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BackgroundIt remains unclear whether financial support interventions (e.g., furlough, mortgage freezes, foodbanks, Universal Credit) provide protection against the negative impact of financial adversity on mental health. MethodsData were from adults who took part in the UCL COVID -19 Social Study between 1 April 2020 and 4 April 2022 who had variability over time in depression (N = 27,297) and anxiety symptoms (N = 26,452). Fixed-effects Poisson regressions examined the associations between an index of financial adversity (e.g., job or income loss) with depression and anxiety symptoms and controlled for other adversities and loneliness. Interaction terms between financial adversity and having used i) any, ii) charity based, iii) government based, iv) work based, and v) other forms of financial supports were examined. ResultsExperiencing financial adversity had a negative impact on mental health. Only charity based support (e.g., foodbanks) consistently attenuated the impact of financial adversity on mental health, whilst work based support exacerbated the impact. Government based support only attenuated the impact of facing limited financial adversity on depression symptoms. ConclusionFindings suggest that most financial interventions are insufficient for alleviating mental health difficulties resulting from financial adversity.
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BackgroundRelationship breakdowns or conflict are frequent precipitants for self-harm thoughts and behaviours, but the majority who experience these stressful life events do not think about or engage in self-harm. Understanding factors that attenuate or exacerbate this risk is therefore needed. The aim of this paper is to investigate whether relationship breakdowns, loss, and conflict lead to more frequent self-harm thoughts and behaviours. We also examine whether coping styles and neuroticism, posited by diathesis-stress models of suicide risk to interact with these events, attenuate or exacerbate the risk for self-harm thoughts and behaviours from these events. MethodsThis study utilised data collected during the COVID-19 pandemic, which acted as a natural experiment by leading to a greater prevalence of relationship breakdowns than usual. Data from 21,581 adults who participated in the UCL COVID-19 Social Study between 28 February 2021 and 4 April 2022 were utilised. Poisson regression models which controlled for socio-demographics and a diagnosed mental health condition were used to examine the impact of four predictor variables (separation or divorce, family problem, an other relationship breakdown [e.g., friend or colleague], and the death of a close relative or friend) with the number of times self-harm thoughts and behaviours were reported over the study period. Interactions between these events and coping styles (problem-focused, emotion-focused, socially supported, and avoidant coping) were also examined. ResultsVariables representing relationship breakdowns, loss, and conflict were associated with an increased frequency of self-harm thoughts (incidence rate ratio [RRR] range: 1.04 to 1.77) and behaviours (RRR range: 1.48 to 1.96). The use of more avoidant coping strategies (e.g., substance use, denial) increased the risk for both outcomes but unexpectedly attenuated associations between predictor variables and self-harm thoughts. Socially supported coping increased the likelihood of both outcomes, but not in sensitivity analyses which excluding venting from the scale. Problem-focused coping strategies (e.g., active planning) attenuated the impact of separation or divorce and having had a family problem on the frequency of self-harm behaviours. ConclusionsFindings underscore the importance of interpersonal loss and conflict for the frequency of thinking about and engaging in self-harm and suggest that the magnitude of these associations may depend on different coping styles.
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BackgroundDemographic and infection-related characteristics have been identified as risk factors for long COVID, but research on the influence of health behaviours (e.g., exercise, smoking) immediately preceding the index infection is lacking. Methods1,811 UK adults from the UCL COVID-19 Social Study and who had previously been infected with COVID-19 were analysed. Health behaviours in the month before infection were weekly exercise frequency, days of fresh air per week, sleep quality, smoking, consuming more than the number of recommended alcoholic drinks per week (>14), and the number of mental health care behaviours (e.g., online mental health programme). Logistic regressions controlling for covariates (e.g., COVID-19 infection severity and pre-existing health conditions) examined the impact of health behaviours on long COVID and three long COVID symptoms (difficulty with mobility, cognition, and self-care). ResultsIn the month before infection with COVID-19, poor quality sleep increased the odds of long COVID (odds ratio [OR]: 3.53; (95% confidence interval [CI]: 2.01 to 6.21), as did average quality sleep (OR: 2.44; 95% CI: 1.44 to 4.12). Having smoked (OR: 8.39; 95% CI: 1.86 to 37.91) increased and meeting recommended weekly physical activity guidelines (3+ hours) (OR: 0.05; 95% CI: 0.01 to 0.39) reduced the likelihood of difficulty with self-care (e.g., washing all over or dressing) amongst those with long COVID. ConclusionResults point to the importance of sleep quality for long COVID, potentially helping to explain previously demonstrated links between stress and long COVID. Results also suggest that exercise and smoking may be modifiable risk factors for preventing the development of difficulty with self-care. FundingThe Nuffield Foundation [WEL/FR-000022583], the MARCH Mental Health Network funded by the Cross-Disciplinary Mental Health Network Plus initiative supported by UK Research and Innovation [ES/S002588/1], and the Wellcome Trust [221400/Z/20/Z and 205407/Z/16/Z]. What is already known on the topicLong COVID is rapidly becoming a public health concern. Although existing evidence to date has identified health characteristics such as obesity as risk factors, hardly any research on modifiable risk factors such as health behaviours has been conducted. What this study addsThis study adds to the dearth of evidence on modifiable risk factors occurring before COVID-19 infection. Findings suggest a role of poor sleep quality for the development of long COVID, and for meeting physical activity guidelines (3+ hours per week) and not smoking as modifiable risk factors for self-care difficulties amongst those with long COVID.
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BackgroundLong COVID is increasingly recognised as public health burden. Demographic and infection-related characteristics have been identified as risk factors, but less research has focused on psychosocial predictors such as stress immediately preceding the index infection. Research on whether stressors predict the development of specific long COVID symptoms is also lacking. MethodsData from 1,966 UK adults who had previously been infected with COVID-19 and who took part in the UCL COVID-19 Social Study were analysed. The number of adversity experiences (e.g., job loss) and the number of worries about adversity experiences within the month prior to COVID-19 infection were used to predict the development of self-reported long COVID and the presence of three specific long COVID symptoms (difficulty with mobility, cognition, and self-care). The interaction between a three-level index of socio-economic position (SEP; with higher values indicating lower SEP) and the exposure variables in relation to long COVID status was also examined. Analyses controlled for a range of COVID-19 infection characteristics, socio-demographics, and health-related factors. FindingsOdds of self-reported long COVID increased by 1.25 (95% confidence interval [CI]: 1.04 to 1.51) for each additional worry about adversity in the month prior to COVID-19 infection. Although there was no evidence for an interaction between SEP and either exposure variable, individuals in the lowest SEP group were nearly twice as likely to have developed long COVID as those in the highest SEP group (OR: 1.95; 95% CI: 1.19 to 3.19) and worries about adversity experiences remained a predictor of long COVID (OR: 1.43; 95% CI: 1.04 to 1.98). The number of worries about adversity experiences also corresponded with increased odds of certain long COVID symptoms such as difficulty with cognition (e.g., difficulty remembering or concentrating) by 1.46 (95% CI: 1.02 to 2.09) but not with mobility (e.g., walking or climbing steps) or self-care (e.g., washing all over or dressing). InterpretationResults suggest a key role of stress in the time preceding the acute COVID-19 infection for the development of long COVID and for difficulty with cognition specifically. These findings point to the importance of mitigating worries and experiences of adversities during pandemics both to reduce their psychological impact but also help reduce the societal burden of longer-term illness. FundingThe Nuffield Foundation [WEL/FR-000022583], the MARCH Mental Health Network funded by the Cross-Disciplinary Mental Health Network Plus initiative supported by UK Research and Innovation [ES/S002588/1], and the Wellcome Trust [221400/Z/20/Z and 205407/Z/16/Z].
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BackgroundThe continued success of the COVID-19 vaccination programme in the UK will depend on widespread uptake of booster vaccines. However, there is evidence of hesitancy and unwillingness to receive the booster vaccine, even in fully vaccinated adults. Identifying factors associated with COVID-19 booster vaccine intentions specifically in this population is therefore critical. MethodsWe used data from 22,139 fully vaccinated adults who took part in the UCL COVID-19 Social Study. Multinomial logistic regression examined predictors of uncertainty and unwillingness (versus willingness) to receive a COVID-19 booster vaccine (measured 22 November 2021 to 6 December 2021), including (i) socio-demographic factors, (ii) COVID-19 related factors (e.g., having been infected with COVID-19), and (iii) initial intent to receive a COVID-19 vaccine in the four months following the announcement in the UK that the vaccines had been approved (2 December 2020 to 31 March 2021). Findings4% of the sample reported that they were uncertain about receiving a COVID-19 booster vaccine, and a further 4% unwilling. Initial uncertainty and unwillingness to accept the first COVID-19 vaccine in 2020-21 were each associated with over five times the risk of being uncertain about and unwilling to accept a booster vaccine. Healthy adults (those without a pre-existing physical health condition) were also more likely to be uncertain or unwilling to receive a booster vaccine. In addition, low levels of current stress about catching or becoming seriously ill from COVID-19, consistently low compliance with COVID-19 government guidelines during periods of strict restrictions (e.g., lockdowns), lower levels of educational qualification, lower socio-economic position, and age below 45 years were all associated with uncertainty and unwillingness. InterpretationOur findings highlight that there are a range of factors that predict booster intentions, with the strongest predictor being previous uncertainty and unwillingness. Two other concerning patterns also emerged from our results. First, administration of booster vaccinations may increase social inequalities in experiences of COVID-19 as adults from lower socio-economic backgrounds are also most likely to be uncertain or unwilling to accept a booster vaccine as well as most likely to be seriously affected by the virus. Second, some of those most likely to spread COVID-19 (i.e., those with poor compliance with guidelines) are most likely to be uncertain and unwilling. Public health messaging should be tailored specifically to these groups. FundingThe Nuffield Foundation [WEL/FR-000022583], the MARCH Mental Health Network funded by the Cross-Disciplinary Mental Health Network Plus initiative supported by UK Research and Innovation [ES/S002588/1], and the Wellcome Trust [221400/Z/20/Z and 205407/Z/16/Z].
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ObjectiveTo examine whether racial/ethnic discrimination predicts future COVID-19 vaccine refusal, and whether this association is explained by trust in government and the health system. DesignLongitudinal observational study of racial/ethnic discrimination occurring since the start of the first lockdown (measured in July 2020) and later COVID-19 vaccine status. SettingUK (England, Scotland, Wales, and Northern Ireland) Participants633 adults belonging to ethnic minority groups who took part in the UCL COVID-19 Social Study. Main outcome measureCOVID-19 vaccine refusal (vs accepted/waiting/had at least one dose) between 23 December 2020 and 14 June 2021. ResultsNearly one in ten (6.7%) who had refused a COVID-19 vaccine had experienced racial/ethnic discrimination in a medical setting since the start of the pandemic and had experienced twice as many incidents of racial/ethnic discrimination than those who had accepted the vaccine. Structural equation modelling results indicated a nearly 4-fold (odds ratio [OR] = 3.9, 95% confidence interval [CI] = 1.4 to 10.9) total effect of racial/ethnic discrimination on refusing the vaccine was which was mediated by low trust in the health system to handle the pandemic (OR = 2.5, 95% CI = 1.1 to 5.4). Analyses adjusted for a range of demographic and COVID-19 related factors. ConclusionsFindings underscore the importance of addressing racial/ethnic discrimination and the role the National Health Service in regaining trust from ethnic minority groups to increase COVID-19 vaccine uptake amongst ethnic minority adults.
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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.
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BackgroundLittle is known about which factors exacerbate and buffer the impact of COVID-19 -related adversities on changes in thinking about and engaging in self-harm over time. AimsTo examine how changes in four social factors contribute to changes in self-harm thoughts and behaviours over time and how these factors in turn interact with adversities and worries about adversities to increase risk for these outcomes. MethodData from 49,227 UK adults in the UCL COVID-19 Social Study were analysed across the first 59 weeks of the pandemic. Fixed effects logistic regressions examined time-varying associations between social support quality, loneliness, number of days of face-to-face contact for [≥]15 minutes, and number of days phoning/video calling for [≥]15 minutes with self-harm thoughts and behaviours. We then examined how these four factors in turn interacted with the total number of adversities and worries about adversity on outcomes. ResultsIncreases in the quality of social support decreased the likelihood of both outcomes, whilst greater loneliness increased their likelihood. Associations were inconsistent for telephone/video contact and face-to-face contact with outcomes. Social support buffered and loneliness exacerbated the impact of adversity experiences with self-harm behaviours. Other interactions were inconsistent, and some were in the unexpected direction. ConclusionsThese findings suggest the importance of the quality of ones social support network, rather than the mere presence of contact, is important for reducing the likelihood of self-harm behaviours in the context of COVID-19 pandemic-related adversity and worry.
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ImportanceCOVID-19 public health mitigation measures are likely to have detrimental effects on emotional and behavioural problems in children. However, longitudinal studies with pre-pandemic data are scarce. ObjectiveTo explore trajectories of childrens emotional and behavioural difficulties during the COVID-19 pandemic. Design and settingData were from children from the third generation of a birth cohort study; the Avon Longitudinal Study of Parents and Children - Generation 2 (ALSPAC-G2) in the southwest of England. ParticipantsThe study population comprised of 708 children (median age at COVID-19 data collection was 4.4 years, SD=2.9, IQR= [2.2 to 6.9]), whose parents provided previous pre-pandemic surveys and a survey between 26 May and 5 July 2020 that focused on information about the COVID-19 pandemic as restrictions from the first lockdown in the UK were eased. ExposuresWe employed multi-level mixed effects modelling with random intercepts and slopes to examine whether childrens trajectories of emotional and behavioural difficulties (a combined total difficulties score) during the pandemic differ from expected pre-pandemic trajectories. Main outcomesChildren had up to seven measurements of emotional and behavioural difficulties from infancy to late childhood, using developmentally appropriate scales such as the Emotionality Activity Sociability Temperament Survey in infancy and Strengths and Difficulties Questionnaire in childhood. ResultsThe observed normative pattern of childrens emotional and behavioural difficulties pre-pandemic, was characterised by an increase in scores during infancy peaking around the age of 2, and then declining throughout the rest of childhood. Pre-pandemic, the decline in difficulties scores after age 2 was 0.6 points per month; but was approximately one third of that in post-pandemic trajectories (there was a difference in mean rate of decline after age 2 of 0.2 points per month in pre vs during pandemic trajectories [95 % CI: 0.10 to 0.30, p <0.001]). This lower decline in scores over the years translated to older children having pandemic difficulty scores higher than would be expected from pre-pandemic trajectories (for example, an estimated 10.0 point (equivalent of 0.8 standard deviations) higher score (95% CI: 5.0 to 15.0) by age 8.5 years). Results remained similar although somewhat attenuated after adjusting for maternal anxiety and age. Conclusion and relevanceThe COVID-19 pandemic may be associated with greater persistence of emotional and behavioural difficulties after the age 2. Emotional difficulties in childhood predict later mental health problems. Further evidence and monitoring of emotional and behavioural difficulties are required to fully understand the potential role of the pandemic on young children. Key FindingsO_ST_ABSQuestionC_ST_ABSHow has the COVID-19 pandemic influenced emotional difficulties in young children? FindingsUsing repeated longitudinal data from before and during the pandemic we provide evidence that emotional difficulty scores of primary school aged children are higher by an estimated 10.0 points (0.8 standard deviations) (95% CI: 5.0 to 15.0) by age 8.5 years than would be expected based on pre pandemic data. MeaningThe level of difference in emotional difficulties found in the current study has been linked to increased likelihood of mental health problems in adolescence and adulthood. Therefore, this increase in difficulties needs careful monitoring and support.
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BackgroundThere are concerns that key workers may be at a greater risk for psychological distress than non-key workers during the COVID-19 pandemic. However, little research has included key workers outside of the healthcare sector or has disaggregated key workers into different subgroups. AimsTo examine longitudinal changes in mental health over 12 months during the COVID-19 pandemic comparing four different groups of key workers with non-key workers. MethodLongitudinal data were from 21,874 adults living in England (21 March 2020 to 22 February 2021). Latent growth modelling (LGM) was utilised to compare growth trajectories of depressive and anxiety symptoms in non-key workers and four types of key workers: i) health and social care workers, ii) teachers and childcare workers, iii) public service workers, and iv) essential services key workers (e.g., food chain or utility workers). ResultsWhen accounting for both time-invariant and time-varying covariates, key workers in the essential services category had consistently higher levels of depressive and anxiety symptoms than non-key workers across the whole of the study period. There was little difference in mental health trajectories between health/social care, teachers/childcare and public service worker categories and non-key workers. ConclusionsOur findings suggest risk for poorer mental health during the COVID-19 pandemic varies within the broad category of key workers generally, and that those working in utility, food chain, and transport roles are especially at risk. Future research should focus on identifying which aspects of working conditions may be contributing to occupational stress in these groups.
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BackgroundThere is concern that the COVID-19 pandemic and its aftermath will result in excess suicides by increasing known risk factors such as self-harm, but evidence on how pandemic-related risk factors contribute to changes in these outcomes is lacking. AimsTo examine how different COVID-19-related adverse experiences and adversity worries contribute to changes in self-harm thoughts and behaviours. MethodData from 49,324 UK adults in the UCL COVID-19 Social Study were analysed (1 April 2020 to 17 May 2021). Fixed effects regressions explored associations between weekly within-person variation in five categories of adversity experiences and adversity worries with changes in self-harm thoughts and behaviours across age groups (18-29, 30-44, 45-59, and 60+ years). Results26.1% and 7.9% respondents reported self-harm thoughts and behaviours, respectively, at least once over the study period. More adverse experiences were more strongly related to outcomes than worries. The largest specific adversity contributing to increases in both outcomes was having experienced physical or psychological abuse. Financial worries increased the likelihood of both outcomes in most age groups, whilst having had COVID-19 increased the likelihood of both outcomes in young (18-29 years) and middle-aged (45-59 years) adults. ConclusionsFindings suggest that a significant portion of UK adults may be at increased risk for self-harm thoughts and behaviours during the pandemic. Given the likelihood that the economic and social consequences of the pandemic will accumulate, policy makers can begin adapting evidence-based suicide prevention strategies and other social policies to help mitigate its consequences.
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BackgroundNegative attitudes towards vaccines and an uncertainty or unwillingness to receive vaccinations are major barriers to managing the COVID-19 pandemic in the long-term. We estimate predictors of four domains of negative attitudes towards vaccines and identify groups most at risk of uncertainty and unwillingness to receive a COVID-19 vaccine in a large sample of UK adults. MethodsData were from 32,361 adults in the UCL COVID-19 Social Study. Ordinary least squares regression analyses examined the impact of socio-demographic and COVID-19 related factors on four types of negative vaccine attitudes: mistrust of vaccine benefit, worries about unforeseen effects, concerns about commercial profiteering, and preference for natural immunity. Multinomial logistic regression examined the impact of socio-demographic and COVID-19 related factors, negative vaccine attitudes, and prior vaccine behaviour on uncertainty and unwillingness to be vaccinated for COVID-19. Findings16% of respondents displayed high levels of mistrust or misinformation about vaccines across one or more domains. Distrustful attitudes towards vaccination were higher amongst individuals from ethnic minority backgrounds, with lower levels of education, lower annual income, poor knowledge of COVID-19, and poor compliance with government COVID-19 guidelines. Overall, 14% of respondents reported unwillingness to receive a vaccine for COVID-19, whilst 22% were unsure. The largest predictors of both COVID-19 vaccine uncertainty and refusal were low income (< {pound}30,000 a year), having not received a flu vaccine last year, poor adherence to COVID-19 government guidelines, female gender, and living with children. Amongst vaccine attitudes, intermediate to high levels of vaccine benefit mistrust and concerns about future unforeseen side effects were the most important determinants of both uncertainty and unwillingness to vaccinate against COVID-19. InterpretationNegative attitudes towards vaccines are major public health concerns in the UK. General mistrust in vaccines and concerns about future side effects in particular will be barriers to achieving population immunity to COVID-19 through vaccination. Public health messaging should be tailored to address these concerns. FundingThe Nuffield Foundation [WEL/FR-000022583], the MARCH Mental Health Network funded by the Cross-Disciplinary Mental Health Network Plus initiative supported by UK Research and Innovation [ES/S002588/1], and the Wellcome Trust [221400/Z/20/Z and 205407/Z/16/Z]. O_TEXTBOXEvidence before this studyWe searched PubMed for articles published in English from 1 January 2020 to 20 September 2020 with the following keywords: ("COVID19 vaccine" OR "coronavirus vaccine") and ("intent*" OR "refusal"). Our search found 639 titles. Several previous studies have examined predictors of intent to vaccinate for COVID-19 when it becomes available. Reasons for unwillingness to receive the COVID-19 vaccination when it becomes available centred on concerns about its newness, safety, and potential side effects. However, estimates and predictors of negative vaccine attitudes in general and how these attitudes predict uncertainty and unwillingness to vaccinate in the context of COVID-19 are unavailable. Added value of this studyThe attitudinal and behavioural barriers to being unsure about receiving a COVID-19 vaccine and not intending to receive one were largely overlapping; 1) didnt get a flu vaccine last year, 2) poor adherence to government guidelines, 3) concerns about the unforeseen future effects of vaccines, and 4) and general mistrust in the benefits of vaccines. Implications of all of the available evidenceMistrust towards vaccines represent a significant challenge in achieving the vaccination coverage required for population immunity. Taken together, there is evidence that groups most vulnerable to falling ill and dying of COVID-19 (e.g. those from ethnic minority backgrounds and who have lower incomes) have more negative attitudes towards vaccines and are less willing to vaccinate against COVID-19. Not everyone who intends to receive a COVID-19 vaccination will be able to do so because of practical barriers such as lack of accessibility and government decisions on the availability of the vaccine, underscoring the importance of improving vaccine attitudes in the general population to improve vaccine uptake amongst those who are offered a vaccine and prevent widening socio-economic health inequalities. Vaccine safety communication to increase public trust by the time a COVID-19 vaccine is available should begin now. C_TEXTBOX
