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BackgroundThe COVID-19 pandemic increased psychiatric distress and impacts differed by family structure. We aimed to identify mechanisms contributing to these inequalities. MethodsSurvey data were from the UK Household Longitudinal Study. Psychiatric distress (GHQ-12) was measured in April 2020 (first UK lockdown; n=10,516), and January 2021 (lockdown re-introduced following eased restrictions; n=6,893). Pre-lockdown family structure comprised partner status and presence of children (<16 years). Mediating mechanisms included: active employment, financial strain, childcare/home-schooling, caring, and loneliness. Monte Carlo g-computation simulations were used to adjust for confounding and estimate total effects and decompositions into: controlled direct effects (effects if the mediator was absent), and portions eliminated (PE; representing differential exposure and vulnerability to the mediator). ResultsIn January 2021, after adjustment, we estimated increased risk of distress among couples with children compared to couples with no children (RR: 1.48; 95% CI: 1.15-1.82), largely because of childcare/home-schooling (PE RR: 1.32; 95% CI: 1.00-1.64). Single respondents without children also had increased risk of distress compared to couples with no children (RR: 1.55; 95% CI: 1.27-1.83), and the largest PE was for loneliness (RR: 1.16; 95% CI: 1.05-1.27), though financial strain contributed (RR: 1.05; 95% CI: 0.99-1.12). Single parents demonstrated the highest levels of distress, but confounder adjustment suggested uncertain effects with wide confidence intervals. Findings were similar in April 2020 and when stratified by sex. ConclusionsAccess to childcare/schooling, financial security and social connection are important mechanisms that need addressing to avoid widening mental health inequalities during public health crises. Key MessagesO_LICouples with young children compared to those without, had raised risk of psychiatric distress during UK lockdowns. Effect decompositions suggested this was largely due to a combination of differential exposure and vulnerability to childcare and home-schooling. C_LIO_LIAmong those without young children, being single compared to in a couple was associated with raised risk of psychiatric distress during UK lockdowns, with differential exposure to financial strain and loneliness both contributing to this inequality. C_LIO_LIThere was not sufficient evidence to indicate that being single with young children increased risk of psychiatric distress relative to couples with young children or singles without. C_LI
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ObjectivesThe COVID-19 pandemic has substantially affected workers mental health. We investigated changes in UK workers mental health by industry, social class, and occupation and differential effects by UK country of residence, gender and age. MethodsWe used representative Understanding Society data from 6,474 adults (41,207 observations) in paid employment who participated in pre-pandemic (2017-2020) and at least one COVID-19 survey. The outcome was psychological distress (General Health Questionnaire-12; score>=4). Exposures were industry, social class and occupation and are examined separately. Mixed-effects logistic regression was used to estimate relative (OR) and absolute (%) increases in distress before and during pandemic. Differential effects were investigated for UK countries of residence (Non-England/England), gender (Male/female), and age (Younger/Older) using 3-way interaction effects. ResultsPsychological distress increased in relative terms most for professional, scientific and technical (OR:3.15, 95% CI 2.17-4.59) industry in the pandemic versus pre-pandemic period. Absolute risk increased most in hospitality (+11.4%). For social class, small employers/self-employed were most affected in relative and absolute terms (OR:3.24, 95% CI 2.28-4.63; +10.3%). Across occupations Sales and customer service (OR:3.01, 95% CI 1.61-5.62; +10.7%) had the greatest increase. Analysis with 3-way interactions showed considerable gender differences, while for UK country of residence and age results are mixed. ConclusionsPsychological distress increases during the COVID-19 pandemic were concentrated among professional and technical and hospitality industries, small employers/self-employed and sales and customers service workers. Female workers often exhibited greater differences in risk by industry and occupation. Policies supporting these industries and groups are needed. O_TEXTBOXWhat is already known about this subject?Employment has been disrupted by the COVID-19 pandemic and non-pharmaceutical interventions (e.g. national and regional lockdowns) introduced to control the pandemic. The pandemic has impacted on different occupational groups in different ways and has been linked to substantial deteriorations in mental health. What are the new findings?The effect of the COVID-19 pandemic on mental health has been particularly pronounced for those working in professional and technical industries, hospitality, customer service occupations, small employers and the self-employed as well as female workers. How might this impact on policy or clinical practice in the foreseeable future?Policies should prioritise support to certain industries, occupations, the self-employed/small business owners, and particular demographic groups (e.g., women in sales and customer service occupations, younger construction or non-England workers in Public Administration and Defence) with high risk. C_TEXTBOX
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BackgroundThere are concerns that COVID-19 mitigation measures, including the "lockdown", may have unintended health consequences. We examined trends in mental health and health behaviours in the UK before and during the initial phase of the COVID-19 lockdown and differences across population subgroups. MethodsRepeated cross-sectional and longitudinal analysis of the UK Household Longitudinal Study, including representative samples of adults (aged 18+) interviewed in four survey waves between 2015 and 2020 (n=48,426). 9,748 adults had complete data for longitudinal analyses. Outcomes included psychological distress (General Health Questionnaire-12 (GHQ)), loneliness, current cigarette smoking, use of e-cigarettes and alcohol consumption. Cross-sectional prevalence estimates were calculated and multilevel Poisson regression assessed associations between time period and the outcomes of interest, as well as differential associations by age, gender, education level and ethnicity. ResultsPsychological distress increased one month into lockdown with the prevalence rising from 19.4% (95% CI 18.7%-20.0%) in 2017-19 to 30.3% (95% CI 29.1%-31.6%) in April 2020 (RR=1.3, 95% CI: 1.1,1.4). Groups most adversely affected included women, young adults, people from an Asian background and those who were degree educated. Loneliness remained stable overall (RR=0.9, 95% CI: 0.6,1.5). Smoking declined (RR=0.9, 95% CI=0.8,1.0) and the proportion of people drinking four or more times per week increased (RR=1.4, 95% CI: 1.3,1.5), as did binge drinking (RR=1.5, 95% CI: 1.3,1.7). ConclusionsPsychological distress increased one month into lockdown, particularly among women and young adults. Smoking declined, but adverse alcohol use generally increased. Effective measures are required to mitigate adverse impacts on health. O_LSTWhat is already known on this topicC_LSTO_LICountries around the world have implemented radical COVID-19 lockdown measures, with concerns that these may have unintended consequences for a broad range of health outcomes. C_LIO_LIEvidence on the impact of lockdown measures on mental health and health-related behaviours remains limited. C_LI O_LSTWhat this study addsC_LSTO_LIIn the UK, psychological distress markedly increased during lockdown, with women particularly adversely affected. C_LIO_LICigarette smoking fell, but adverse drinking behaviour generally increased. C_LI
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ObjectivesTo investigate severe COVID-19 risk by occupational group. MethodsBaseline UK Biobank data (2006-10) for England were linked to SARS-CoV-2 test results from Public Health England (16 March to 26 July 2020). Included participants were employed or self-employed at baseline, alive and aged less than 65 years in 2020. Poisson regression models adjusted sequentially for baseline demographic, socioeconomic, work-related, health, and lifestyle-related risk factors to assess risk ratios (RRs) for testing positive in hospital or death due to COVID-19 by three occupational classification schemes (including Standard Occupation Classification 2000). ResultsOf 120,075 participants, 271 had severe COVID-19. Relative to non-essential workers, healthcare workers (RR 7.43, 95% CI:5.52,10.00), social and education workers (RR 1.84, 95% CI:1.21,2.82) and other essential workers (RR=1.60, 95% CI:1.05,2.45) had higher risk of severe COVID-19. Using more detailed groupings, medical support staff (RR 8.70, 95% CI:4.87,15.55), social care (RR 2.46, 95% CI:1.47,4.14) and transport workers (RR= 2.20, 95% CI:1.21,4.00) had highest risk within the broader groups. Compared to white non-essential workers, non-white non-essential workers had a higher risk (RR 3.27, 95% CI: 1.90,5.62) and non-white essential workers had the highest risk (RR 8.34, 95% CI:5.17,13.47). Using SOC2000 major groups, associate professional and technical occupations, personal service occupations and plant and machine operatives had higher risk, compared to managers and senior officials. ConclusionsEssential workers have higher risk of severe COVID-19. These findings underscore the need for national and organizational policies and practices that protect and support workers with elevated risk of severe COVID-19. Trial registration-N/AO_LSTWhat is already known on this topicC_LSTO_LIEssential workers have a higher exposure to the SARS-CoV-2 virus due to the nature of their work. C_LIO_LIIn comparison to non-essential workers, healthcare workers appear to have a higher risk of SARS-CoV-2 infection. C_LI O_LSTWhat this study addsC_LSTO_LIHealthcare workers had a more than seven-fold higher risk of severe COVID-19; those working in social care and transport occupations had a two-fold higher risk. C_LIO_LIAdjusting for potential confounding and mediating variables did not fully account for the differences in the observed risk amongst most occupational groups. C_LIO_LINon-white essential workers had the highest risk of severe COVID-19 infection. C_LI O_LSTHow might this impact on policy or clinical practice in the foreseeable future?C_LSTO_LIOur findings reinforce the need for adequate health and safety arrangements and provision of PPE, particularly in the health and social care sectors, and highlight the need for national and organizational policies and practices that protect and support workers with elevated risk of SARS-CoV-2 infection. C_LI
