Mental health before and during the COVID-19 pandemic in two longitudinal UK population cohorts

  1. Alex S. F. Kwong
  2. Rebecca M. Pearson
  3. Mark J. Adams
  4. Kate Northstone
  5. Kate Tilling
  6. Daniel Smith
  7. Chloe Fawns-Ritchie
  8. Helen Bould
  9. Naomi Warne
  10. Stanley Zammit
  11. David J. Gunnell
  12. Paul A. Moran
  13. Nadia Micali
  14. Abraham Reichenberg
  15. Matthew Hickman
  16. Dheeraj Rai
  17. Simon Haworth
  18. Archie Campbell
  19. Drew Altschul
  20. Robin Flaig
  21. Andrew M. McIntosh
  22. Deborah A. Lawlor
  23. David Porteous
  24. Nicholas J. Timpson

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Abstract

The COVID-19 pandemic and mitigation measures are likely to have a marked effect on mental health. It is important to use longitudinal data to improve inferences.

Aims

To quantify the prevalence of depression, anxiety and mental well-being before and during the COVID-19 pandemic. Also, to identify groups at risk of depression and/or anxiety during the pandemic.

Method

Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC) index generation ( n = 2850, mean age 28 years) and parent generation ( n = 3720, mean age 59 years), and Generation Scotland ( n = 4233, mean age 59 years). Depression was measured with the Short Mood and Feelings Questionnaire in ALSPAC and the Patient Health Questionnaire-9 in Generation Scotland. Anxiety and mental well-being were measured with the Generalised Anxiety Disorder Assessment-7 and the Short Warwick Edinburgh Mental Wellbeing Scale.

Results

Depression during the pandemic was similar to pre-pandemic levels in the ALSPAC index generation, but those experiencing anxiety had almost doubled, at 24% (95% CI 23–26%) compared with a pre-pandemic level of 13% (95% CI 12–14%). In both studies, anxiety and depression during the pandemic was greater in younger members, women, those with pre-existing mental/physical health conditions and individuals in socioeconomic adversity, even when controlling for pre-pandemic anxiety and depression.

Conclusions

These results provide evidence for increased anxiety in young people that is coincident with the pandemic. Specific groups are at elevated risk of depression and anxiety during the COVID-19 pandemic. This is important for planning current mental health provisions and for long-term impact beyond this pandemic.

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  1. ScreenIT

    SciScore for 10.1101/2020.06.16.20133116: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIACUC: Ethical approval for the study was obtained from the ALSPAC Ethics and Law Committee and the Local Research Ethics Committees. Generation Scotland: Scottish Family Health Study (GS) is a family longitudinal study of 24,084 individuals recruited across Scotland between 2006 and 2011.[20] Participants were recruited into the study if they were aged 18 or over.
    IRB: Ethical approval for the study was approved by NHS Tayside Committee on Medical Research Ethics (reference 05/S1401/89).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableThe Avon Longitudinal Study of Parents and Children (ALSPAC) is an ongoing longitudinal population-based study that recruited pregnant women residing in Avon in the south-west of England with expected delivery dates between 1st April 1991 and 31st December 1992.

    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:
    There are several limitations to this work. Firstly, as the pandemic is a universal exposure, it is difficult to attribute factors to the impact of the COVID-19 pandemic specifically, with many factors likely to show an association with later depression and anxiety at any time. [31] However, using longitudinal data and methods, we were able to demonstrate that anxiety and lower wellbeing were worse during COVID-19 than expected, given the comparison between baseline and pandemic assessments, so it is unlikely these effects are not related to COVID-19. Secondly, there were heterogeneous measurements of mental health in COVID-19 specific surveys and baseline, as well as differences in the length of follow up across cohorts. This poses a challenge in inferring strong conclusions on change and specificity of findings to generations or cohorts. However, several sensitivity analyses in both cohorts and exploring different baselines reached similar conclusions. Thirdly, we were only able to assess change over the pandemic in ALSPAC-G1. Therefore, our inferences may only be relevant to young adult populations. However, given the replication between younger ages and higher rates of depression and anxiety, it is likely these effects will be observed in other studies. Fourthly, although we were able to use existing data such as educational background to predict baseline missingness and use such variables in imputation models, we did not impute further than the sample with complete COVID...

    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 10.1192/bjp.2020.242
  3. ScreenIT

    SciScore for 10.1101/2020.06.16.20133116: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementEthical approval for the study was obtained from the ALSPAC Ethics and Law Committee and the Local Research Ethics Committees . Generation Scotland: Scottish Family Health Study ( GS ) is a family longitudinal study of 24,084 individuals recruited across Scotland between 2006 and 2011 . [ 20 ] Participants were recruited into the study if they were aged 18 or over .Randomizationnot detected.Blindingnot detected.Power Analysisnot detected.Sex as a biological variableIn both ALSPAC and GS , depression and anxiety were greater in younger populations , women , those with pre-existing mental and physical health conditions , those living alone and in socio-economic adversity .

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    A comprehensive list of grants funding is available on the ALSPAC website (http://www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf).
    ALSPAC
    suggested: (ALSPAC, SCR_007260)
    Part of this data was collected using REDCap, see the REDCap website for details https://projectredcap.org/resources/citations/).
    REDCap
    suggested: (REDCap, SCR_003445)

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

    • There are several limitations to this work.
    • Firstly, as the pandemic is a universal exposure, it is 325 difficult to attribute factors to the impact of the COVID-19 pandemic specifically, with many factors 326 likely to show an association with later depression and anxiety at any time.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    Results from OddPub: We did not find a statement about open data. We also did not find a statement about open code. Researchers are encouraged to share open data when possible (see Nature blog).

    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 is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2020.06.16.20133116v1 on medRxiv