ABSTRACT
BackgroundMental health problems increased during the COVID-19 pandemic. Knowledge that one is less at risk after being vaccinated may alleviate distress, but this hypothesis remains unexplored. Here we test whether psychological distress declined in those vaccinated against COVID-19 in the US and whether changes in perceived risk mediated any association. MethodsA nationally-representative cohort of U.S. adults (N=5,792) in the Understanding America Study were interviewed every two weeks from March 2020 to June 2021 (28 waves). Difference-in-difference regression tested whether getting vaccinated reduced distress (PHQ-4 scores), with mediation analysis used to identify potential mechanisms, including perceived risks of infection, hospitalization, and death. ResultsVaccination was associated with a 0.09 decline in distress scores (95% CI:-0.15 to -0.04) (0-12 scale), a 5.7% relative decrease compared to mean scores in the wave prior to vaccination. Vaccination was also associated with an 8.44 percentage point reduction in perceived risk of infection (95% CI:-9.15% to -7.73%), a 7.44-point reduction in perceived risk of hospitalization (95% CI:-8.07% to -6.82%), and a 5.03-point reduction in perceived risk of death (95% CI:-5.57% to -4.49%). Adjusting for risk perceptions decreased the vaccination-distress association by two-thirds. Event study models suggest vaccinated and never vaccinated respondents followed similar PHQ-4 trends pre-vaccination, diverging significantly post-vaccination. Analyses were robust to individual and wave fixed effects, time-varying controls, and several alternative modelling strategies. Results were similar across sociodemographic groups. ConclusionReceiving a COVID-19 vaccination was associated with declines in distress and perceived risks of infection, hospitalization, and death. Vaccination campaigns could promote these additional benefits of being vaccinated.
ABSTRACT
BackgroundFood supply concerns have featured prominently in the UK response to the COVID-19 pandemic. We assess changes in food insecurity in the UK population from April to July 2020. MethodWe analyze 11,095 respondents from the April through July waves of the Understanding Society COVID-19 longitudinal study survey linked with Wave 9 of the UK Understanding Society study. Food insecurity was defined as having used a food bank in the last 4 weeks; being hungry but not eating in the last week; or not able to eat healthy and nutritious food in the last week. Unadjusted estimates to examine changes in population prevalence and logistic regression were used to assess the association between employment transitions and food insecurity. FindingsThe prevalence of reporting at least one form of food insecurity rose from 7{middle dot}1% in April to 20{middle dot}2% by July 2020. Some of the largest increases were among Asian respondents (22{middle dot}91 percentage points), the self-employed (15{middle dot}90 percentage points), and 35-44-year-olds (17{middle dot}08 percentage points). In logistic regression models, those moving from employment to unemployment had higher odds of reporting food insecurity relative to furloughed individuals (OR = 2{middle dot}23; 95% CI: 1{middle dot}20-4{middle dot}131) and to the persistently employed (OR=2{middle dot}38; 95% CI: 1{middle dot}33-4{middle dot}27), adjusting for sociodemographic characteristics. Furloughed individuals did not differ significantly in their probability of experiencing food insecurity compared to the persistently employed (OR=1{middle dot}07; 95% CI: 0{middle dot}83 to 1{middle dot}37). InterpretationFood insecurity has increased substantially in the UK. Steps are needed to provide subsidies or food support to vulnerable groups. O_TEXTBOXEvidence before this studyWe searched Google Scholar with the terms "COVID-19" and "food insecurity" and "UK"; and "food insecurity" and "UK" and "coronavirus", published between January 1st and October 31st, 2020. One cross-sectional report was identified, which found higher levels of food insecurity in early April 2020 relative to 2018. Importantly, the report relied on items used to measure food insecurity that referred to a 12-month time span in 2018 and then a 30-day time span in April 2020, a potential source of bias for examining changes in population prevalence over time. Added value of this studyHere we provide the first longitudinal national probability study that tracks temporal changes in population prevalence of food insecurity several months following the initial COVID-19-related lockdown measures in the UK. The prevalence of food insecurity rose for all socioeconomic and demographic and groups from April to July 2020, but did so for some more than others. Some of the largest increases in food insecurity were among Asian respondents, the self-employed, respondents aged 35-44, and those living in Scotland, London, and the North West of England. At the individual level, losing employment was associated with a higher odds of food insecurity compared to those furloughed under the Coronavirus Job Retention Scheme and the persistently employed. Importantly, furloughed individuals did not differ in their probability of food insecurity relative to the persistently employed. Implications of all the available evidenceThis study documents an alarming increase in food insecurity in the United Kingdom during the pandemic, with important implications for policy. While Coronavirus the Job Retention Scheme appeared to have conferred some protection, it is clear that not enough has been done to mitigate overall increases food insecurity in the UK. Steps are needed to provide subsidies or food support, especially since during the pandemic emergency food assistance may not be readily accessible. Taken together our results show that, while COVID is first of all a health crisis, it also has potential to become an escalating social and economic crisis if steps are not taken to protect the weak. C_TEXTBOX
