‘When will this end? Will it end?’ The impact of the March–June 2020 UK COVID-19 lockdown response on mental health: a longitudinal survey of mothers in the Born in Bradford study

  1. Josie Dickerson
  2. Brian Kelly
  3. Bridget Lockyer
  4. Sally Bridges
  5. Christopher Cartwright
  6. Kathryn Willan
  7. Katy Shire
  8. Kirsty Crossley
  9. Maria Bryant
  10. Najma Siddiqi
  11. Trevor A Sheldon
  12. Deborah A Lawlor
  13. John Wright
  14. Rosemary RC McEachan
  15. Kate E Pickett

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Abstract

To explore clinically important increases in depression/anxiety from before to during the first UK COVID-19 lockdown and factors related to this change, with a particular focus on ethnic differences.

Design

Pre-COVID-19 and lockdown surveys nested within two longitudinal Born in Bradford cohort studies.

Participants

1860 mothers with a child aged 0–5 or 9–13, 48% Pakistani heritage.

Main outcome measures

ORs for a clinically important increase (5 points or more) in depression (eight item Patient Health Questionnaire (PHQ-8)) and anxiety (Generalised Anxiety Disorder Assessment (GAD-7)) in unadjusted regression analyses, repeated with exposures of interest separated by ethnicity to look for differences in magnitude of associations, and lived experience of mothers captured in open text questions.

Results

The number of women reporting clinically important depression/anxiety increased from 11% to 20% (95% CI 10%–13%; 18%–22%) and from 10% to 16% (95% CI 8%–11%; 15%–18%), respectively. Increases in depression/anxiety were associated with loneliness (OR=8.37, 95% CI 5.70 to 12.27; 8.50, 95% CI 5.71 to 12.65, respectively); financial (6.23, 95% CI 3.96 to 9.80; 6.03, 95% CI 3.82 to 9.51), food (3.33, 95% CI 2.09 to 5.28; 3.46, 95% CI 2.15 to 5.58) and housing insecurity (3.29, 95% CI 2.36 to 4.58; 3.0, 95% CI 2.11 to 4.25); a lack of physical activity (3.13, 95% CI 2.15 to 4.56; 2.55, 95% CI 1.72 to 3.78); and a poor partner relationship (3.6, 95% CI 2.44 to 5.43; 5.1, 95% CI 3.37 to 7.62). The magnitude of associations between key exposures and worsening mental health varied between ethnic groups.

Responses to open text questions illustrated a complex interplay of challenges contributing to mental ill health including: acute health anxieties; the mental load of managing multiple responsibilities; loss of social support and coping strategies; pressures of financial and employment insecurity; and being unable to switch off from the pandemic.

Conclusions

Mental ill health has worsened for many during the COVID-19 lockdown, particularly in those who are lonely and economically insecure. The magnitude of associations between key exposures and worsening mental health varied between ethnic groups. Mental health problems may have longer term consequences for public health and interventions that address the potential causes are needed.

Article activity feed

  1. Version published to 10.1136/bmjopen-2020-047748
  2. Version published to 10.1101/2020.11.30.20239954v3 on medRxiv
  3. Version published to 10.1101/2020.11.30.20239954v2 on medRxiv
  4. ScreenIT

    SciScore for 10.1101/2020.11.30.20239954: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: For the Covid-19 survey, verbal consent was taken for questionnaires completed over the phone and implied consent was assumed for all questionnaires completed via post or online.
    IRB: Ethics: This study was approved by the HRA and Bradford/Leeds research ethics committee (Substantial amendments to: BiBGU 16/YH/0320 and BiBBS 15/YH/0455)
    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:
    Study strengths and limitations in comparison to other studies: This is a longitudinal study containing linked data collected before the Covid-19 pandemic and at the beginning of the March-June 2020 lockdown which has allowed us to explore change over that time period. It also provides findings from a highly ethnically diverse population, the majority of whom live in the most deprived centiles in the UK. We are not aware of other studies that have explored longitudinal change in mental health from pre- to during- the Covid-19 lock down in a similar ethnically diverse deprived population Respondents were mothers of children aged 0-5 and/or 9-13 which may limit the wider generalizability, though our findings are broadly similar to those from a previous longitudinal study of two UKC cohorts that included adult men and women (not all of whom were mothers), and found the increased risk of poor mental health in lockdown to be greater in women4. Our pre-COVID19 measures were taken from data collected over the past 4 years, so we cannot with confidence attribute all changes to the pandemic and the lockdown. For example, it is possible that some of the difference reflects age related change in the women and/or their children over time. It is also possible that we have underestimated some of the adverse impact of lockdown as a significant percentage of the participants were pregnant at baseline, which itself is associated with raised levels of depression. However, the deterioration in ...

    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

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  5. Version published to 10.1101/2020.11.30.20239954v1 on medRxiv