Work- and mental health-related events and body mass index trajectories during the Covid-19 lockdown. Evidence from the lifelines cohort study in the Netherlands.

BACKGROUND: The aim of this study was to identify heterogeneity in trajectories of body mass index (BMI) during the Covid-19 pandemic in the Netherlands. Moreover, we aimed to investigate whether work- and mental health-related disruptive events experienced during the pandemic, such as job insecurity or depression, were associated with such BMI trajectories. METHODS: Longitudinal data from the Lifelines Covid Questionnaire was used (21 waves between April 2020 and July 2021; n = 64,630). Different trajectories were identified using group-based trajectory models. Multinomial regression models were fitted to analyse the main determinants of experiencing changes in BMI during the pandemic. RESULTS: Trajectories of increased BMI, and, to a lesser extent also trajectories of decreased BMI, were more common among those who experienced disruptive work-related events (e.g., being laid-off or having a temporary contract) and mental health-related events (e.g., anxiety or depression) during the pandemic. Those experiencing multiple events were particularly likely to show trajectories of increased or decreased BMI. CONCLUSIONS: During the Covid-19 pandemic, strong heterogeneity was observed in BMI trajectories. This was partially related to work- and mental health-related events.

Understanding trends in loneliness during the COVID-19 pandemic in The Netherlands: the moderating role of gender, age, and living arrangement.

Objectives: Evidence suggests that the COVID-19 pandemic and the preventive lockdown measures increased loneliness levels. However, most studies are cross-sectional or rely on a pre-post (pandemic) design. This study relies on multiple observations to analyze the impact of the lockdown on loneliness levels in the Netherlands, and test whether it differed by gender, age, and living arrangement.Methods: Longitudinal data from the Covid-Questionnaire within the Lifelines Cohort Study from the northern Netherlands was used. Data was gathered between March 2020 and July 2021 with a total of 21 waves and 769,526 observations nested in 74,844 individuals. The outcome was a multi-dimensional Loneliness Index. The association between the lockdown period and loneliness levels was estimated using fixed-effects linear regression. Moderation effects were tested by means of two-way interactions.Results: Loneliness levels increased during stricter lockdown periods, and decreased when preventive measures were relaxed. Women and young adults experienced stronger fluctuations in their loneliness levels, whereas living arrangement did not play a notable moderating role.Conclusion: This study calls for special attention to be paid to the public issue of loneliness during periods of lockdown. Women and young adults appear as particularly vulnerable groups during the Covid-19 pandemic.

Changes in anxiety and depression symptoms during the Covid-19 lockdown in the Netherlands. The moderating role of pre-existing mental health, employment situation and alcohol consumption.

PURPOSE: Evidence suggests an increase of depression and anxiety symptoms during the Covid-19 pandemic but most studies relied on cross-sectional designs and/or small samples, and they often overlooked subgroup effects in the impact of the lockdown. We investigated the effect of the pandemic on depression and anxiety symptoms, and whether it differed by employment situation and alcohol consumption. METHODS: This longitudinal study used 23 waves of the Covid-Questionnaire (April 2020-July 2021), within the Lifelines cohort from the Netherlands (n = 76,254). Depression and anxiety symptoms were combined in a "mental health score". Linear fixed-effects models were fitted to analyse trends in mental health throughout the observation period. The moderating role of pre-existing mental health, employment situation, and alcohol consumption was tested. RESULTS: Depression and anxiety symptoms fluctuated considerably during the observation period, with clear peaks in winter 2021, during the strictest lockdown period. Moreover, temporal patterns differed by employment situation and alcohol consumption patterns, suggesting that various subgroups reacted to the pandemic and the lockdown in different ways. CONCLUSION: Lockdowns increased depression and anxiety symptoms in the Netherlands. The effect was particularly strong for unemployed individuals, those with risky alcohol consumption patterns and those with pre-existing mental health disorders.

Disentangling the association between alcohol consumption and employment status: causation, selection or confounding?

BACKGROUND: Alcohol use constitutes a major health risk and is related to unemployment. However, the direction of this relationship is unclear: unemployment may change drinking patterns (causation), but heavy drinkers may also be more prone to lose their job (selection). We simultaneously examined selection and causation, and assessed the role of residual confounding. Moreover, we paid attention to the subgroup of abstainers and occupationally disabled, often disregarded in the literature. METHODS: Longitudinal data (three waves collected between 2006 and 2018) of the Lifelines Cohort study from the Netherlands were used (138 875 observations of 55 415 individuals, aged 18-60 at baseline). Alcohol use was categorized as 'abstaining', 'moderate drinking' and 'binge drinking' (≥5 drinks/occasion for male; ≥4 for women). Employment status included occupational disability, short (<6 months) and long-term (≥6 months) unemployment. Random- and fixed-effects multinomial regression models were fitted in order to account for residual confounding. Reciprocal causality was assessed through generalized structural equation modelling with fixed-effects. RESULTS: Long unemployment spells increase the risk for both binge drinking (ß = 0.23; 95% CI 0.04-0.42) and abstinence (ß = 0.27; 95% CI 0.11-0.44), and the effects hold after accounting for reciprocal causality and time-constant confounding. Contrarily, the effect of binge drinking on unemployment is weak (ß = 0.14; 95% CI -0.03 to 0.31). Abstinence is strongly associated with occupational disability (ß = 0.40; 95% CI 0.24-0.57). CONCLUSIONS: We find evidence supporting the causation hypothesis (unemployment altering drinking patterns), whereas evidence for the selection hypothesis is weak and mostly confounded by unobserved variables, such as poor health prior to baseline.

The impact of the COVID lockdown on alcohol consumption in the Netherlands. The role of living arrangements and social isolation.

BACKGROUND: The COVID-19 pandemic and the subsequent lockdown have a strong impact on health and health behaviours, such as alcohol consumption. Although there is some evidence of an overall decline in alcohol consumption during the lockdown, studies also show an increase in risky drinking patterns, e.g. solitary drinking, and differences between subgroups of individuals, e.g. depending on their living arrangement. Yet most studies rely on cross-sectional designs with retrospective questions, and small samples. METHODS: A longitudinal study was conducted using 13 waves of the COVID-Questionnaire within the Lifelines cohort from the northern Netherlands (n = 63,194). The outcome was alcohol consumption (glasses per week) between April 2020 and July 2021. Linear fixed-effects models were fitted to analyse trends in alcohol consumption, and these were compared with pre-COVID drinking levels. Moreover, the role of living arrangement and feelings of social isolation as potential moderators was tested. RESULTS: Alcohol consumption during the pandemic was lower than in previous years, and the seasonal pattern differed from the pre-COVID one, with levels being lower when lockdown measures were stricter. Moreover, the seasonal pattern differed by living arrangement: those living alone saw a relative increase in drinking throughout tight lockdown periods, whereas those living with children showed the strongest increase during the summer. Social isolation showed a weaker moderation effect. CONCLUSIONS: Overall alcohol levels were down in the pandemic, and in particular during strict lockdowns. Those living on their own and those who felt more isolated reacted more strongly to the lockdown, the longer it lasted.

The association between unemployment trajectories and alcohol consumption patterns. Evidence from a large prospective cohort in The Netherlands.

Unemployment is expected to influence alcohol consumption, but studies show mixed results, partly because most studies concentrate on current employment status. However, unemployment could be particularly consequential if it is part of a trajectory of employment precariousness. Moreover, the association between unemployment and alcohol consumption may not be homogeneous across the population, but differ by subgroups (e.g. socioeconomic status). This study longitudinally analyses the association between different employment trajectories and alcohol consumption, and examines if the association is moderated by socioeconomic status (SES), partner status, age and gender. Four waves of data of the Lifelines Cohort study are used. Sample consists of individuals from 18-50 years old, active in the labor market (n = 104,766) from the northern provinces of the Netherlands. Employment trajectories are defined by employment status in each wave, duration of unemployment, and number of exposures to unemployment. Drinking patterns are divided into "abstainers", "moderate drinking" (<1.5 drinks/day), "heavy drinking" (≥1.5 drinks/day) and "binge drinking" (≥5 drinks/occasion; 4 for women). The associations are estimated with multinomial logistic regression models. Results show that recent, long-term unemployment (≥ 6 months) is associated with higher rates of heavy drinking (RRR = 1.26 [95 % CI 1.03-1.54]), whereas short-term unemployment does not show any association with the outcome. Being continuously unemployed throughout the observation period shows a strong association with binge drinking (RRR = 1.43 [95 % CI 1.06-1.93]), as well as reporting 2 or more long unemployment spells (RRR = 1.49 [95 % CI 1.21-1.83]). The group of abstainers (77.95 % women) have significantly lower SES, and poorer health than their peers. For some individuals, recent unemployment increases the likelihood for abstinence (RRR = 1.23 [95 % CI 1.00-1.51]). Evidence suggests that length of unemployment is key in order to grasp its effects in terms of changing drinking patterns.