Factors associated with self-reported anxiety, depression, and general health during the UK lockdown; a cross-sectional survey

  1. Louise E. Smith
  2. Richard Amlot
  3. Helen Lambert
  4. Isabel Oliver
  5. Charlotte Robin
  6. Lucy Yardley
  7. G James Rubin

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Abstract

Background

To investigate factors associated with anxiety, depression, and self-reported general health during “lockdown” due to COVID-19 in the UK.

Methods

Online cross-sectional survey of a nationally-representative sample of 2240 participants living in the UK aged 18 years or over (data collected 6-7 May 2020). Participants were recruited from YouGov’s online research panel.

Outcomes

In this sample, 21·9% (n=458, 95% CI [20·1% to 23·7%]) reported probable anxiety (scored three or over on the GAD-2); while 23·5% (n=494, 95% CI [21·7% to 25·3]) reported probable depression (scored three or over on the PHQ-2). Poorer mental health was associated with greater financial hardship during the lockdown, thinking that you would lose contact with friends or family if you followed Government measures, more conflict with household members during the lockdown, less sense of community with people in your neighbourhood, and lower perceived effectiveness of Government measures. Females and those who were younger were likely to report higher levels of anxiety and depression. The majority of participants reported their general health as “good” (as measured by the first item of the SF-36). Poorer self-reported general health was associated with psychological distress, greater worry about COVID-19 and markers of inequality.

Interpretation

Rates of self-reported anxiety and depression in the UK during the lockdown were greater than population norms. Reducing financial hardship, promoting social connectedness, and increasing solidarity with neighbours and household members may help ease rifts within the community which are associated with distress, thereby improving mental health. Reducing inequality may also improve general health.

RESEARCH IN CONTEXT

Evidence before this study

  • Quarantine is associated with adverse psychological outcomes.

  • Psychological distress during quarantine is associated with greater financial loss, greater perceived susceptibility to and severity of the illness, and greater frustration and boredom during quarantine.

  • Measures put in place to prevent the spread of COVID-19 have highlighted existing inequalities in society, disproportionally affecting younger people, those in lower-income households, and Black and minority ethnic groups.

  • Research in the UK and other countries indicates that rates of anxiety and depression during restrictions of movement such as “lockdown” measures are higher than population norms.

Added value of this study

  • In this study, 22% of the sample reported anxiety, while 24% reported depression. Normative data indicate that these rates are usually approximately 5% and 7% respectively.

  • Factors associated with psychological distress included greater financial hardship, poorer social connectedness, greater conflict within the household and the wider neighbourhood, being female and of younger age.

  • Self-reported general health in the sample was “good” on average. Factors associated with poorer self-reported general health included markers of inequality and greater worry about COVID-19.

Implications of all the available evidence

  • Decreasing the financial impact of measures put in place to prevent the spread of COVID-19 may help improve mental health.

  • Interventions promoting social connectedness in isolated young people and measures that increase household and neighbourhood solidarity may help improve mental health.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.06.23.20137901: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethics: Ethical approval for this study was granted by the King’s College London Research Ethics Committee (reference: LRS-19/20-18687).
    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:
    This study has several limitations. First, while quota sampling was used and data were weighted to increase representativeness of the sample to the UK general population, we cannot be certain that views of survey respondents are representative of views of the general population.30,31 However, associations within the data still provide useful insights.12 Second, the cross-sectional nature of this study means that we are unable to imply causality. Third, we investigated self-reported general health using the first item of the SF-36, rather than the complete measure. Therefore, we were not able to compare data to population norms.32 This decision was taken due to time and space restrictions for the survey. Fourth, we calculated rates of probable anxiety and depression based on scores from self-report scales (GAD-2 and PHQ-2 respectively). However, these scales have been validated and are widely used as screening tools for psychological ill-health.16,17 Fifth, we did not measure ethnicity and so cannot say if mental health was differentially affected in different ethnic groups. While we cannot be certain of the exact prevalence, rates of probable anxiety and depression in the UK were substantially higher during the lockdown than population norms. Most people rated their general health as “good”. Data suggest that psychological distress was associated with greater financial hardship, lower social support and greater conflict. Psychological distress was also associated with sociode...

    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.

  2. Version published to 10.1101/2020.06.23.20137901v1 on medRxiv