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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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BackgroundHome working rates have increased since the COVID-19 pandemics onset, but the health implications of this transformation are unclear. We assessed the association between home working and social and mental wellbeing through harmonised analyses of seven UK longitudinal studies. MethodsWe estimated associations between home working and measures of psychological distress, low life satisfaction, poor self-rated health, low social contact, and loneliness across three different stages of the COVID-19 pandemic (T1= Apr-Jun 2020 - first lockdown, T2=Jul-Oct 2020 - eased restrictions, T3=Nov 2020-Mar 2021 - second lockdown), in seven population-based cohort studies using modified Poisson regression and meta-analyses to pool results across studies. FindingsAmong 34,131 observations spread over three time points, we found higher rates of home working at T1 and T3 compared with T2, reflecting lockdown periods. Home working was not associated with psychological distress at T1 (RR=0.92, 95%CI=0.79-1.08) or T2 (RR=0.99, 95%CI=0.88-1.11), but a detrimental association was found with psychological distress at T3 (RR=1.17, 95%CI=1.05-1.30). Poorer psychological distress associated with home working was observed for those educated to below degree level at T2 and T3. Men working from home reported poorer self-reported health at T2. InterpretationNo clear evidence of an association between home working and mental wellbeing was found, apart from greater risk of psychological distress associated with home working during the second lockdown, but differences across sub-groups may exist. Longer term shifts to home working might not have adverse impacts on population wellbeing in the absence of pandemic restrictions but further monitoring of health inequalities is required. FundingNational Core Studies, funded by UKRI, NIHR and the Health and Safety Executive.
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BackgroundEvidence on associations between COVID-19 illness and mental health is mixed. We examined longitudinal associations between COVID-19 and mental health while considering: 1) pre-pandemic mental health, 2) time since infection; 3) subgroup differences; and 4) confirmation of infection via self-reported test, and serology data. MethodsUsing data from 11 UK longitudinal studies, involving 54,442 participants, with 2 to 8 repeated measures of mental health and COVID-19 between April 2020 and April 2021, we standardised continuous mental health scales within each study across time. We investigated associations between COVID-19 (self-report, test-confirmed, serology-confirmed) and mental health using multilevel generalised estimating equations. We examined whether associations varied by age, sex, ethnicity, education and pre-pandemic mental health. Effect-sizes were pooled in random-effects meta-analyses. OutcomesPooled estimates of the standardized difference in outcome between those with and without self-reported COVID-19 suggested associations with subsequent psychological distress (0.10 [95%CI: 0.06; 0.13], I2=42.8%), depression (0.08 [0.05; 0.10], I2=20.8%), anxiety (0.08 [0.05; 0.10], I2=0%), and lower life satisfaction (-0.06 [-0.08; -0.04], I2=29.2%). Associations did not vary by time since infection until 3+ months and were present in all age groups, with some evidence of stronger effects in those aged 50+. Self-reported COVID-19, whether suspected or test-confirmed and irrespective of serology status, was associated with poorer mental health. InterpretationSelf-reporting COVID-19 was longitudinally associated with deterioration in mental health and life satisfaction. Our findings have important implications for mental health service provision, given the substantial prevalence of COVID-19 in the UK and worldwide. FundingMRC and NIHR
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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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BackgroundThe COVID-19 pandemic has led to major economic disruptions. In March 2020, the UK implemented the Coronavirus Job Retention Scheme - known as furlough - to minimize the impact of job losses. We investigate associations between change in employment status and mental and social wellbeing during the early stages of the pandemic. MethodsData were from 25,670 respondents, aged 17 to 66, across nine UK longitudinal studies. Furlough and other employment changes were defined using employment status pre-pandemic and during the first lockdown (April-June 2020). Mental and social wellbeing outcomes included psychological distress, life satisfaction, self-rated health, social contact, and loneliness. Study-specific modified Poisson regression estimates, adjusting for socio-demographic characteristics and pre-pandemic mental and social wellbeing measures, were pooled using meta-analysis. ResultsCompared to those who remained working, furloughed workers were at greater risk of psychological distress (adjusted risk ratio, ARR=1.12; 95% CI: 0.97, 1.29), low life satisfaction (ARR=1.14; 95% CI: 1.07, 1.22), loneliness (ARR=1.12; 95% CI: 1.01, 1.23), and poor self-rated health (ARR=1.26; 95% CI: 1.05, 1.50), but excess risk was less pronounced than that of those no longer employed (e.g., ARR for psychological distress=1.39; 95% CI: 1.21, 1.59) or in stable unemployment (ARR=1.33; 95% CI: 1.09, 1.62). ConclusionsDuring the early stages of the pandemic, those furloughed had increased risk for poor mental and social wellbeing. However, their excess risk was lower in magnitude than that of those who became or remained unemployed, suggesting that furlough may have partly mitigated poorer outcomes.
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BackgroundDisruptions to employment status can impact smoking and alcohol consumption. During the COVID-19 pandemic, the UK implemented a furlough scheme to prevent job loss. We examine how furlough was associated with participants smoking, vaping and alcohol consumption behaviours in the early stages of the pandemic. MethodsData were from 27,841 participants in eight UK adult longitudinal surveys. Participants self-reported employment status and current smoking, current vaping and drinking alcohol (>4 days/week or 5+ drinks per typical occasion) both before and during the pandemic (April-July 2020). Risk ratios were estimated within each study using modified Poisson regression, adjusting for a range of potential confounders, including pre-pandemic behaviour. Findings were synthesised using random effects meta-analysis. Sub-group analyses were used to identify whether associations differed by gender, age or education. ResultsCompared to stable employment, neither furlough, no longer being employed, nor stable unemployment were associated with smoking, vaping or drinking, following adjustment for pre-pandemic characteristics. However, some sex differences in these associations were observed, with stable unemployment associated with smoking for women (ARR=1.35; 95% CI: 1.00-1.82; I2: 47%) but not men (0.84; 95% CI: 0.67-1.05; I2: 0%). No longer being employed was associated with vaping among women (ARR=2.74; 95% CI: 1.59-4.72; I2: 0%) but not men (ARR=1.25; 95% CI: 0.83-1.87; I2: 0%). There was little indication of associations with drinking differing by age, gender or education. ConclusionsWe found no clear evidence of furlough or unemployment having adverse impacts on smoking, vaping or drinking behaviours during the early stages of the COVID-19 pandemic in the UK, with differences in risk compared to those who remained employed largely explained by pre-pandemic characteristics.
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ImportanceHow population mental health has evolved across the COVID-19 pandemic under varied lockdown measures is poorly understood, with impacts on health inequalities unclear. ObjectiveWe investigated changes in mental health and sociodemographic inequalities from before and across the first year of the COVID-19 pandemic in 11 longitudinal studies. Design, Setting and ParticipantsData from 11 UK longitudinal population-based studies with pre-pandemic measures of psychological distress were jointly analysed and estimates pooled. Multi-level regression was used to examine changes in psychological distress from pre-pandemic to during the first year of the COVID-19 pandemic. ExposuresTrends in the prevalence of poor mental health were assessed pre-pandemic (TP0) and at three pandemic time periods: initial lockdown (TP1, Mar-June 20); easing of restrictions (TP2, July-Oct 20); and a subsequent lockdown (TP3, Nov 20-Mar 21). We stratified analyses by sex, ethnicity, education, age, and UK country. Main Outcomes and MeasuresPsychological distress was assessed using the General Health Questionnaire 12 (GHQ-12), Kessler-6, 9-item Malaise Inventory, Short Mood and Feelings Questionnaire (SMFQ), Patient Health Questionnaire-8 and 9 (PHQ-8/9), Hospital Anxiety and Depression Scale (HADS) and Centre for Epidemiological Studies - Depression (CES-D), across different studies. ResultsIn total, 49,993 adult participants (61.2% female; 8.7% Non-White) were analysed. Across the 11 studies, mental health deteriorated from pre-pandemic scores across all three pandemic time periods, but with considerable heterogeneity across the study-specific effect sizes estimated (pooled estimate TP1 Standardised Mean Difference (SMD): 0.15 (95% CI: 0.06, 0.25); TP2 SMD: 0.18 (0.09, 0.27); TP3 SMD: 0.21 (0.10, 0.32)). Changes in psychological distress across the pandemic were higher in females (TP3 SMD: 0.23 (0.11, 0.35)) than males (TP3 SMD: 0.16 (0.06, 0.26)), and lower in below-degree level educated persons at TP3 (SMD: 0.18 (0.06, 0.30)) compared to those who held degrees (SMD: 0.26 (0.14, 0.38)). Increased psychological distress was most prominent amongst adults aged 25-34 and 35-44 years compared to other age groups. We did not find evidence of changes in distress differing by ethnicity or UK country. Conclusions and RelevanceThe substantial deterioration in mental health seen in the UK during the first lockdown did not reverse when lockdown lifted, and a sustained worsening was observed across the pandemic. Mental health declines have been unequal across the population, with females, those with higher degrees, and those aged 25-44 years more affected.
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BackgroundThe impact of long COVID is considerable, but risk factors are poorly characterised. We analysed symptom duration and risk factor from 10 longitudinal study (LS) samples and electronic healthcare records (EHR). MethodsSamples: 6907 adults self-reporting COVID-19 infection from 48,901 participants in the UK LS, and 3,327 adults with COVID-19, were assigned a long COVID code from 1,199,812 individuals in primary care EHR. Outcomes for LS included symptom duration lasting 4+ weeks (long COVID) and 12+ weeks. Association with of age, sex, ethnicity, socioeconomic factors, smoking, general and mental health, overweight/obesity, diabetes, hypertension, hypercholesterolaemia, and asthma was assessed. ResultsIn LS, symptoms impacted normal functioning for 12+ weeks in 1.2% (mean age 20 years) to 4.8% (mean age 63 y) of COVID-19 cases. Between 7.8% (mean age 28 y) and 17% (mean age 58 y) reported any symptoms for 12+ weeks, and greater proportions for 4+ weeks. Age was associated with a linear increased risk in long COVID between 20 and 70 years. Being female (LS: OR=1.49; 95%CI:1.24-1.79; EHR: OR=1.51 [1.41-1.61]), having poor pre-pandemic mental health (LS: OR=1.46 [1.17-1.83]; EHR: OR=1.57 [1.47-1.68]) and poor general health (LS: OR=1.62 [1.25-2.09]; EHR: OR=1.26; [1.18-1.35]) were associated with higher risk of long COVID. Individuals with asthma (LS: OR=1.32 [1.07-1.62]; EHR: OR=1.56 [1.46-1.67]), and overweight or obesity (LS: OR=1.25 [1.01-1.55]; EHR: OR=1.31 [1.21-1.42]) also had higher risk. Non-white ethnic minority groups had lower risk (LS: OR=0.32 [0.22-0.47]), a finding consistent in EHR. . Few participants had been hospitalised (0.8-5.2%). ConclusionLong COVID is associated with sociodemographic and pre-existing health factors. Further investigations into causality should inform strategies to address long COVID in the population.
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BackgroundHealth systems worldwide have faced major disruptions due to COVID-19 which could exacerbate health inequalities. The UK National Health Service (NHS) provides free healthcare and prioritises equity of delivery, but the pandemic may be hindering the achievement of these goals. We investigated associations between multiple social characteristics (sex, age, occupational social class, education and ethnicity) and self-reported healthcare disruptions in over 65,000 participants across twelve UK longitudinal studies. MethodsParticipants reported disruptions from March 2020 up to late January 2021. Associations between social characteristics and three types of self-reported healthcare disruption (medication access, procedures, appointments) and a composite of any of these were assessed in logistic regression models, adjusting for age, sex and ethnicity where relevant. Random-effects meta-analysis was conducted to obtain pooled estimates. ResultsPrevalence of disruption varied across studies; between 6.4% (TwinsUK) and 31.8 % (Understanding Society) of study participants reported any disruption. Females (Odd Ratio (OR): 1.27 [95%CI: 1.15,1.40]; I2=53%), older persons (e.g. OR: 1.39 [1.13,1.72]; I2=77% for 65-75y vs 45-54y), and Ethnic minorities (excluding White minorities) (OR: 1.19 [1.05,1.35]; I2=0% vs White) were more likely to report healthcare disruptions. Those in a more disadvantaged social class (e.g. OR: 1.17 [1.08, 1.27]; I2=0% for manual/routine vs managerial/professional) were also more likely to report healthcare disruptions, but no clear differences were observed by education levels. ConclusionThe COVID-19 pandemic has led to unequal healthcare disruptions, which, if unaddressed, could contribute to the maintenance or widening of existing health inequalities.
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BackgroundIn March 2020 the UK implemented the Coronavirus Job Retention Scheme (furlough) to minimize job losses. Our aim was to investigate associations between furlough and diet, physical activity, and sleep during the early stages of the COVID-19 pandemic. MethodsWe analysed data from 25,092 participants aged 16 to 66 years from eight UK longitudinal studies. Changes in employment (including being furloughed) were defined by comparing employment status pre- and during the first lockdown. Health behaviours included fruit and vegetable consumption, physical activity, and sleeping patterns. Study-specific estimates obtained using modified Poisson regression, adjusting for socio-demographic characteristics and pre-pandemic health and health behaviours, were statistically pooled using random effects meta-analysis. Associations were also stratified by sex, age, and education. ResultsAcross studies, between 8 and 25% of participants were furloughed. Compared to those who remained working, furloughed workers were slightly less likely to be physically inactive (RR:0.85, [0.75-0.97], I2=59%) and did not differ in diet and sleep behaviours, although findings for sleep were heterogenous (I2=85%). In stratified analyses, furlough was associated with low fruit and vegetable consumption among males (RR=1.11; 95%CI: 1.01-1.22; I2: 0%) but not females (RR=0.84; 95%CI: 0.68-1.04; I2: 65%). Considering change in these health behaviours, furloughed workers were more likely than those who remained working to report increased fruit and vegetable consumption, exercise, and hours of sleep. ConclusionsThose furloughed exhibited broadly similar levels of health behaviours to those who remained in employment during the initial stages of the pandemic. There was little evidence to suggest that such social protection policies if used in the post-pandemic recovery period and during future economic crises would have adverse impacts on population health behaviours.
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BackgroundThe COVID-19 pandemic and associated virus suppression measures have disrupted lives and livelihoods and people already experiencing mental ill-health may have been especially vulnerable. AimTo quantify mental health inequalities in disruptions to healthcare, economic activity and housing. Method59,482 participants in 12 UK longitudinal adult population studies with data collected prior to and during the COVID-19 pandemic. Within each study we estimated the association between psychological distress assessed pre-pandemic and disruptions since the start of the pandemic to three domains: healthcare (medication access, procedures, or appointments); economic activity (employment, income, or working hours); and housing (change of address or household composition). Meta-analyses were used to pool estimates across studies. ResultsAcross the analysed datasets, one to two-thirds of participants experienced at least one disruption, with 2.3-33.2% experiencing disruptions in two or more domains. One standard deviation higher pre-pandemic psychological distress was associated with: (i) increased odds of any healthcare disruptions (OR=1.30; [95% CI:1.20-1.40]) with fully adjusted ORs ranging from 1.24 [1.09-1.41] for disruption to procedures and 1.33 [1.20- 1.49] for disruptions to prescriptions or medication access; (ii) loss of employment (OR=1.13 [1.06-1.21]) and income (OR=1.12 [1.06 -1.19]) and reductions in working hours/furlough (OR=1.05 [1.00-1.09]); (iii) no associations with housing disruptions (OR=1.00 [0.97-1.03]); and (iv) increased likelihood of experiencing a disruption in at least two domains (OR=1.25 [1.18-1.32]) or in one domain (OR=1.11 [1.07-1.16]) relative to no disruption. ConclusionPeople experiencing psychological distress pre-pandemic have been more likely to experience healthcare and economic disruptions, and clusters of disruptions across multiple domains during the pandemic. Failing to address these disruptions risks further widening the existing inequalities in mental health.
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BackgroundVaccination is crucial to address the COVID-19 pandemic but vaccine hesitancy could undermine control efforts. We aimed to investigate the prevalence of COVID-19 vaccine hesitancy in the UK population, identify which population subgroups are more likely to be vaccine hesitant, and report stated reasons for vaccine hesitancy. MethodsNationally representative survey data from 12,035 participants were collected from 24th November to 1st December 2020 for wave 6 of the Understanding Society COVID-19 web survey. Participants were asked how likely or unlikely they would be to have a vaccine if offered and their main reason for hesitancy. Cross-sectional analysis assessed prevalence of vaccine hesitancy and logistic regression models conducted. FindingsOverall intention to be vaccinated was high (82% likely/very likely). Vaccine hesitancy was higher in women (21.0% vs 14.7%), younger age groups (26.5% in 16-24 year olds vs 4.5% in 75+) and less educated (18.6% no qualifications vs 13.2% degree qualified). Vaccine hesitancy was particularly high in Black (71.8%), Pakistani/Bangladeshi (42.3%), Mixed (32.4%) and non-UK/Irish White (26.4%) ethnic groups. Fully adjusted models showed gender, education and ethnicity were independently associated with vaccine hesitancy. Odds ratios for vaccine hesitancy were 12.96 (95% CI:7.34, 22.89) in the Black/Black British and 2.31 (95% CI:1.55, 3.44) in Pakistani/Bangladeshi ethnic groups (compared to White British/Irish ethnicity) and 3.24 (95%CI:1.93, 5.45) for people with no qualifications compared to degree educated. The main reason for hesitancy was fears over unknown future effects. InterpretationOlder people at greatest COVID-19 mortality risk expressed the greatest willingness to be vaccinated but Black and Pakistani/Bangladeshi ethnic groups had greater vaccine hesitancy. Vaccine programmes should prioritise measures to improve uptake in specific minority ethnic groups. FundingMedical Research Council Research in contextO_ST_ABSEvidence before this studyC_ST_ABSWe searched Embase and Medline up to November 16, 2020, using key words "vaccine hesitancy" and "COVID-19" or "SARS-CoV-2". Vaccine hesitancy is complex but also context specific. Previous research about vaccine hesitancy relates to existing adult and childhood vaccines, with limited evidence currently available on willingness to be vaccinated for newly available COVID-19 vaccines. Existing vaccination programmes often have lower uptake among more socioeconomically disadvantaged groups. Uptake of vaccines has often varied across ethnic groups, but patterns have often varied across different vaccine programmes. Added value of this studyOur study describes the sub-groups of the UK population who are more likely to be hesitant about a COVID-19 vaccine and examines possible explanations for this. We used nationally representative data from the COVID-19 survey element of the UKs largest household panel study. We asked specifically about vaccine hesitancy in relation to a COVID-19 vaccine at a time when initial results of vaccine trials were being reported in the media. We found willingness to be vaccinated is generally high across the UK population but marked differences exist across population subgroups. Willingness to be vaccinated was greater in older age groups and in men. However, some minority ethnic groups, particularly Black/Black British and Pakistani/Bangladeshi, had high levels of vaccine hesitancy but this was not seen across all minority ethnic groups. People with lower education levels were also more likely to be vaccine hesitant. Implications of all the available evidenceThe current evidence base on vaccine hesitancy in relation to COVID-19 is rapidly emerging but remains limited. Polling data has also found relatively high levels of willingness to take up a COVID-19 vaccine and suggested greater risks of vaccine hesitancy among Black, Asian and Minority Ethnic (BAME) people. Our study suggests that the risk of vaccine hesitancy differs across minority ethnic groups considerably, with Black ethnic groups particularly likely to be vaccine hesitant within the UK. Some White minority ethnic groups are also more likely to be vaccine hesitant than White British/Irish people. Herd immunity may be achievable through vaccination in the UK but a focus on specific ethnic minority and socioeconomic groups is needed to ensure an equitable vaccination programme.