Mental health in relation to changes in sleep, exercise, alcohol and diet during the COVID-19 pandemic: examination of four UK cohort studies
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Abstract
Background
Responses to the COVID-19 pandemic have included lockdowns and social distancing with considerable disruptions to people's lives. These changes may have particularly impacted on those with mental health problems, leading to a worsening of inequalities in the behaviours which influence health.
Methods
We used data from four national longitudinal British cohort studies ( N = 10 666). Respondents reported mental health (psychological distress and anxiety/depression symptoms) and health behaviours (alcohol, diet, physical activity and sleep) before and during the pandemic. Associations between pre-pandemic mental ill-health and pandemic mental ill-health and health behaviours were examined using logistic regression; pooled effects were estimated using meta-analysis.
Results
Worse mental health was related to adverse health behaviours; effect sizes were largest for sleep, exercise and diet, and weaker for alcohol. The associations between poor mental health and adverse health behaviours were larger during the May lockdown than pre-pandemic. In September, when restrictions had eased, inequalities had largely reverted to pre-pandemic levels. A notable exception was for sleep, where differences by mental health status remained high. Risk differences for adverse sleep for those with the highest level of prior mental ill-health compared to those with the lowest were 21.2% (95% CI 16.2–26.2) before lockdown, 25.5% (20.0–30.3) in May and 28.2% (21.2–35.2) in September.
Conclusions
Taken together, our findings suggest that mental health is an increasingly important factor in health behaviour inequality in the COVID era. The promotion of mental health may thus be an important component of improving post-COVID population health.
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SciScore for 10.1101/2021.03.26.21254424: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and Limitations: Our study benefits from a large sample of participants from four UK cohort studies, spanning from age 19 to age 62. Because these cohorts have been followed longitudinally prior to the pandemic it was …
SciScore for 10.1101/2021.03.26.21254424: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and Limitations: Our study benefits from a large sample of participants from four UK cohort studies, spanning from age 19 to age 62. Because these cohorts have been followed longitudinally prior to the pandemic it was possible to examine previous measures of mental health and not just mental health concurrent with the pandemic. It is to our knowledge the first study to provide evidence on the effect of the pandemic on widening health behaviour inequalities based on mental health in the UK. Whilst this study has many strengths it is important to carefully consider its limitations. As in many other COVID-19 surveys, fieldwork was planned and carried out rapidly. The online format used is likely to have contributed to the low response rates also observed in other comparable national studies (Niedzwiedz et al., 2021). While non-response weights (developed using individual and demographic data from previous sweeps) were used in analyses, we cannot fully exclude the possibility of there being unobserved predictors of missing data influencing our results. Other limitations relate to the self-reported the measures of health behaviours and mental health. In terms of health behaviours, although the recall period for pre-pandemic health behaviours was short, recall bias may have affected these measures. And it is possible that those with mental health problems may be especially affected by such recall bias, and respond differentially to health questions, potentially biasing as...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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