Disruption of long-term psychological distress trajectories during the COVID-19 pandemic: evidence from three British birth cohorts

  1. Darío Moreno-Agostino
  2. Helen L. Fisher
  3. Alissa Goodman
  4. Stephani L Hatch
  5. Craig Morgan
  6. Marcus Richards
  7. Jayati Das-Munshi
  8. George B. Ploubidis

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Abstract

Importance

Mental health disorders were among the leading global contributors to years lived with disability prior to the COVID-19 pandemic onset, and growing evidence suggests that population mental health outcomes have worsened since the pandemic started. The extent that these changes have altered common age-related trends in psychological distress, where distress typically rises until mid-life and then falls in both sexes, is unknown.

Objective

To analyse whether long-term pre-pandemic psychological distress trajectories have altered during the pandemic, and whether these changes have been different across generations and by sex.

Design

Cross-cohort study with prospective data collection over a 40-year period (earliest time point: 1981; latest time point: February/March 2021).

Setting

Population-based (adult general population), Great Britain.

Participants

Members of three nationally representative birth cohorts which comprised all people born in Great Britain in a single week of 1946, 1958, or 1970, and who participated in at least one of the data collection waves conducted after the start of the pandemic (40.6%, 42.8%, 39.4%, respectively).

Exposure(s)

Time, COVID-19 pandemic.

Main Outcome(s) and Measure(s)

Psychological distress factor scores, as measured by validated self-reported questionnaires.

Results

16,389 participants (2,175 from the 1946 birth cohort, 52.8% women; 7,446 from the 1958 birth cohort, 52.4% women; and 6,768 from the 1970 birth cohort, 56.2% women) participated in the study. By September/October 2020, psychological distress levels had reached or exceeded the levels of the peak in the pre-pandemic life-course trajectories, with larger increases in younger cohorts: Standardised Mean Differences (SMD) and 95% confidence intervals (CIs) of -0.02 [-0.07, 0.04], 0.05 [0.02, 0.07], and 0.09 [0.07, 0.12] for the 1946, 1958, and 1970 birth cohorts, respectively. Increases in distress were larger among women than men, widening the pre-existing inequalities observed in the pre-pandemic peak and in the most recent pre-pandemic assessment.

Conclusions and Relevance

Pre-existing long-term psychological distress trajectories of adults born between 1946 and 1970 were disrupted during the COVID-19 pandemic, particularly among women, who reached the highest levels ever recorded in up to 40 years of follow-up data. This may impact future trends of morbidity, disability, and mortality due to common mental health problems.

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    SciScore for 10.1101/2022.04.22.22274164: (What is this?)

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

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: Our study has several strengths. It is, to the best of our knowledge, the longest longitudinal study of psychological distress trajectories to date, following the same individuals for up to 40 years and showing the unique effect of the pandemic over the life-course. Using data from birth cohorts enabled us to understand the potential impact of the COVID-19 pandemic in the context of the distress levels experienced by the same individuals throughout their adulthood prior to the pandemic’s onset, with data collected prospectively, and a high degree of generalisability, due to the cohorts being nationally representative. Through the use of an IRT-based linking approach leveraging the existence of common distress indicators across the birth cohorts used, we were able to increase the comparability across these cohorts compared to previous evidence.14 By using multiple operationalisations of psychological distress, including but not limited to binary outcomes, we qualify previous evidence focused on the latter,8 showing that our main results are robust to these different operationalisations while acknowledging the differences across them. Our study also has limitations. As expected in cohort designs, our study suffered from high proportions of attrition with respect to the original samples. To limit the impact of attrition, we used non-response weights which have been found to be effective at restoring sample representativeness with respect to the charact...

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    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
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    • No protocol registration statement was detected.

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  2. Version published to 10.1101/2022.04.22.22274164v1 on medRxiv