How are adversities during COVID-19 affecting mental health? Differential associations for worries and experiences and implications for policy

  1. Liam Wright
  2. Andrew Steptoe
  3. Daisy Fancourt

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Abstract

Importance

Multiple data sources suggest that COVID-19 is having adverse effects on mental health. But it is vital to understand what is causing this: worries over potential adversities due to the pandemic, or the toll of experiencing adverse events.

Objective

To explore the time-varying longitudinal relationship between (i) worries about adversity, and (ii) experience of adversity, and both anxiety and depression and test the moderating role of socio-economic position.

Design

Longitudinal cohort study

Setting

Community study

Participants

A well-stratified sample of UK adults recruited into the UCL COVID -19 Social Study (a panel study collecting data weekly during the Covid-19 pandemic) via a combination of convenience and targeted recruitment. The sample was weighted to population proportions of gender, age, ethnicity, education and geographical location.

Exposures

Worries or experiences of adversities during the COVID-19 pandemic

Outcomes

Anxiety (GAD-7) and depression (PHQ-9)

Results

Data were analysed from 41,909 UK adults (weighted data: 51% female, aged 18-99) followed up across 6 weeks (178,430 observations). Using fixed effects regression was used to explore within-person variation over time, cumulative number of worries and experience of adversities were both related to higher levels of anxiety and depression. Number of worries were associated more with anxiety than depression, but number of experiences were equally related to anxiety and depression. Individuals of lower socio-economic position were more negatively affected psychologically by adverse experiences.

Conclusions & relevance

Measures over the first few weeks of lockdown in the UK appear to have been insufficient at reassuring people given we are still seeing clear associations with poor mental health both for cumulative worries and also for a range of specific worries relating to finance, access to essentials, personal safety and COVID-19. Interventions are required that both seek to prevent adverse events (e.g. redundancies) and that reassure individuals and support adaptive coping strategies.

Key points

Question

How do worries over potential adversities due to the COVID-19 pandemic, or the toll of experiencing adverse events affect mental health?

Findings

Cumulative number of worries and experience of adversities were both related to higher levels of anxiety and depression during COVID-19, especially amongst individuals of lower socio-economic position.

Meaning

During a pandemic, interventions are required that both seek to prevent adverse events (e.g. redundancies) and that reassure individuals and support adaptive coping strategies.

Article activity feed

  1. Version published to 10.1101/2020.05.14.20101717v2 on medRxiv
  2. ScreenIT

    SciScore for 10.1101/2020.05.14.20101717: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the UCL Research Ethics Committee [12467/005] and all participants gave informed consent.
    Consent: The study was approved by the UCL Research Ethics Committee [12467/005] and all participants gave informed consent.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot 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:
    However, the study had several limitations. Our sampling was not random, so although we deliberately sampled from groups such as individuals of low SEP and individuals with existing mental illness, it is possible that more extreme experiences were not adequately captured in the study. It is also possible that individuals experiencing particularly extreme situations during the lockdown withdrew from the study. While our statistical method means their data is still included, we would lack longitudinal follow-up on their changing experiences. We also focused on just six types of adversities, including those relating to health, safety, finances and basic needs. However, many other types of adversity were not included in the study, including those relating to interpersonal relationships, displacement, and bereavement. Finally, our study only followed individuals up for a few weeks looking at the immediate associations with mental health. As such, it remains for future studies to assess how experience of adversities during the COVID-19 pandemic relates to long-term mental health consequences. Overall, the finding that mental health was associated both with experiences and worries about adversities suggests that interventions are required that both seek to prevent adverse events (such as loss of jobs) but also that reassure individuals and support adaptive coping strategies. This appears to be particularly important for managing anxiety, where provision of online cognitive-behaviour...

    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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.05.14.20101717v1 on medRxiv