Mental health outcomes following COVID-19 infection: Evidence from 11 UK longitudinal population studies

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

Risk factors for long COVID: analyses of 10 longitudinal studies and electronic health records in the UK

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.

Inequalities in healthcare disruptions during the Covid-19 pandemic: Evidence from 12 UK population-based longitudinal studies

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.

Mental health inequalities in healthcare, economic, and housing disruption during COVID -19: an investigation in 12 longitudinal studies

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.

The impact of asthma on mental health & wellbeing during COVID-19 lockdown

IntroductionThe global SARS CoV2 pandemic resulted in social isolation measures with unintended negative impacts, particularly on mental health. We hypothesised that people with asthma are likely to be more vulnerable to worse mental health during lockdown. MethodsWe examined COVID-19 surveys (completed April/May 2020), nested within two generations of the Avon Longitudinal Study of Parents and Children (ALSPAC): index-generation ALSPAC-G1 (n= 2942, mean age=28) and the parents generation ALSPAC-G0 (n=3737, mean age=59). We used Poisson and logistic regression models to estimate the effect of asthma on wellbeing, anxiety and depression, and factors related to COVID-19 and lockdown. Models were adjusted for validated pre-pandemic measures of mental health and socio-economic factors. ResultsAsthma was associated with a 13% increase in depression score in ALSPAC-G1 (p=0.005) and 15% increase in ALSPAC-G0 (p=0.05) compared to participants without asthma, anxiety scores increased by 14% in ALSPAC-G1 (p=0.005) and by 16% in ALSPAC-G0 (p=0.02). Asthma was associated with a similar increase of anxiety and depression scores during COVID-19 in both generations (Z test p values >0.80). DiscussionPeople with asthma have worse mental health & wellbeing during lockdown compared to people without asthma. Although the effect of asthma on mental health is of similar magnitude between the generations, younger participants with asthma declined to lower levels of mental health despite reporting less symptoms, COVID-19 infection and self-isolation. This has important implications given repeated lockdowns. Young people with asthma should be closely monitored and supported to mitigate the impact of lockdown on their mental health. Key Messages What is the question?What is the impact of asthma on mental health & wellbeing during COVID-19 pandemic? What is the bottom line?People living with asthma report worse wellbeing, anxiety and depression in lockdown compared to those without asthma, the effect is not entirely explained by pre-existing mental health problems, physical symptoms or COVID-19 infections. Why read on?Young people living with asthma are more likely to report concerns about susceptibility to COVID 19 and job security. The negative impact of asthma on length of self-isolation, suspected COVID and symptoms appears greater in older people with asthma.