The prevalence, characteristics, and psychological wellbeing of unpaid carers in the United Kingdom.

BACKGROUND: This study sought to describe the characteristics of unpaid carers in the UK and assess levels of depression, anxiety, and mental health treatment seeking behaviours in this population. METHODS: Data was derived from Wave 9 (n = 2790) of the COVID-19 Psychological Research Consortium (C19PRC) study, a longitudinal survey of adults in the UK. Logistic regression analyses were conducted to examine the characteristics of unpaid carers, association between caregiver status and psychological wellbeing, and caregiver-specific factors associated with risk of poor psychological wellbeing. RESULTS: Approximately 15% (n = 417) of the sample reported providing unpaid care. Younger age, having three or more children in the household, and lower income were identified as significant correlates of caregiver status. Unpaid caregivers were at increased risk of depression or anxiety and mental health help-seeking. Unpaid caregivers who were younger, lived in households with one or two children, and had a lower income were at greater risk of depression or anxiety and engaging in mental health help-seeking. Caring for an individual with a terminal illness, long-term illness, learning disability or difficulty, mental health problems, physical disability, and other were linked to increased risk of depression or anxiety, while caring for someone with a learning disability increased risk of mental health help-seeking. CONCLUSIONS: This study indicates that at least one in eight people in the UK provide unpaid care, and that those who provide unpaid care have a far higher risk of experiencing depression or anxiety and seeking mental health treatment. The identification of risk factors associated with these mental health outcomes will facilitate the identification of those in most need of support.

Parental physical activity, parental mental health, children's physical activity, and children's mental health.

Introduction: The benefits of physical activity for mental health and well-being and the associations between parental mental health and children's mental health have been well established. These important issues tend to be examined separately however, and there is limited research on the associations between parent and child physical activity and mental health when all considered together. While family focused practice is recommended to provide support for parents who have mental health problems and their families and includes various components (such as psychoeducation, support for mental health and parenting), promoting physical activity for parents and children is not usually a core component of these interventions. Methods: The Northern Ireland Youth Wellbeing Survey aimed to provide estimates of the prevalence of mental health problems among children and young people. The survey also included questions about parental physical activity, parental mental health, and children's physical activity (for those aged 11-19 years). The main aim of the analysis reported in this article was to explore possible bivariate associations between parent and child physical activity and mental health and also explore these associations when all considered together. Participants were included in the analysis where there were completed interviews for the young person and one of their parents, and both young person and parent provided responses in relation to questions on weekly physical activity (n = 882). Results: The findings highlight the positive associations between parental physical activity and parental mental health, and between children's physical activity and children's mental health. They also explore some of the more complex interactions between these four variables, which suggest that gender may also be an important consideration. There were significant associations between father's physical activity and son's mental health, and son's physical activity and father's mental health. Discussions: These findings suggest that including support for parental physical activity and children's physical activity should be a routine component of family focused mental health interventions. It is important to acknowledge that there may be additional barriers to engaging in physical activity for families where a parent is experiencing mental health problems, and these should also be explored and addressed.

Prevalence and risk factors of parental mental health problems: A cross-sectional study.

An understanding of the prevalence and risk factors of parental mental health problems is important for early intervention and prevention measures and shaping services for parents and their children. However, large representative surveys of parental mental health problems and associated risk factors are lacking. The aim of this study was to estimate prevalence rates of parental mental health problems using a standardised measure of psychiatric morbidity (General Health Questionnaire; GHQ-12), in a representative sample of parents and caregivers of children and young people (2-19 years) in Northern Ireland. Further, this study explored associated risk factors of parental mental health problems. A random household survey of parents and children was conducted between June 2019 and March 2020. Parental responses on demographic, economic, familial and psychological measures were collected (N = 2815) and 22% of parents and caregivers screened positive for mental health problems. The STROBE checklist for observational research was adhered to. Multivariate logistic regression indicated that being in receipt of benefits, having poor family support, a history of adverse childhood experiences, a history of exposure to politically motivated violence (the Troubles), and a child with conduct problems and poor health were all independent risk factors of increased parental mental health problems. Findings will help to inform future commissioning and development of services and broaden understanding of the correlates of parental mental health problems.

Psychological distress, wellbeing and resilience: modelling adolescent mental health profiles during the COVID-19 pandemic.

There has been concern about adolescent mental health during the pandemic. The current study examined adolescent mental health during the initial phase of the COVID-19 pandemic in the UK. Using indicator of psychological distress, wellbeing and resilience, latent profile analysis was used to identify homogeneous mental health groups among young people aged 13-24 (N = 1971). Multinomial logistic regression was then used to examine which sociodemographic and psychosocial variables predicted latent class membership. Four classes were found. The largest class (Class 1, 37.2%) was characterised by moderate symptomology and moderate wellbeing. Class 2 (34.2%) was characterised by low symptomology and high wellbeing, while Class 3 (25.4%) was characterised by moderate symptomology and high wellbeing. Finally, Class 4 was the smallest (3.2%) and was characterised by high symptomology and low wellbeing. Compared to the low symptomology, high wellbeing class, all other classes were associated with less social engagement with friends, poorer family functioning, greater somatic symptoms, and a less positive model of self. A number of unique associations between the classes and predictor variables were identified. Although around two-thirds of adolescents reported moderate-to-high symptomology, most of these individuals also reported concurrent moderate-to-high levels of wellbeing, reflecting resilience. Furthermore, these findings demonstrate how a more comprehensive picture of mental health can be gained through adopting a dual-continua conceptualisation of mental health that incorporates both pathology and well-being. In this way, at-risk youth can be identified and interventions and resources targeted appropriately.

The structure of the Prodromal Questionnaire-16 (PQ-16) in a non-help-seeking youth population: Exploratory and confirmatory factor analyses study.

AIMS: The present study aimed to examine the structure of the Prodromal Questionnaire-16 (PQ-16) in a non-help-seeking youth population through exploratory and confirmatory factor analysis. Previous studies have not examined the structure of this self-report measure in this age group outside a clinical setting. METHODS: Participants (n = 1165) aged 11-19 years were recruited to an epidemiological study of young people in Northern Ireland, and completed the PQ-16 alongside other measures. The dataset was split randomly in two for separate factor analyses. A polychoric correlation matrix was created and exploratory factor analysis was used to identify the optimal number of factors. In addition, based on previous studies, six models were tested through confirmatory factor analysis to determine best fit. A one-factor, 3 two-factor, a three-factor and a four-factor model were all tested. RESULTS: The exploratory factor analysis indicated a two-factor structure of the PQ-16 in this population, which we have labelled 'general unusual experiences' and 'hallucinations'. Confirmatory analysis indicated that the two-factor model identified through the exploratory analysis was the best fit for the data. DISCUSSION: The present study suggests that the structure of the PQ-16 may vary across age groups in non-clinical settings, and adds further support to the validity of the PQ-16 is a cost-effective, easy to administer self-report measure that is suitable for use in non-help-seeking populations as a screening tool for prodromal symptoms.

Predicting resilience during the COVID-19 Pandemic in the United Kingdom: Cross-sectional and longitudinal results.

Although the COVID-19 pandemic has impacted the psychological wellbeing of some people, there is evidence that many have been much less affected. The Ecological Model of Resilience (EMR) may explain why some individuals are not resilient whilst others are. In this study we test the EMR in a comparison of UK survey data collected from the COVID-19 Psychological Research Consortium (C19PRC) longitudinal study of a representative sample of the United Kingdom (UK) adult population and data from an Italian arm of the study. We first compare data from the third wave of the UK arm of the study, collected in July/August 2020, with data from an equivalent sample and stage of the pandemic in Italy in July 2020. Next, using UK longitudinal data collected from C19PRC Waves 1, 3 and 5, collected between March 2020 and April 2021 we identify the proportion of people who were resilient. Finally, we examine which factors, drawn from the EMR, predict resilient and non-resilient outcomes. We find that the 72% of the UK sample was resilient, in line with the Italian study. In the cross-sectional logistic regression model, age and self-esteem were significantly associated with resilience whilst death anxiety thoughts, neuroticism, loneliness, and Post Traumatic Stress Disorder (PTSD) symptoms related to COVID-19 were significantly associated with Non-Resilient outcomes. In the longitudinal UK analysis, at Wave 5, 80% of the sample was Resilient. Service use, belonging to wider neighbourhood, self-rated health, self-esteem, openness, and externally generated death anxiety were associated with Resilient outcomes. In contrast, PTSD symptoms and loneliness were associated with Non-Resilient outcomes. The EMR effectively explained the results. There were some variables which are amenable to intervention which could increase resilience in the face of similar future challenges.

Functioning, symptom expression and risk along the psychosis continuum.

BACKGROUND: The psychosis continuum implies that subclinical psychotic experiences (PEs) can be differentiated from clinically relevant expressions since they are not accompanied by a 'need for care'. METHODS: Using data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 34 653), the current study examined variation in functioning, symptomology and aetiological risk across the psychosis phenotype [i.e. variation from (i) no PEs, 'No PEs' to (ii) non-distressing PEs, 'PE-Experienced Only' to (iii) distressing PEs, 'PE-Impaired' to (iv) clinically defined psychotic disorder, 'Diagnosed']. RESULTS: A graded trend was present such that, compared to those with no PEs, the Diagnosed group had the poorest functioning, followed by the PE-Impaired then PE-Experienced Only groups. In relation to symptom expression, the PE-Impaired group were more likely than the PE-Experienced Only and the Diagnosed groups to endorse most PEs. Predictors of group membership tended to vary quantitatively rather than qualitatively. Trauma, current mental health diagnoses (anxiety and depression) and drug use variables differentiated between all levels of the continuum, with the exception of the extreme end (PE-Impaired v. Diagnosed). Only a few variables distinguished groups at the upper end of the continuum: female sex, older age, unemployment, parental mental health hospitalisation and lower likelihood of having experienced physical assault. CONCLUSIONS: The findings highlight the importance of continuum-based interpretations of the psychosis phenotype and afford valuable opportunities to consider if and how impairment, symptom expression and risk change along the continuum.

Symptoms and levels of ICD-11 Prolonged Grief Disorder in a representative community sample of UK adults.

BACKGROUND: Prolonged Grief Disorder (PGD) is a new disorder included in ICD-11 (WHO, 2018). There is a growing body of literature surrounding the prevalence and correlates of ICD-11 PGD symptoms as assessed using various measures. This study was the first to assess levels of ICD-11 PGD symptoms as measured by the International Prolonged Grief Disorder Scale (IPGDS), a self-report scale directly aligned with the ICD-11 definition of PGD, among the United Kingdom adult general population, and identify correlates. METHOD: Participants included 2025 adults who participated in Wave 5 of the COVID-19 Psychological Research Consortium Study (C19PRC-UK). Prevalence rates of PGD were estimated based on two commonly used algorithms defined as 'strict' and 'moderate'. Sociodemographic, loss-related, and mental health correlates (i.e., anxiety, depression, mental health treatment seeking, loneliness) of strict and moderate PGD were then examined using multinomial logistic regressions. RESULTS: It was found that 2.4% (n = 43) of participants met probable caseness for PGD using the strict criteria while 7.9% (n = 140) met probable caseness for PGD using the moderate criteria. Multinomial logistic regression analysis results showed, as predicted, that income, time since bereavement, death of a child, religiosity, and depression were associated with both moderate and strict PGD. Correlates of moderate PGD included country of residence, urbanicity, younger age of bereaved, and loneliness. CONCLUSIONS: This study highlights that some symptoms of PGD are commonly reported in the general population, although relatively few meet the criteria for clinical significance. The routine assessment for PGD following a bereavement is discussed and the development of appropriate interventions are recommended.

The influence of adverse and positive childhood experiences on young people's mental health and experiences of self-harm and suicidal ideation.

BACKGROUND: Few studies have examined the interaction of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) with mental health outcomes in nationally representative European populations. OBJECTIVE: The primary objective was to test models of resilience through investigating associations between ACEs and PCEs and young people's risk of common mood and anxiety disorders, self-harm and suicidal ideation. PARTICIPANTS AND SETTING: Data were from the Northern Ireland Youth Wellbeing Survey (NIYWS), a stratified random probability household survey conducted between June 2019 and March 2020. Analysis is based on data from adolescents aged 11-19 years (n = 1299). METHOD: Logistic regression was used to test the direct effects of ACEs and PCEs on mental health outcomes and the moderating effect of PCEs at different levels of ACE exposure. RESULTS: Prevalence rates of mental health outcomes were: common mood and anxiety disorders (16 %); self-harm (10 %); suicidal ideation (12 %). ACEs and PCEs both independently predicted common mood and anxiety disorders, self-harm and suicidal ideation. Every additional ACE increased the likelihood of a common mood and anxiety disorder (81 %), self-harm (88 %) and suicidal ideation (88 %). Every additional PCE reduced common mood and anxiety disorders (14 %), self-harm (13 %) and suicidal ideation (7 %). There was no moderating effect of PCEs on ACEs and mental health outcomes. CONCLUSION: The findings suggest that PCEs act largely independently of ACEs and that initiatives to increase PCEs can assist in the prevention of mental health problems.

Quantifying skip-out information loss when assessing major depression symptoms.

Large-scale mental health surveys screen participants for the presence of the core diagnostic criteria of a mental disorder such as major depressive disorder (MDD). Only participants who screen positive are administered the full diagnostic module; the remainder "skip-out." Although this procedure adheres faithfully to the psychiatric classification of mental disorders, it limits the use of the resulting survey data for conducting high-quality research of importance to scientists, clinicians, and policymakers. Here, we conduct a series of exploratory analyses using the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders (VATSPSUD) data, a unique survey which suspended the skip-out procedure for assessing past-year MDD. Adult twins (N = 8,980) born between 1930 and 1974 were recruited from a multiple-birth record database established in 1980 and interviewed in mid-adulthood between 1987 and 1996. We compared the: (a) prevalence and levels of impairment of the diagnostic criteria (and disaggregated symptom items) of adults screening positive/negative and (b) patterns of associations between MDD diagnostic criteria (and disaggregated symptom items) under three conditions: (a) full data; (b) "skip-out" data substituted with zeros; and (c) "skip-out" data treated via listwise deletion. Important differences in the patterns of associations between diagnostic criteria and disaggregated symptom sets emerged which changed the statistical evidence regarding the dimensionality of the criteria/symptom items (i.e., Condition C). An ill-defined correlation matrix which was unsuitable for statistical analysis was produced (i.e., Condition B). Given the problems with these widely used approaches, we offer researchers and data analysts practical alternatives to using the skip-out procedure in future surveys. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The clustering of physical health conditions and associations with co-occurring mental health problems and problematic alcohol use: a cross-sectional study.

BACKGROUND: There is strong evidence for the co-occurrence of mental health conditions and alcohol problems, yet physical health outcomes among this group are not well characterised. This study aimed to identify clusters of physical health conditions and their associations with mental health and problematic alcohol use in England's general population. METHODS: Cross-sectional analysis of the 2014 Adult Psychiatric Morbidity Survey (N = 7546) was conducted. The survey used standardised measures of problematic alcohol use and mental health conditions, including the Alcohol Use Disorders Identification Test (AUDIT) and the Clinical Interview Schedule-Revised. Participants self-reported any lifetime physical health conditions. Latent class analysis considered 12 common physical illnesses to identify clusters of multimorbidity. Multinomial logistic regression (adjusting for age, gender, ethnicity, education, and occupational grade) was used to explore associations between mental health, hazardous drinking (AUDIT 8 +), and co-occurring physical illnesses. RESULTS: Five clusters were identified with statistically distinct and clinically meaningful disease patterns: 'Physically Healthy' (76.62%), 'Emerging Multimorbidity' (3.12%), 'Hypertension & Arthritis' (14.28%), 'Digestive & Bowel Problems'' (3.17%), and 'Complex Multimorbidity' (2.8%). Having a mental health problem was associated with increased odds of 'Digestive & Bowel Problems' (adjusted multinomial odds ratio (AMOR) = 1.58; 95% CI [1.15-2.17]) and 'Complex Multimorbidity' (AMOR = 2.02; 95% CI [1.49-2.74]). Individuals with co-occurring mental health conditions and problematic alcohol use also had higher odds of 'Digestive & Bowel Problems' (AMOR = 2.64; 95% CI [1.68-4.15]) and 'Complex Multimorbidity' (AMOR = 2.62; 95% CI [1.61-4.23]). CONCLUSIONS: Individuals with a mental health condition concurrent with problematic alcohol use experience a greater burden of physical illnesses, highlighting the need for timely treatment which is likely to include better integration of alcohol and mental health services.

Prevalence of probable eating disorders and associated risk factors: An analysis of the Northern Ireland Youth Wellbeing Survey using the SCOFF.

OBJECTIVES: Eating disorders (ED) are associated with significant morbidity and mortality rates and are most common in young people aged between 15 and 19 years. Large representative surveys on disordered eating in youth are lacking. The main aims were to estimate the prevalence of disordered eating in a representative sample of 11-19 year olds in Northern Ireland and investigate the associations between probable eating disorder and a range of risk factors. DESIGNS AND METHODS: A large nationally representative household survey was conducted, and the bivariate and multivariate associations between demographic, familial, economic and psychological risk factors and probable eating disorder were assessed. RESULTS: A total of 16.2% (n = 211) of the sample met the SCOFF screening criteria for disordered eating. Probable eating disorder was associated with being female (OR = 2.44), having a parent with mental health problems (OR = 1.68), suffering from certain psychological problems, such as mood or anxiety disorder (OR = 2.55), social media disorder (OR = 2.95), being the victim of physical bullying (OR = 1.71) and having smoked (OR = 2.46). CONCLUSIONS: This study provides the first prevalence estimates of probable eating disorder among youth in Northern Ireland. Furthermore, the study identifies unique risk factors for probable eating disorder among this representative sample.

Effects of ethnic density on the risk of compulsory psychiatric admission for individuals attending secondary care mental health services: evidence from a large-scale study in England.

BACKGROUND: Black, Asian and minority ethnicity groups may experience better health outcomes when living in areas of high own-group ethnic density - the so-called 'ethnic density' hypothesis. We tested this hypothesis for the treatment outcome of compulsory admission. METHODS: Data from the 2010-2011 Mental Health Minimum Dataset (N = 1 053 617) was linked to the 2011 Census and 2010 Index of Multiple Deprivation. Own-group ethnic density was calculated by dividing the number of residents per ethnic group for each lower layer super output area (LSOA) in the Census by the LSOA total population. Multilevel modelling estimated the effect of own-group ethnic density on the risk of compulsory admission by ethnic group (White British, White other, Black, Asian and mixed), accounting for patient characteristics (age and gender), area-level deprivation and population density. RESULTS: Asian and White British patients experienced a reduced risk of compulsory admission when living in the areas of high own-group ethnic density [odds ratios (OR) 0.97, 95% credible interval (CI) 0.95-0.99 and 0.94, 95% CI 0.93-0.95, respectively], whereas White minority patients were at increased risk when living in neighbourhoods of higher own-group ethnic concentration (OR 1.18, 95% CI 1.11-1.26). Higher levels of own-group ethnic density were associated with an increased risk of compulsory admission for mixed-ethnicity patients, but only when deprivation and population density were excluded from the model. Neighbourhood-level concentration of own-group ethnicity for Black patients did not influence the risk of compulsory admission. CONCLUSIONS: We found only minimal support for the ethnic density hypothesis for the treatment outcome of compulsory admission to under the Mental Health Act.

The development and initial validation of self-report measures of ICD-11 depressive episode and generalized anxiety disorder: The International Depression Questionnaire (IDQ) and the International Anxiety Questionnaire (IAQ).

BACKGROUND: The new International Classification of Diseases came into effect in 2022 (ICD-11; World Health Organization, 2022) and included updated descriptions and diagnostic rules for "Depressive Episode" and "Generalized Anxiety Disorder." No self-report measures align with these disorders so this study reports the development and initial validation of the "International Depression Questionnaire" (IDQ) and "International Anxiety Questionnaire" (IAQ). METHODS: Items were developed that aligned to the ICD-11 descriptions and their performance was assessed using data from a community sample (N = 2058) that was representative of the United Kingdom adult population. RESULTS: Item response theory models indicated that the two scales were unidimensional, and the items performed well in terms of difficulty and discrimination. Estimates of internal reliability were high. Based on ICD-11 derived diagnostic algorithms, 7.4% met requirements for ICD-11 Depressive Episode and 7.1% for Generalized Anxiety Disorder. CONCLUSIONS: The IDQ and the IAQ are short, easy to use, self-report measures aligned to the new and updated ICD-11 diagnostic descriptions. This study provides initial evidence that the scales produce scores that are reliable and valid.

An 18-month follow-up of the Covid-19 psychology research consortium study panel: Survey design and fieldwork procedures for Wave 6.

OBJECTIVES: Established in March 2020, the C19PRC Study monitors the psychological and socio-economic impact of the pandemic in the UK and other countries. This paper describes the protocol for Wave 6 (August-September 2021). METHODS: The survey assessed: COVID-19 related experiences; experiences of common mental health disorders; psychological characteristics; and social and political attitudes. Adult participants from any previous wave (N = 3170) were re-invited, and sample replenishment procedures helped manage attrition. Weights were calculated using a survey raking algorithm to ensure the on-going original panel (from baseline) was nationally representative in terms of gender, age, and household income, amongst other factors. RESULTS: 1643 adults were re-interviewed at Wave 6 (51.8% retention rate). Non-participation was higher younger adults, those born outside UK, and adults living in cities. Of the adults recruited at baseline, 54.3% (N = 1100) participated in Wave 6. New respondent (N = 415) entered the panel at this wave, resulting in cross-sectional sample for Wave 6 of 2058 adults. The raking procedure re-balanced the longitudinal panel to within 1.3% of population estimates for selected socio-demographic characteristics. CONCLUSIONS: This paper outlines the growing strength of the publicly available C19PRC Study data for COVID-19-related interdisciplinary research.

Prevalence and predictors of benevolent childhood experiences among a representative sample of young people.

Emerging research evidence suggests that benevolent childhood experiences (BCEs) may partly explain more favourable mental health outcomes among individuals affected by adverse childhood experiences (ACEs). However, much of this research has focused on adult populations. Consequently, this study sought to provide the first rigorous assessment of the prevalence and predictors of BCEs using a nationally representative sample of young people from Northern Ireland (NI). Participants were 11-19-years-olds (N = 1293) who participated in the NI Youth Wellbeing Prevalence Survey (NI-YWS, 2020). Prevalence rates, gender differences and predictors of BCEs were investigated. Results revealed how most of the sample experienced multiple BCEs (95%, n = 1084), with females reporting higher levels of BCEs. Significant positive predictors of BCEs were female gender, parental education, living with both biological parents, and living in areas with lower deprivation, while significant negative predictors of BCEs included family being in receipt of social welfare and older age. Overall, this study highlights how BCEs are common, while the identification of factors associated with likelihood of having positive experiences during early development provides novel insights into those young people who may be at greater risk for maladaptive psychological outcomes.

Refuting the myth of a 'tsunami' of mental ill-health in populations affected by COVID-19: evidence that response to the pandemic is heterogeneous, not homogeneous.

BACKGROUND: The current study argues that population prevalence estimates for mental health disorders, or changes in mean scores over time, may not adequately reflect the heterogeneity in mental health response to the COVID-19 pandemic within the population. METHODS: The COVID-19 Psychological Research Consortium (C19PRC) Study is a longitudinal, nationally representative, online survey of UK adults. The current study analysed data from its first three waves of data collection: Wave 1 (March 2020, N = 2025), Wave 2 (April 2020, N = 1406) and Wave 3 (July 2020, N = 1166). Anxiety-depression was measured using the Patient Health Questionnaire Anxiety and Depression Scale (a composite measure of the PHQ-9 and GAD-7) and COVID-19-related posttraumatic stress disorder (PTSD) with the International Trauma Questionnaire. Changes in mental health outcomes were modelled across the three waves. Latent class growth analysis was used to identify subgroups of individuals with different trajectories of change in anxiety-depression and COVID-19 PTSD. Latent class membership was regressed on baseline characteristics. RESULTS: Overall prevalence of anxiety-depression remained stable, while COVID-19 PTSD reduced between Waves 2 and 3. Heterogeneity in mental health response was found, and hypothesised classes reflecting (i) stability, (ii) improvement and (iii) deterioration in mental health were identified. Psychological factors were most likely to differentiate the improving, deteriorating and high-stable classes from the low-stable mental health trajectories. CONCLUSIONS: A low-stable profile characterised by little-to-no psychological distress ('resilient' class) was the most common trajectory for both anxiety-depression and COVID-19 PTSD. Monitoring these trajectories is necessary moving forward, in particular for the ~30% of individuals with increasing anxiety-depression levels.

Perceived manageability of debt and mental health during the COVID-19 pandemic: A UK population analysis.

OBJECTIVES: This study examined the association between perceived manageability of debt and risk of depression, anxiety, and mental health help-seeking among a nationally representative sample of adults living in the United Kingdom (UK). METHODS: Data was derived from the COVID-19 Psychological Research Consortium (C19PRC) Study Wave 6 (August/September 2021) which examined the psychological, social, and economic effects of the COVID-19 pandemic on the UK adult population. Bivariate and logistic regression analyses were conducted to determine the association between different levels of perceived debt manageability (i.e., "easily manageable", "some problems", "quite serious problems", "very serious problems", "cannot manage at all") and mental health related outcomes. RESULTS: Almost a quarter of the sample (24%, n = 494) reported debt management problems, and debt manageability associated with higher levels of anxiety, depression, and mental health help-seeking. After adjusting for demographic variables (e.g. income, receipt of benefits), logistic regression analysis demonstrated a dose-response association between increasing levels of debt manageability problems and mental health outcomes. Specifically, adjusted odds ratios for anxiety ranged from 2.28 ('some problems') to 11.18 ('very serious problems'), for depression ranged from 2.80 ('some problems') to 16.21 ('cannot manage at all'), and for mental health help-seeking ranged from 1.69 ('some problems') to 3.18 ('quite serious problems', 'very serious problems'). CONCLUSION: This study highlights that debt manageability problems represent a robust predictor of depression, anxiety, and mental-health help seeking.