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1.
J Child Psychol Psychiatry ; 2022 Feb 23.
Article in English | MEDLINE | ID: covidwho-1704827

ABSTRACT

BACKGROUND: Adolescence is a critical period for social and emotional development. We sought to examine the impacts of Covid-19 and related social restrictions and school closures on adolescent mental health, particularly among disadvantaged, marginalised, and vulnerable groups. METHODS: We analysed four waves of data - 3 pre-Covid-19 (2016-2019) and 1 mid-Covid-19 (May-Aug 2020; n, 1074; 12-18 years old, >80% minority ethnic groups, 25% free school meals) from REACH (Resilience, Ethnicity, and AdolesCent Mental Health), an adolescent cohort based in inner-London, United Kingdom. Mental health was assessed using validated measures at each time point. We estimated temporal trends in mental distress and examined variations in changes in distress, pre- to mid-Covid-19, by social group, and by pre- and mid-pandemic risks. RESULTS: We found no evidence of an overall increase in mental distress midpandemic (15.9%, 95% CI: 13.0, 19.4) compared with prepandemic (around 18%). However, there were variations in changes in mental distress by subgroups. There were modest variations by social group and by pre-Covid risks (e.g., a small increase in distress among girls (b [unstandardised beta coefficient] 0.42 [-0.19, 1.03]); a small decrease among boys (b - 0.59 [-1.37, 0.19]); p for interaction .007). The most notable variations were by midpandemic risks: that is, broadly, increases in distress among those reporting negative circumstances and impacts (e.g., in finances, housing, social support and relationships, and daily routines) and decreases in distress among those reporting positive impacts. CONCLUSIONS: We found strong evidence that mental distress increased among young people who were most negatively impacted by Covid-19 and by related social restrictions during the first lockdown in the United Kingdom.

2.
EuropePMC;
Preprint in English | EuropePMC | ID: ppcovidwho-327517

ABSTRACT

Background Research suggests that there have been inequalities in the impact of the COVID-19 pandemic and related non-pharmaceutical interventions on population mental health. We explored these inequalities during the first year of the pandemic using nationally representative cohorts from the UK. Methods We analysed data from 26,772 participants from five longitudinal cohorts representing generations born between 1946 and 2000, collected in May 2020, September-October 2020, and February-March 2021 across all five cohorts. We used a multilevel growth curve modelling approach to explore sociodemographic and socioeconomic differences in levels of anxiety and depressive symptomatology, loneliness, and life satisfaction over time. Results Younger generations had worse levels of mental and social wellbeing throughout the first year of the pandemic. Whereas these generational inequalities narrowed between the first and last observation periods for life satisfaction (−0.33 [95% CI: −0.51, −0.15]), they became larger for anxiety (0.22 [0.10, 0.33]). Pre-existing generational inequalities in depression and loneliness did not change, but initial depression levels of the youngest cohort were worse than expected if the generational inequalities had not accelerated. Women and those experiencing financial difficulties had worse initial mental and social wellbeing levels than men and those financially living comfortably, respectively, and these gaps did not substantially differ between the first and last observation periods. Inequalities by additional factors are reported. Conclusions By March 2021, mental and social wellbeing inequalities persisted in the UK adult population. Pre-existing generational inequalities may have been exacerbated with the pandemic onset. Policies aimed at protecting vulnerable groups are needed.

3.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-319097

ABSTRACT

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).

4.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-293948

ABSTRACT

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. <br><br>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. <br><br>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). <br><br>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.<br><br>Funding Statement: This study was unfunded.<br><br>Declaration of Interests: The authors declare no competing interests. <br><br>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.

5.
Occup Environ Med ; 78(11): 801-808, 2021 11.
Article in English | MEDLINE | ID: covidwho-1286749

ABSTRACT

OBJECTIVES: This study reports preliminary findings on the prevalence of, and factors associated with, mental health and well-being outcomes of healthcare workers during the early months (April-June) of the COVID-19 pandemic in the UK. METHODS: Preliminary cross-sectional data were analysed from a cohort study (n=4378). Clinical and non-clinical staff of three London-based NHS Trusts, including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire. Secondary outcomes are probable anxiety (seven-item Generalised Anxiety Disorder), depression (nine-item Patient Health Questionnaire), post-traumatic stress disorder (PTSD) (six-item Post-Traumatic Stress Disorder checklist), suicidal ideation (Clinical Interview Schedule) and alcohol use (Alcohol Use Disorder Identification Test). Moral injury is measured using the Moray Injury Event Scale. RESULTS: Analyses showed substantial levels of probable CMDs (58.9%, 95% CI 58.1 to 60.8) and of PTSD (30.2%, 95% CI 28.1 to 32.5) with lower levels of depression (27.3%, 95% CI 25.3 to 29.4), anxiety (23.2%, 95% CI 21.3 to 25.3) and alcohol misuse (10.5%, 95% CI 9.2 to 11.9). Women, younger staff and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one's moral code) was strongly associated with increased levels of probable CMDs, anxiety, depression, PTSD symptoms and alcohol misuse. CONCLUSIONS: Our findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic.


Subject(s)
COVID-19/psychology , Health Personnel/psychology , Pandemics , Adult , Anxiety/epidemiology , Anxiety/etiology , COVID-19/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Depression/etiology , Female , Health Personnel/statistics & numerical data , Humans , Male , Middle Aged , Occupational Diseases/epidemiology , Occupational Diseases/etiology , Occupational Diseases/psychology , Pandemics/statistics & numerical data , Prevalence , Psychology , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Suicidal Ideation , Surveys and Questionnaires , United Kingdom/epidemiology
6.
Ethn Health ; : 1-20, 2021 Jun 06.
Article in English | MEDLINE | ID: covidwho-1258690

ABSTRACT

OBJECTIVE: COVID-19-related inequities experienced by racial and ethnic minority groups including healthcare professionals mirror wider health inequities, which risk being perpetuated by lower uptake of vaccination. We aim to better understand lower uptake among racial and ethnic minority staff groups to inform initiatives to enhance uptake. DESIGN: Twenty-five semi-structured interviews were conducted (October 2020-January 2021) with UK-based healthcare staff. Data were inductively and thematically analysed. RESULTS: Vaccine decision-making processes were underpinned by an overarching theme, 'weighing up risks of harm against potential benefits to self and others'. Sub-themes included 'fear of harm', 'moral/ethical objections', 'potential benefits to self and others', 'information and misinformation', and 'institutional or workplace pressure'. We identified ways in which these were weighted more heavily towards vaccine hesitancy for racial and ethnic minority staff groups influenced by perceptions about institutional and structural discrimination. This included suspicions and fear around institutional pressure to be vaccinated, racial injustices in vaccine development and testing, religious or ethical concerns, and legitimacy and accessibility of vaccine messaging and communication. CONCLUSIONS: Drawing on a critical race perspective, we conclude that acknowledging historical and contemporary abuses of power is essential to avoid perpetuating and aggravating mistrust by de-contextualising hesitancy from the social processes affecting hesitancy, undermining efforts to increase vaccine uptake.

7.
Clin Transl Immunology ; 10(6): e1292, 2021.
Article in English | MEDLINE | ID: covidwho-1258049

ABSTRACT

OBJECTIVES: It remains unknown how inflammatory marker levels differ amongst individuals susceptible to coronavirus disease 2019 (COVID-19), prior to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the onset of the cytokine storm. We used genetic risk scores to model how susceptibility to severe COVID-19 correlates with baseline levels of 35 inflammatory markers, by testing their impact in a SARS-CoV-2-negative population cohort. Because of the established effects of age and body mass index on severe COVID-19 risk, we further considered how these variables interacted with genetic risk to affect inflammatory marker levels. METHODS: We accessed data on 406 SARS-CoV-2-negative individuals as part of a UK population study. Multiplex electrochemiluminescence methods were applied to blood serum, and 35 inflammatory markers were assayed. Corresponding genotype data, alongside results from a large genome-wide association study of severe COVID-19, allowed us to construct genetic risk scores and to test their impact on inflammatory protein levels. RESULTS: Our results revealed that a higher genetic risk for severe COVID-19 was associated with lower blood levels of interferon gamma (IFN-γ), vascular endothelial growth factor D (VEGF-D) and tumor necrosis factor alpha (TNF-α). Inflammatory profiles of those with high genetic risk increasingly diverge from the norm in association with age and obesity. CONCLUSION: Our results support the theory that individuals at risk of severe COVID-19 have a deficient innate immunity marked by reduced levels of inflammatory markers at baseline, including IFN-γ, VEGF-D and TNF-α. We hypothesise that a secondary overactive adaptive immune response may subsequently explain the high levels of cytokines observed in SARS-CoV-2-positive COVID-19 patients.

8.
Lancet Psychiatry ; 8(7): 610-619, 2021 07.
Article in English | MEDLINE | ID: covidwho-1219821

ABSTRACT

BACKGROUND: The mental health of the UK population declined at the onset of the COVID-19 pandemic. Convenience sample surveys indicate that recovery began soon after. Using a probability sample, we tracked mental health during the pandemic to characterise mental health trajectories and identify predictors of deterioration. METHODS: This study was a secondary analysis of five waves of the UK Household Longitudinal Study (a large, national, probability-based survey that has been collecting data continuously since January, 2009) from late April to early October, 2020 and pre-pandemic data taken from 2018-19. Mental health was assessed using the 12-item General Health Questionnaire (GHQ-12). We used latent class mixed models to identify discrete mental health trajectories and fixed-effects regression to identify predictors of change in mental health. FINDINGS: Mental health was assessed in 19 763 adults (≥16 years; 11 477 [58·1%] women and 8287 [41·9%] men; 3453 [17·5%] participants from minority ethnic groups). Mean population mental health deteriorated with the onset of the pandemic and did not begin improving until July, 2020. Latent class analysis identified five distinct mental health trajectories up to October 2020. Most individuals in the population had either consistently good (7437 [39·3%] participants) or consistently very good (7623 [37·5%] participants) mental health across the first 6 months of the pandemic. A recovering group (1727 [12·0%] participants) showed worsened mental health during the initial shock of the pandemic and then returned to around pre-pandemic levels of mental health by October, 2020. The two remaining groups were characterised by poor mental health throughout the observation period; for one group, (523 [4·1%] participants) there was an initial worsening in mental health that was sustained with highly elevated scores. The other group (1011 [7·0%] participants) had little initial acute deterioration in their mental health, but reported a steady and sustained decline in mental health over time. These last two groups were more likely to have pre-existing mental or physical ill-health, to live in deprived neighbourhoods, and be of Asian, Black or mixed ethnicity. Infection with SARS-CoV-2, local lockdown, and financial difficulties all predicted a subsequent deterioration in mental health. INTERPRETATION: Between April and October 2020, the mental health of most UK adults remained resilient or returned to pre-pandemic levels. Around one in nine individuals had deteriorating or consistently poor mental health. People living in areas affected by lockdown, struggling financially, with pre-existing conditions, or infection with SARS-CoV-2 might benefit most from early intervention. FUNDING: None.


Subject(s)
COVID-19/complications , Mental Disorders/epidemiology , Mental Health/statistics & numerical data , Models, Statistical , Adolescent , Adult , Female , Humans , Longitudinal Studies , Male , Middle Aged , Surveys and Questionnaires , United Kingdom/epidemiology , Young Adult
9.
Lancet Psychiatry ; 7(10): 883-892, 2020 10.
Article in English | MEDLINE | ID: covidwho-665107

ABSTRACT

BACKGROUND: The potential impact of the COVID-19 pandemic on population mental health is of increasing global concern. We examine changes in adult mental health in the UK population before and during the lockdown. METHODS: In this secondary analysis of a national, longitudinal cohort study, households that took part in Waves 8 or 9 of the UK Household Longitudinal Study (UKHLS) panel, including all members aged 16 or older in April, 2020, were invited to complete the COVID-19 web survey on April 23-30, 2020. Participants who were unable to make an informed decision as a result of incapacity, or who had unknown postal addresses or addresses abroad were excluded. Mental health was assessed using the 12-item General Health Questionnaire (GHQ-12). Repeated cross-sectional analyses were done to examine temporal trends. Fixed-effects regression models were fitted to identify within-person change compared with preceding trends. FINDINGS: Waves 6-9 of the UKHLS had 53 351 participants. Eligible participants for the COVID-19 web survey were from households that took part in Waves 8 or 9, and 17 452 (41·2%) of 42 330 eligible people participated in the web survey. Population prevalence of clinically significant levels of mental distress rose from 18·9% (95% CI 17·8-20·0) in 2018-19 to 27·3% (26·3-28·2) in April, 2020, one month into UK lockdown. Mean GHQ-12 score also increased over this time, from 11·5 (95% CI 11·3-11·6) in 2018-19, to 12·6 (12·5-12·8) in April, 2020. This was 0·48 (95% CI 0·07-0·90) points higher than expected when accounting for previous upward trends between 2014 and 2018. Comparing GHQ-12 scores within individuals, adjusting for time trends and significant predictors of change, increases were greatest in 18-24-year-olds (2·69 points, 95% CI 1·89-3·48), 25-34-year-olds (1·57, 0·96-2·18), women (0·92, 0·50-1·35), and people living with young children (1·45, 0·79-2·12). People employed before the pandemic also averaged a notable increase in GHQ-12 score (0·63, 95% CI 0·20-1·06). INTERPRETATION: By late April, 2020, mental health in the UK had deteriorated compared with pre-COVID-19 trends. Policies emphasising the needs of women, young people, and those with preschool aged children are likely to play an important part in preventing future mental illness. FUNDING: None.


Subject(s)
Coronavirus Infections/psychology , Mental Disorders/epidemiology , Pneumonia, Viral/psychology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , COVID-19 , Cross-Sectional Studies , Female , Humans , Longitudinal Studies , Male , Middle Aged , Pandemics , Prevalence , Regression Analysis , Sampling Studies , Sex Distribution , Surveys and Questionnaires , United Kingdom/epidemiology , Young Adult
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