Mental health and health behaviours before and during the initial phase of the COVID-19 lockdown: longitudinal analyses of the UK Household Longitudinal Study

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Abstract

There are concerns that COVID-19 mitigation measures, including the ‘lockdown’, may have unintended health consequences. We examined trends in mental health and health behaviours in the UK before and during the initial phase of the COVID-19 lockdown and differences across population subgroups.

Methods

Repeated cross-sectional and longitudinal analysis of the UK Household Longitudinal Study, including representative samples of over 27,000 adults (aged 18+) interviewed in four survey waves between 2015 and 2020. A total of 9748 adults had complete data for longitudinal analyses. Outcomes included psychological distress (General Health Questionnaire-12), loneliness, current cigarette smoking, use of e-cigarettes and alcohol consumption. Cross-sectional prevalence estimates were calculated and multilevel Poisson regression assessed associations between time period and the outcomes of interest, as well as differential associations by age, gender, education level and ethnicity.

Results

Psychological distress increased 1 month into lockdown with the prevalence rising from 19.4% (95% CI 18.7% to 20.1%) in 2017–2019 to 30.6% (95% CI 29.1% to 32.3%) in April 2020 (RR=1.3, 95% CI 1.2 to 1.4). Groups most adversely affected included women, young adults, people from an Asian background and those who were degree educated. Loneliness remained stable overall (RR=0.9, 95% CI 0.6 to 1.5). Smoking declined (RR=0.9, 95% CI=0.8,1.0) and the proportion of people drinking four or more times per week increased (RR=1.4, 95% CI 1.3 to 1.5), as did binge drinking (RR=1.5, 95% CI 1.3 to 1.7).

Conclusions

Psychological distress increased 1 month into lockdown, particularly among women and young adults. Smoking declined, but adverse alcohol use generally increased. Effective measures are required to mitigate negative impacts on health.

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  1. SciScore for 10.1101/2020.06.21.20136820: (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

    Software and Algorithms
    SentencesResources
    Covariates: We adjusted for a range of potential confounders that were likely causes of the outcomes and that did not lie on the causal pathway between lockdown and the outcomes: age group (18-24, 25-44, 45-64, 65+ years at wave 9) and self-reported gender (male/female).
    Covariates
    suggested: None

    Results from OddPub: Thank you for sharing your data.


    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Some limitations should be noted. First, survey non-participation may have introduced bias in our estimates, especially as the response rate in the COVID survey was lower than usual. However, weights were used to reduce concerns about non-response and attrition. Second, there were changes in the modality by which the COVID survey was administered (moving from mixed mode (face-to-face, web and phone) to online surveys)), which may have led to modest reporting changes. However, empirical investigation suggested this is unlikely to have biased responses.22 Relatedly, there were minor changes to the questionnaire items about alcohol consumption, so that questions related to the pandemic period rather than the entire previous year. This meant that a modified version of the AUDIT-C scale was used, which is not strictly comparable with previous years and so these initial results should be interpreted with caution. Alcohol consumption is also known to be under-reported in surveys.23,24 The pandemic context may have also influenced participant reporting more broadly. For example, the increase in being less able to enjoy usual activities may not reflect anhedonia, but rather the reality of experiencing lockdown and could be considered a normal response. Relatedly, what people perceive as a ‘typical’ drinking day is likely to have changed, especially among younger people, which could explain the conflicting results for this measure of alcohol consumption. While a body of literature is d...

    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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