-2 PCR-positive and PCR-negative participants matched according to age, sex, and geographical area. Participants: Children and young people aged 11-17 years who were tested for SARS-CoV-2 infection in England, January to March 2021. Main outcome measure: one or more physical symptom 3 months after initial PCR-testing which affected physical, mental or social well-being and interfered with daily living. Results: A total of 50,836 children and young people were approached; 7,096 (3,227 test-positives, 3,869 test-negatives) who completed a questionnaire 3 months after their PCR-test were included. 39.6% (1,279/3,227) of SAR-CoV-2 PCR-positives and 30.6% (1,184/3,869) of SAR-CoV-2 PCR-negatives had at least one impairing physical symptom 3 months post-test. The final model contained predictors: SARS-COV-2 status, number of symptoms at testing, sex, age, ethnicity, self-rated physical and mental health, feelings of loneliness and four EQ-5D-Y items before testing. Internal validation showed minimal overfitting with excellent calibration and discrimination measures (optimism adjusted calibration slope:0.97527; C-statistic:0.83640). Conclusions and relevance: We developed a risk prediction equation to identify those most at risk of experiencing at least one impairing physical symptom 3 months after a SARS-CoV-2 PCR-test which could serve as a useful triage and management tool for children and young people during the ongoing pandemic. External validation is required before large-scale implementation.
Subject(s)
COVID-19ABSTRACT
Background Social isolation is strongly associated with poor mental health. The COVID-19 pandemic and ensuing social restrictions disrupted young people’s social interactions and resulted in several periods during which school closures necessitated online learning. We hypothesise that digitally excluded young people would demonstrate greater deterioration in their mental health than their digitally connected peers during this time. Methods We analysed representative mental health data from a sample of UK 10–15-year-olds ( N = 1387); Understanding Society collected the Strengths and Difficulties Questionnaire in 2017-19 and thrice during the pandemic (July 2020, November 2020 and March 2021). We employed cross-sectional methods and longitudinal latent growth curve modelling to describe trajectories of adolescent mental health for participants with and without access to a computer or a good internet connection for schoolwork. Outcomes Adolescent mental health had a quadratic trajectory during the COVID-19 pandemic, with the highest mean Total Difficulties score around December 2020. The worsening and recovery of mental health during the pandemic was greatly pronounced among those without access to a computer, although we did not find evidence for a similar effect among those without a good internet connection. Interpretation Digital exclusion, as indicated by lack of access to a computer, is a tractable risk factor that likely compounds other adversities facing children and young people during periods of social isolation. Funding British Psychological Society; School of the Biological Sciences, University of Cambridge; NIHR Applied Research Centre; Medical Research Council; Economic and Social Research Council; and Emmanuel College, University of Cambridge.
Subject(s)
COVID-19 , Intellectual DisabilityABSTRACT
Background: The UK population’s mental health declined at the pandemic onset. Convenience sample surveys indicate recovery began soon after. Using a probability sample, we tracked average mental health during the pandemic, characterised distinct mental health trajectories and identified predictors of deterioration.Methods: Secondary analysis of five waves of UK Household Longitudinal Survey from late April-early October 2020 and pre-pandemic data, 2018-2019. Mental health was assessed in 19,763 adults (≥16 years) using 12-item General Health Questionnaire. Latent class growth models identified discrete mental health trajectories and fixed-effects regression identified predictors of change in mental health.Findings: Average population mental health deteriorated with onset of the pandemic and did not begin improving until July 2020. Latent class analysis identified six distinct mental health trajectories up to October 2020. Three-quarters had consistently good (46·2%) or very good (30·9%) mental health. Two ‘recovery’ groups (15·8%) initially experienced marked declines in mental health, improving to their pre-pandemic levels by October. For 4·8%, mental health steadily deteriorated and for 2·3% it was very poor throughout. These two groups were more likely to have pre-existing mental or physical ill-health, live in deprived neighbourhoods and be non-white. Infection with COVID-19, local lockdown and financial difficulties all predicted subsequent mental health deterioration.Interpretation: Between April-October 2020, the mental health of most UK adults remained resilient or returned to pre-pandemic levels. One-in-fourteen experienced deteriorating or consistently poor mental health. People living in areas affected by lockdown, struggling financially, with pre-existing conditions or COVID infection might benefit most from early intervention.Funding Statement: None.Declaration of Interests: None.Ethics Approval Statement: Ethics approval was granted by the University of Essex Ethics Committee for the COVID-19 web and telephone surveys (ETH1920-1271).
Subject(s)
COVID-19 , Intellectual DisabilityABSTRACT
Background: There is growing global concern about the potential impact of the Covid-19 pandemic on population mental health. We examine changes in adult mental health in the UK population before and during the lockdown. Methods: Secondary analysis of the UK Household Longitudinal Study Waves 6 (2014/15) to 9 (2018/19), matched to the Covid-19 web-survey completed by 17,452 panel members 23-29 April 2020. Mental health was assessed using the 12-item General Health Questionnaire (GHQ). Repeated cross-sectional analyses were conducted to examine annual temporal trends. Fixed effects regression models were fitted to identify within-person change compared to preceding trends. Findings: Mean population GHQ-12 score increased from 11·5 (95% confidence interval: 11·3–11·6) in 2018/19 to 12·6 (12·5–12·8) in April 2020, one month into lockdown. This was 0·48 (0·07-0·90) points higher than expected when accounting for prior upward trends between 2013 and 2019. Comparing scores within-individuals, adjusting for time-trends and predictors, increases were greatest in 18-24-year-olds (2·7, 1·89-3·48), 25-34-year-olds (1·6, 0·96-2·18), women (0·9, 0·50-1·35), and people living with young children (1·45, 0·79-2·12). People employed before the pandemic averaged a notable increase (0·6; 0·20-1·06). Interpretation: In late April 2020, mental health in the UK deteriorated compared to trends pre-Covid, particularly in young people, women and those living with young children. Those in employment before the pandemic also experienced greater deterioration one month into lockdown, perhaps due to actual or anticipated redundancy. While deterioration occurred across income groups, we anticipate inequalities may widen over time, as in other causes of recessions.Funding Statement: This study was unfunded.Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The data used are publicly available via UK Data Service repository (study numbers 6614 and 8644), and do not require ethical assessment for academic research purposes.