Physical activity, low-grade inflammation, and psychological responses to the COVID-19 pandemic among older adults in England (preprint)

Mental health responses to the COVID-19 pandemic have been widely studied, but less is known about the potentially protective role of physical activity (PA) and the impact of low-grade inflammation. Using a sample of older adults from England, this study tested (1) if pre-pandemic PA and its changes during the pandemic were associated with mental health responses; (2) if older adults with low-grade inflammation experienced greater increases in depression and anxiety, compared to pre-pandemic levels; (3) if PA attenuated the association between inflammation and depression/anxiety. The study used data from the English Longitudinal Study of Ageing, a cohort study following a national sample aged 50+. Information on mental health and PA were collected before the pandemic (2016/17 and 2018/19) and during November and December 2020. Inflammation was ascertained using pre-pandemic C-reactive protein (CRP). Analyses were adjusted for sociodemographic and health-related factors and pre-pandemic mental health. Increasing PA from before to during the pandemic was linked to reduced odds of depression (OR = 0.955, 95%CI [0.937, 0.974]) and anxiety (OR = 0.954, 95%CI [0.927; 0.982]). Higher pre-pandemic PA was associated with reduced odds of depression (OR = 0.964, 95%CI [0.948, 0.981]) and anxiety (OR = 0.976, 95%CI [0.953, 1.000]), whereas elevated CRP was associated with 1.343 times higher odds of depression (95%CI [1.100, 1.641]). PA did not attenuate the inflammation-depression association. The findings suggest that PA may contribute to psychological resilience among older adults, independently of inflammation. Further research is needed to explore the psychobiological pathways underlying this protective mechanism.

Examining the inter-relationships between social isolation and loneliness and their correlates among older British adults before and during the COVID-19 lockdown: evidence from four British longitudinal studies (preprint)

Background and Objectives: Unprecedented social restrictions during the COVID-19 pandemic have provided a new lens for considering the inter-relationship between social isolation and loneliness in later life. We present these inter-relationships before and during the COVID-19 restrictions and investigate to what extent demographic, socio-economic, and health factors associated with such experiences differed during the pandemic. Research Design and Method: We used data from four British longitudinal population-based studies (1946 MRC NSHD, 1958 NCDS, 1970 BCS, and ELSA). Rates, co-occurrences, and correlates of social isolation and loneliness are presented prior to and during the early stage of the COVID-19 pandemic and the inter-relationships between these experiences are elucidated in both periods. Results: Across the four studies, pre-pandemic proportions reporting social isolation ranged from 15 to 54%, with higher rates in older ages (e.g., 32% of 70-79 and 54% of those over 80). During the pandemic, the percentage of older people reporting both social isolation and loneliness and isolation only slightly increased. The inter-relationship between social isolation and loneliness did not change. Associations between socio-demographic and health characteristics and social isolation and loneliness also remained consistent, with greater burden among those with greater economic precarity (females, non-homeowners, unemployed, illness and greater financial stress). Discussion and Implications: There were already large inequalities in experiences of social isolation and loneliness and the pandemic had a small impact on worsening these inequalities. The concepts of loneliness and social isolation are not transferable and clarity is needed in how they are conceptualised, operationalised, and interpreted.

The impact of long-term conditions and comorbidity patterns on COVID-19 infection and hospitalisation: a cohort study (preprint)

Introduction Older adults are usually more vulnerable to COVID-19 infections; however, little is known about which comorbidity patterns are related to a higher probability of COVID-19 infection. This study investigated the role of long-term conditions or comorbidity patterns on COVID-19 infection and related hospitalisations. Methods This study included 4,428 individuals from Waves 8 (2016-2017) and 9 (2018-2019) of the English Longitudinal Study of Ageing (ELSA), who also participated in the ELSA COVID-19 Substudy in 2020. Comorbidity patterns of chronic conditions were identified using an agglomerative hierarchical clustering method. The relationships between comorbidity patterns or long-term conditions and COVID-19 related outcomes were examined using multivariable logistic regression. Results Among a representative sample of community-dwelling older adults in England, those with cardiovascular disease (CVD) and complex comorbidities had an almost double risk of COVID-19 infection (OR=1.87, 95% CI=1.42-2.46) but not of COVID-19 related hospitalisation. A similar pattern was observed for the heterogeneous comorbidities cluster (OR=1.56, 95% CI=1.24-1.96). The individual investigations of long-term conditions with COVID-19 infection highlighted primary associations with CVD (OR=1.46, 95% CI=1.23-1.74), lung diseases (OR=1.40, 95% CI=1.17-1.69), psychiatric conditions (OR=1.40, 95% CI=1.16-1.68), retinopathy/eye diseases (OR=1.39, 95% CI=1.18-1.64), and arthritis (OR=1.27, 95% CI=1.09-1.48). In contrast, metabolic disorders and diagnosed diabetes were not associated with any COVID-19 outcomes. Discussion/Conclusion This study provides novel insights into the comorbidity patterns that are more vulnerable to COVID-19 infections and highlights the importance of CVD and complex comorbidities. These findings facilitate crucial new evidence for appropriate screening measures and tailored interventions for older adults in the ongoing global outbreak.

Changes in depression and anxiety among people with cognitive impairment and dementia during the COVID-19 pandemic: Analysis of the English Longitudinal Study of Ageing (preprint)

Background: Some studies have identified declines in mental health over the course of the COVID-19 pandemic across the world and in different age groups, including older people. As anxiety and depression are common neuropsychiatric symptoms among people with dementia or mild cognitive impairment, the mental health experiences of older people during the pandemic should therefore take cognitive function into consideration. This should also be examined using quantitative measures that were assessed prior to the pandemic. This study addresses such gaps in the evidence base on depression and anxiety among older people with cognitive impairment before and throughout the COVID-19 pandemic. Methods and Findings: Using data from the English Longitudinal Study of Ageing (ELSA) collected from 2018/19 to Nov/Dec 2020, we estimated changes in depression and anxiety for people aged 50+ in England across three cognitive function groups: no impairment, mild cognitive impairment, and dementia. We found that depression (measured with CES-D score) worsened from 2018/19 to Nov/Dec 2020 for people with mild cognitive impairment (1.39 (95%CI: 1.29-1.49) to 2.16 (2.02-2.30)) or no impairment (1.17 (95%CI: 1.12-1.22) to 2.03 (1.96-2.10)). Anxiety, using a single-item rating of 0-10 also worsened among those with mild cognitive impairment (2.48 (2.30-2.66) to 3.14 (2.95-3.33)) or no impairment (2.20 (2.11-2.28) to 2.85 (2.77-2.95)). No statistically significant increases were found for those with dementia. Using a clinical cutoff for likely depression (CES-D>=4), we found statistically significant increases in the probability of likely clinical depression between 2018/19 and Nov/Dec 2020 for those with no impairment (0.110 (0.099-0.120) to 0.206 (0.191-0.222)) and those with mild impairment (0.139 (0.120-0.159) to 0.234 (0.204-0.263)). We also found that differences according to cognitive function that existed before the pandemic were no longer present by June/July 2020, and there were no statistically significant differences in depression or anxiety among cognitive groups in Nov/Dec 2020. Conclusions: Our findings on measures collected before and during the pandemic suggest a convergence in mental health across cognitive function groups during the pandemic. This suggests mental health services will need to meet an increased demand that will come from older adults, especially those not living with cognitive impairment or dementia. We also found little significant change in mental health outcomes among those with dementia; as their existing need for support will remain, policymakers and care practitioners will need to ensure this group continues to have equitable access to support for their mental health.

Longitudinal associations between physical activity and other health behaviours during the COVID-19 pandemic: A fixed effects analysis (preprint)

Government enforced restrictions on movement during the COVID-19 pandemic are likely to have had profound impacts on the daily behaviours of many individuals, including physical activity (PA). Given the associations between PA and other health behaviours, changes in PA during the pandemic may have been detrimental for other health behaviours. This study aimed to evaluate whether changes in PA during and after the first national lockdown in the United Kingdom (UK) were associated with concurrent changes in alcohol consumption, sleep, nutrition quality, diet quantity and sedentary time. Data were derived from the UCL COVID-19 Social Study whereby 52,784 adults were followed weekly across 22 weeks of the pandemic from 23rd March to 23rd August 2020. Fixed effects regression models revealed that greater PA was positively associated with improved sleep and nutrition quality. However, increases in PA also showed modest associations with increased alcohol consumption and sedentary time. Encouraging people to engage in PA may lead to wider changes in their other health behaviours in times of adversity. These associations could be a result of increases in available leisure time for many people during COVID-19 restrictions and are of ongoing importance given the emerging, long-term changes to lifestyle and working patterns.

Depressive and anxiety symptoms during the COVID-19 pandemic: A two-year follow-up (preprint)

Background: There has been much research into the mental health impact of the COVID-19 pandemic and how it is related to time-invariant individual characteristics (e.g. age and gender). However, there is still a lack of research showing long-term trajectories of mental health across different stages of the pandemic. And little is known regarding the longitudinal association of time-varying contextual and individual factors (e.g. COVID-19 policy response and pandemic intensity) with mental health outcomes. This study aimed to provide a longitudinal profile of how depressive and anxiety symptoms changed by month between March 2020 and April 2022, and to examine their longitudinal associations with time-varying contextual and individual level factors. Methods and findings: Drawing data from a large panel study of over 58,000 adults living in England, we showed that mental health changes were largely in line with changes in COVID-19 policy response and pandemic intensity. Further, data were analysed using fixed-effects, with models fitted separately across three stages of the COVID-19 pandemic. We found that more stringent policy response was associated with increased mental health symptoms, in particular during lockdown periods. Higher COVID-19 deaths were also associated with poorer mental health, but this association weakened over time. Finally, there was also evidence for the longitudinal association of mental health with individual level factors, including confidence in government/healthcare/essentials, COVID-19 knowledge, COVID-19 stress, COVID-19 infection and social support. Conclusions: Our results provided empirical evidence on how changes in contextual and individual level factors were related to depressive and anxiety symptoms. While some factors clearly acted as consistent predictors of mental health during a pandemic, other factors were dependent on the specific situations occurring within society. This could provide important implications for policy making and for a better understanding of mental health of the general public during a national or global health crisis.

Urban greenspace and anxiety symptoms during the COVID-19 pandemic: A 20-month follow up of 19,848 participants in England (preprint)

This study examined the association between greenspace and the growth trajectories of anxiety symptoms during the COVID-19 pandemic. Using data from 19,848 urban residents in England who were followed for 20 months between March 2020 and October 2021, we found that living in an area with higher greenspace coverage was associated with fewer anxiety symptoms over time independent of population density, area deprivation levels, socio-demographics, and health profiles. There was limited evidence that greenspace was related to the change of anxiety symptoms over time. No association with anxiety trajectories was found when using greenspace proximity.

Longitudinal associations between physical activity and other health behaviours during the COVID-19 pandemic: A fixed effects analysis (preprint)

BackgroundGovernment enforced restrictions on movement during the COVID-19 pandemic are likely to have had profound impacts on the daily behaviours of many individuals, including physical activity (PA). Given the pre-pandemic evidence for associations between PA and other health behaviours, changes in PA during the pandemic may have been detrimental for other health behaviours. This study aimed to evaluate whether changes in PA during and after the first national lockdown in the United Kingdom (UK) were associated with concurrent changes in other health behaviours, namely alcohol consumption, sleep, nutrition quality, diet quantity and sedentary time. MethodsData were derived from the UCL COVID-19 Social Study. The analytical sample consisted of 52,784 adults followed weekly across 22 weeks of the pandemic from 23rd March to 23rd August 2020. Data were analysed using fixed effects regression. ResultsThere was significant within-individual variation in both PA and other health behaviours throughout the study period. Increased PA was positively associated with improved sleep and nutrition quality. However, increases in PA also showed modest associations with increased alcohol consumption and sedentary time. ConclusionOur findings indicate that, whilst the first wave of COVID-19 restrictions were in place, increases in PA were associated with improved sleep and better diet. Encouraging people to engage in PA may therefore lead to positive change in other health behaviours in times of adversity. However, increases in PA were also associated with more engagement in the negative health behaviours of alcohol consumption and sedentary time. These associations could be a result of increases in available leisure time for many people during COVID-19 restrictions and require further investigation to inform future public health guidance.

Long-term psychological consequences of long Covid: a propensity score matching analysis comparing trajectories of depression and anxiety symptoms before and after contracting long Covid vs short Covid (preprint)

Background: There is a growing global awareness of the psychological consequences of long Covid, supported by emerging empirical evidence. However, the mergence and long-term trajectories of psychological symptoms following the infection are still unclear. Aims: To examine when psychological symptoms first emerge following the infection with SARS-CoV-2, and the long-term trajectories of psychological symptoms comparing long and short Covid groups. Methods: We analysed longitudinal data from the UCL Covid-19 Social Study (March 2020-November 2021). We included data from adults living in England who reported contracting SARS-CoV-2 by November 2021 (N=3,115). Of these, 15.9% reported having had long Covid (N=495). They were matched to participants who had short Covid using propensity score matching on a variety of demographic, socioeconomic and health covariates (N=962, n=13,325) and data were further analysed using growth curve modelling. Results: Depressive and anxiety symptoms increased immediately following the onset of infection in both long and short Covid groups. But the long Covid group had substantially greater initial increases in depressive symptoms and heightened levels over 22 months follow-up. Initial increases in anxiety were not significantly different between groups, but only the short Covid group experienced an improvement in anxiety over follow-up, leading to widening differences between groups. Conclusions: The findings shed light on the psychobiological pathways involved in the development of psychological symptoms relating to long Covid. The results highlight the need for monitoring of mental health and provision of adequate support to be interwoven with diagnosis and treatment of the physical consequences of long Covid.

Association of COVID-19 employment disruption with mental and social wellbeing: evidence from nine UK longitudinal studies (preprint)

Background: The COVID-19 pandemic has led to major economic disruptions. In March 2020, the UK implemented the Coronavirus Job Retention Scheme, known as furlough, to minimize the impact of job losses. We investigate associations between change in employment status and mental and social wellbeing during the early stages of the pandemic. Methods: Data from 25,670 respondents, aged 16 to 66, from nine UK longitudinal studies were analysed. Changes in employment (including being furloughed) were defined by comparing employment status pre-pandemic and during the first lockdown. Mental and social wellbeing outcomes included psychological distress, life satisfaction, self-rated health, social contact, and loneliness. Study-specific modified Poisson regression estimates, adjusting for socio-demographic characteristics and pre-pandemic outcome measures, were pooled using meta-analysis. Results: Compared to those who remained working, furloughed workers were at greater risk of psychological distress (adjusted risk ratio, ARR=1.12; 95% CI: 0.97, 1.29), low life satisfaction (ARR=1.14; 95% CI: 1.07, 1.22), loneliness (ARR=1.12; 95% CI: 1.01, 1.23), and fair/poor self-rated health (ARR=1.26; 95% CI: 1.05, 1.50), but risk ratios appear less pronounced compared to those no longer employed (e.g., psychological distress, ARR=1.39; 95% CI: 1.21, 1.59) or stable unemployed (e.g., psychological distress, ARR=1.33; 95% CI: 1.09, 1.62). Conclusions: During the early stages of the pandemic those furloughed had increased risk for poor mental and social wellbeing. However, their excess risk was lower in magnitude than those who became or remained unemployed, suggesting that furlough partly mitigated poorer outcomes.

Psychological Distress Before and During the COVID-19 Pandemic: Sociodemographic Inequalities in 11 UK Longitudinal Studies (preprint)

Background: How population mental health has evolved across the COVID-19 pandemic under varied lockdown measures is poorly understood, with impacts on health inequalities unclear. We investigated changes in mental health and sociodemographic inequalities from before and across the first year of the pandemic in 11 longitudinal studies. Methods: Data from 11 UK longitudinal population-based studies with pre-pandemic measures of psychological distress were analysed and estimates pooled. Trends in the prevalence of poor mental health were assessed across the pandemic at three time periods: initial lockdown (TP1, Mar-June 20); easing of restrictions (TP2, July-Oct 20); and a subsequent lockdown (TP3, Nov 20-Mar 21). Multi-level regression was used to examine changes in psychological distress compared to pre-pandemic; with stratified analyses by sex, ethnicity, education, age, and UK country. Results: Across the 11 studies (n=54,609), mental health had deteriorated from pre-pandemic scores across all three pandemic time periods (TP1 Standardised Mean Difference (SMD): 0.13 (95% CI: 0.03, 0.23); TP2 SMD: 0.18 (0.09, 0.27); TP3 SMD: 0.20 (0.09, 0.31)). Changes in psychological distress across the pandemic were higher in females (TP3 SMD: 0.23 (0.11, 0.35)) than males (TP3 SMD: 0.16 (0.06, 0.26)), and slightly lower in below-degree level educated persons at some time periods (TP3 SMD: 0.18 (0.06, 0.30)) compared to those who held degrees (TP3 SMD: 0.26 (0.14, 0.38)). Increased distress was most prominent amongst adults aged 35-44 years (TP3 SMD: 0.49 (0.15, 0.84)). We did not find evidence of changes in distress differing by ethnicity or UK country. 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 is observed across the pandemic. Mental health declines have not been equal across the population, with females, those with higher degrees, and younger adults more affected.

Longitudinal changes in home confinement and mental health implications: A 17-month follow-up study in England during the COVID-19 pandemic (preprint)

Background: The COVID-19 pandemic has brought about significant behavioural changes, one of which is increased time spent at home. Although official lockdowns were typically short-term and allowed people to leave their homes for exercise and essential activities, some individuals did not leave their home for prolonged periods due to a range of factors including clinical vulnerability. This study aimed to explore longitudinal patterns of such 'home confinement' across different stages of the COVID-19 pandemic in the UK, and its associated predictors and mental health outcomes. Methods: Data were from the UCL COVID -19 Social Study. The analytical sample consisted of 25,390 adults in England who were followed up for 17 months from March 2020 to July 2021. Data were analysed using growth mixture models. Results: Our analyses identified three classes of growth trajectories, including one class showing a high level of persistent home confinement (24.8%), one changing class with clear alignment with national containment policy/advice (32.0%), and one class with a persistently low level of confinement (43.1%). A range of factors were found to be associated the class membership of home confinement trajectories, such as age, gender, income, employment status, social relationships and health. The class with a high level of confinement had the highest number of depressive and anxiety symptoms at the end of the follow-up independent of potential confounders. Conclusions: There was substantial heterogeneity in longitudinal patterns of home confinement during the COVID-19 pandemic. However, a striking proportion of our sample maintained a high level of home confinement over the course of 17 months, even during periods when containment measures were eased or removed and when infection rates were low. They also had the worst mental health outcomes. This group warrants special attention in addressing the mental health impact of the COVID-19 pandemic.

How did people cope during the COVID-19 pandemic? A Structural Topic Modelling Analysis of Free-Text Data from 11,000 UK Adults (preprint)

Background: The COVID-19 pandemic has had substantial impacts on lives across the globe. Job losses have been widespread, and individuals have experienced significant restrictions on their usual activities, including extended isolation from family and friends. While studies suggest population mental health worsened from before the pandemic, not all individuals appear to have experienced poorer mental health. This raises the question of how people managed to cope during the pandemic. Methods: To understand the coping strategies individuals employed during the COVID-19 pandemic, we used structural topic modelling, a text mining technique, to extract themes from free-text data on coping from over 11,000 UK adults, collected between 14 October and 26 November 2020. Results: We identified 16 topics. The most discussed coping strategy was 'thinking positively' and involved themes of gratefulness and positivity. Other strategies included engaging in activities and hobbies (such as doing DIY, exercising, walking and spending time in nature), keeping routines, and focusing on one day at a time. Some participants reported more avoidant coping strategies, such as drinking alcohol and binge eating. Coping strategies varied by respondent characteristics including age, personality traits and sociodemographic characteristics and some coping strategies, such as engaging in creative activities, were associated with more positive lockdown experiences. Conclusion: A variety of coping strategies were employed by individuals during the COVID-19 pandemic. The coping strategy an individual adopted was related to their overall lockdown experiences. This may be useful for helping individuals prepare for future lockdowns or other events resulting in self-isolation.

Facilitators and Barriers to Compliance with COVID-19 Guidelines: A Structural Topic Modelling Analysis of Free-Text Data from 17,500 UK Adults (preprint)

BackgroundDuring the COVID-19 pandemic, the UK government has implemented a series of guidelines, rules, and restrictions to change citizens behaviour to tackle the spread of the virus, such as the promotion of face-masks and the imposition of lockdown stay-at-home orders. The success of these measures requires active co-operation on the part of citizens, but compliance has not been complete. Detailed data is required on the factors aiding or hindering compliance with these measures. MethodsTo understand the facilitators and barriers to compliance with COVID-19 guidelines, we used structural topic modelling, a text mining technique, to extract themes from over 26,000 free-text survey responses from 17,500 UK adults, collected between 17 November and 23 December 2020. ResultsThe main factors facilitating compliance were desires to reduce risk to ones self and ones family and friends and to, a lesser extent, the general public. Also of importance were a desire to return to normality, the availability of activities and technological means to contact family and friends, and the ability to work from home. Identified barriers were difficulties maintaining social distancing in public (due to the actions of other people or environmental constraints), the need to provide or receive support from family and friends, social isolation, missing loved one, and mental health impacts, perceiving the risks as low, social pressure to not comply, and difficulties understanding and keep abreast of changing rules. Several of the barriers and facilitators raised were related to participant characteristics. Notably, women were more likely to discuss needing to provide or receive mental health support from friends and family. ConclusionThe results demonstrate an array of factors contribute to compliance with guidelines. Of particular policy importance, the results suggest that government communications that emphasizes the potential risks of COVID-19 and provides simple, consistent guidance on how to reduce the spread of the virus would improve compliance with preventive behaviours.

Risk factors for long COVID: analyses of 10 longitudinal studies and electronic health records in the UK (preprint)

The impact of long COVID is increasingly recognised, but risk factors are poorly characterised. We analysed questionnaire data on symptom duration from 10 longitudinal study (LS) samples and electronic healthcare records (EHR) to investigate sociodemographic and health risk factors associated with long COVID, as part of the UK National Core Study for Longitudinal Health and Wellbeing. Methods Analysis was conducted on 6,899 adults self-reporting COVID-19 from 45,096 participants of the UK LS, and on 3,327 cases assigned a long COVID code in primary care EHR out of 1,199,812 adults diagnosed with acute COVID-19. In LS, we derived two outcomes: symptoms lasting 4+ weeks and symptoms lasting 12+ weeks. Associations of potential risk factors (age, sex, ethnicity, socioeconomic factors, smoking, general and mental health, overweight/obesity, diabetes, hypertension, hypercholesterolaemia, and asthma) with these two outcomes were assessed, using logistic regression, with meta-analyses of findings presented alongside equivalent results from EHR analyses. Results Functionally limiting long COVID for 12+ weeks affected between 1.2% (age 20), and 4.8% (age 63) of people reporting COVID-19 in LS. The proportion reporting symptoms overall for 12+ weeks ranged from 7.8 (mean age 28) to 17% (mean age 58) and for 4+ weeks 4.2% (age 20) to 33.1% (age 56). Age was associated with a linear increase in long COVID between age 20-70. Being female (LS: OR=1.49; 95%CI:1.24-1.79; EHR: OR=1.51 [1.41-1.61]), poor pre-pandemic mental health (LS: OR=1.46 [1.17-1.83]; EHR: OR=1.57 [1.47-1.68]) and poor general health (LS: OR=1.62 [1.25-2.09]; EHR: OR=1.26; [1.18-1.35]) were associated with higher risk of long COVID. Individuals with asthma also had higher risk (LS: OR=1.32 [1.07-1.62]; EHR: OR=1.56 [1.46-1.67]), as did those categorised as overweight or obese (LS: OR=1.25 [1.01-1.55]; EHR: OR=1.31 [1.21-1.42]) though associations for symptoms lasting 12+ weeks were less pronounced. Non-white ethnic minority groups had lower 4+ week symptom risk (LS: OR=0.32 [0.22-0.47]), a finding consistent in EHR. Associations were not observed for other risk factors. Few participants in the studies had been admitted to hospital (0.8-5.2%). Conclusions Long COVID is clearly distributed differentially according to several sociodemographic and pre-existing health factors. Establishing which of these risk factors are causal and predisposing is necessary to further inform strategies for preventing and treating long COVID.

Inequalities in healthcare disruptions during the Covid-19 pandemic: Evidence from 12 UK population-based longitudinal studies (preprint)

Background: Health systems worldwide have faced major disruptions due to COVID-19 which could exacerbate health inequalities. The UK National Health Service (NHS) provides free healthcare and prioritises equity of delivery, but the pandemic may be hindering the achievement of these goals. We investigated associations between multiple social characteristics (sex, age, occupational social class, education and ethnicity) and self-reported healthcare disruptions in over 65,000 participants across twelve UK longitudinal studies. Methods: Participants reported disruptions from March 2020 up to late January 2021. Associations between social characteristics and three types of self-reported healthcare disruption (medication access, procedures, appointments) and a composite of any of these were assessed in logistic regression models, adjusting for age, sex and ethnicity where relevant. Random-effects meta-analysis was conducted to obtain pooled estimates. Results: Prevalence of disruption varied across studies; between 6.4% (TwinsUK) and 31.8 % (Understanding Society) of study participants reported any disruption. Females (Odd Ratio (OR): 1.27 [95%CI: 1.15,1.40]; I2=53%), older persons (e.g. OR: 1.39 [1.13,1.72]; I2=77% for 65-75y vs 45-54y), and Ethnic minorities (excluding White minorities) (OR: 1.19 [1.05,1.35]; I2=0% vs White) were more likely to report healthcare disruptions. Those in a more disadvantaged social class (e.g. OR: 1.17 [1.08, 1.27]; I2=0% for manual/routine vs managerial/professional) were also more likely to report healthcare disruptions, but no clear differences were observed by education levels. Conclusion: The COVID-19 pandemic has led to unequal healthcare disruptions, which, if unaddressed, could contribute to the maintenance or widening of existing health inequalities.

The Immediate and Longer-Term Impact of the COVID-19 Pandemic on the Mental Health and Wellbeing of Older Adults in England (preprint)

Background: Despite the emphasis placed on the psychological impact of the COVID-19 pandemic, evidence from representative studies of older adults including pre-COVID-19 data and repeated assessments during the pandemic is scarce. We examined changes in mental health before and during the initial and later phases of the pandemic and tested whether patterns varied with sociodemographic characteristics. Methods: The sample included 5146 older adults from the English Longitudinal Study of Ageing (53% women, average age 66·74 years) who provided data before the pandemic (2018-19) and at two occasions in 2020 (June-July and November-December). We tested changes in depression, quality of life, loneliness, and anxiety before and during the pandemic using fixed-effects regression models. Findings: The prevalence of clinically significant depressive symptoms increased from 12·5% pre-pandemic to 22·6% in June-July 2020, with a further rise to 28·5% in November-December. This was accompanied by increased loneliness and deterioration in quality of life. The prevalence of anxiety rose from 9·4% to 10·9% between June-July and November-December 2022. Women and non-partnered people experienced worse changes in mental health. Participants with less wealth had lowest levels of mental health before and during the pandemic. Higher socioeconomic groups had better mental health overall, but responded to the pandemic with more negative changes. Patterns of changes were similar across age groups. Interpretation: Mental health and wellbeing continued to worsen as lockdown continued, and socioeconomic inequalities persisted. Women and non-partnered people experienced greater deterioration in all mental health outcomes.Funding Information: ESRC/UKRI; National Institute on Aging; UK Government Departments.Declaration of Interests: All authors declare no conflict of interests.Ethics Approval Statement: All respondents provided informed consent. Ethical approval for the regular ELSA study was obtained from the National Research Ethics Service. The ELSA COVID-19 Substudy has been approved by the University College London Research Ethics Committee.

The immediate and longer-term impact of the COVID-19 pandemic on the mental health and wellbeing of older adults in England (preprint)

ObjectiveTo evaluate changes in mental health and wellbeing before and during the initial and later phases of the COVID-19 pandemic and investigate whether patterns varied with age, sex, and socioeconomic status. DesignProspective cohort study. ParticipantsEnglish Longitudinal Study of Ageing cohort of 5146 community dwelling adults aged 52 years and older (53% women, average age 66.74 years, standard deviation 10.62) who provided data before the pandemic (2018-19) and at two occasions in 2020 (June-July and November-December). Main outcome measureDepression, poor quality of life, loneliness and anxiety. ResultsThe prevalence of clinically significant depressive symptoms increased from 12.5% pre-pandemic to 22.6% in June-July 2020, with a further rise to 28.5% in November-December. This was accompanied by increased loneliness and deterioration in quality of life. The prevalence of anxiety rose from 9.4% to 10.9% between June-July and November-December 2022. Women and non-partnered people experienced worse changes in mental health and wellbeing. Participants with less wealth had lowest levels of mental health before and during the pandemic. Higher socioeconomic groups had better mental health overall, but responded to the pandemic with more negative changes. Patterns of changes were similar across age groups, the only exception was for depression which showed a smaller increase in the 75+ age group than in the youngest age group (50-59 years). ConclusionsThese data showed that mental health and wellbeing continued to worsen as lockdown continued, and that socioeconomic inequalities persisted. Women and non-partnered people experienced greater deterioration in all mental health outcomes. The immediate provision of diagnosis of mental health problems and targeted psychological interventions should target and support sociodemographic groups of older people at higher risk of psychological distress. What is already known on this topic- The COVID-19 pandemic and mitigation measures have upended the economic and social lives of many, leading to widespread psychological distress. - During the early months of the pandemic, levels of depression, anxiety and loneliness were high and lower levels of wellbeing were reported across the adult population, with certain higher risk groups identified. - However, evidence from longitudinal studies of representative samples of older adults that include pre-pandemic data is scarce, and little is known about mental health beyond the initial period of the pandemic. Repeated assessments are needed in order to understand whether mental health and wellbeing levels recovered or continued to deteriorate throughout 2020. What this study adds- These data suggest that mental health and wellbeing deteriorated significantly during June-July 2020 compared with pre-pandemic levels and continued to deteriorate during the second national lockdown in November-December 2020, showing that older individuals did not adapt to circumstances. - Inequalities in experiences of mental ill-health and poor wellbeing during 2020 were evident, with women, individuals living alone and those with less wealth being particularly vulnerable. Furthermore, socioeconomic inequalities in mental health have persisted during the pandemic.

Longitudinal changes in physical activity during and after the first national lockdown due to the COVID-19 pandemic in England (preprint)

Background Recent studies have shown reduced physical activity at early stages of the COVID-19 pandemic. However, there is a lack of investigation on longitudinal changes in physical activity beyond lockdowns and stay at home orders. Moreover, it is unclear if there is heterogeneity in physical activity growth trajectories. This study aimed to explore longitudinal patterns of physical activity and factors associated with them. Methods Data were from the UCL COVID -19 Social Study. The analytical sample consisted of 35,915 adults in England who were followed up for 22 weeks from 24 th March to 23 rd August 2020. Data were analysed using growth mixture models. Findings Our analyses identified six classes of growth trajectories, including three stable classes showing little change over time (62.4% in total), two classes showing decreasing physical activity (28.6%), and one class showing increasing physical activity over time (9%). A range of factors were found to be associated the class membership of physical activity trajectories, such as age, gender, education, income, employment status, and health. Interpretation There is substantial heterogeneity in longitudinal changes in physical activity during the COVID-19 pandemic. However, a substantial proportion of our sample showed persistent physical inactivity or decreasing physical activity. Given the well-established linked between physical activity and health, persistent or increased physical inactivity is likely to have both immediate and long-term implications for people’s physical and mental health, as well as general wellbeing. More efforts are needed to promote physical activity during the pandemic and beyond. Funding Nuffield Foundation, UK Research and Innovation, Wellcome Trust