key: cord-0902473-pfflchj2 authors: Patel, Kishan; Robertson, Elaine; Kwong, Alex S. F.; Griffith, Gareth J.; Willan, Kathryn; Green, Michael J.; Di Gessa, Giorgio; Huggins, Charlotte F.; McElroy, Eoin; Thompson, Ellen J.; Maddock, Jane; Niedzwiedz, Claire L.; Henderson, Morag; Richards, Marcus; Steptoe, Andrew; Ploubidis, George B.; Moltrecht, Bettina; Booth, Charlotte; Fitzsimons, Emla; Silverwood, Richard; Patalay, Praveetha; Porteous, David; Katikireddi, Srinivasa Vittal title: Psychological Distress Before and During the COVID-19 Pandemic Among Adults in the United Kingdom Based on Coordinated Analyses of 11 Longitudinal Studies date: 2022-04-22 journal: JAMA Netw Open DOI: 10.1001/jamanetworkopen.2022.7629 sha: d3c634ecbb91648963b760bc938b152dffadbda0 doc_id: 902473 cord_uid: pfflchj2 IMPORTANCE: How population mental health has evolved across the COVID-19 pandemic under varied lockdown measures is poorly understood, and the consequences for health inequalities are unclear. OBJECTIVE: To investigate changes in mental health and sociodemographic inequalities from before and across the first year of the COVID-19 pandemic in 11 longitudinal studies. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included adult participants from 11 UK longitudinal population-based studies with prepandemic measures of psychological distress. Analyses were coordinated across these studies, and estimates were pooled. Data were collected from 2006 to 2021. EXPOSURES: Trends in the prevalence of poor mental health were assessed in the prepandemic period (time period 0 [TP 0]) and at 3 pandemic TPs: 1, initial lockdown (March to June 2020); 2, easing of restrictions (July to October 2020); and 3, a subsequent lockdown (November 2020 to March 2021). Analyses were stratified by sex, race and ethnicity, education, age, and UK country. MAIN OUTCOMES AND MEASURES: Multilevel regression was used to examine changes in psychological distress from the prepandemic period across the first year of the COVID-19 pandemic. Psychological distress was assessed using the 12-item General Health Questionnaire, the Kessler 6, the 9-item Malaise Inventory, the Short Mood and Feelings Questionnaire, the 8-item or 9-item Patient Health Questionnaire, the Hospital Anxiety and Depression Scale, and the Centre for Epidemiological Studies–Depression across different studies. RESULTS: In total, 49 993 adult participants (12 323 [24.6%] aged 55-64 years; 32 741 [61.2%] women; 4960 [8.7%] racial and ethnic minority) were analyzed. Across the 11 studies, mental health deteriorated from prepandemic scores across all 3 pandemic periods, but there was considerable heterogeneity across the study-specific estimated effect sizes (pooled estimate for TP 1: standardized mean difference [SMD], 0.15; 95% CI, 0.06-0.25; TP 2: SMD, 0.18; 95% CI, 0.09-0.27; TP 3: SMD, 0.21; 95% CI, 0.10-0.32). Changes in psychological distress across the pandemic were higher in women (TP 3: SMD, 0.23; 95% CI, 0.11, 0.35) than men (TP 3: SMD, 0.16; 95% CI, 0.06-0.26) and lower in individuals with below–degree level education at TP 3 (SMD, 0.18; 95% CI, 0.06-0.30) compared with those who held degrees (SMD, 0.26; 95% CI, 0.14-0.38). Increased psychological distress was most prominent among adults aged 25 to 34 years (SMD, 0.49; 95% CI, 0.14-0.84) and 35 to 44 years (SMD, 0.35; 95% CI, 0.10-0.60) compared with other age groups. No evidence of changes in distress differing by race and ethnicity or UK country were observed. CONCLUSIONS AND RELEVANCE: In this study, the substantial deterioration in mental health seen in the UK during the first lockdown did not reverse when lockdown lifted, and a sustained worsening was observed across the pandemic period. Mental health declines have been unequal across the population, with women, those with higher degrees, and those aged 25 to 44 years more affected than other groups. BiB: Self-reported depressive symptoms were measured using the PHQ-8 10 . The PHQ-8 is an eightitem, validated tool for the assessment of depressive symptoms experienced in the previous two weeks. Participants are asked to indicate how often they have been bothered by problems such as "Little interest or pleasure in doing things?" on a four-point Likert scale from 0 "Not at all" to 3 "Nearly every day". The score is the sum of the eight items, to a total of 24. A score of 10 or more indicates major depression. The pre-pandemic measure was administered in a clinic setting and subsequent data collection waves were completed by post. The GAD-7 anxiety measure is also used, as described for ALSPAC. Representative 0 = Cohort is representative of one UK country 1 = Cohort is representative of more than one UK country Pre/1st Gap 1 = Pre-pandemic response was less than two years before the first pandemic response 2 = Pre-pandemic response was between two and five years years before the first pandemic response 3 = Pre-pandemic response was between five and seven years before the first pandemic response 4 = Pre-pandemic response was more than seven years before the first pandemic response Short screening scales to monitor population prevalences and trends in non-specific psychological distress Manual of the general health questionnaire: Nfer Nelson The PHQ-9: a new depression diagnostic and severity measure Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners The CES-D scale: A self-report depression scale for research in the general population The hospital anxiety and depression scale The PHQ-8 as a measure of current depression in the general population Validation and Standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the General Population The Avon Longitudinal Study of Parents and Children (ALSPAC): an updated on the enrolled sample of index children in 2019 ALSPAC: Pregnant women resident in Avon, UK with expected dates of delivery 1st April 1991 to 31st December 1992 were invited to take part in the study. The initial number of pregnancies enrolled is 14,541 (for these at least one questionnaire has been returned or a "Children in Focus" clinic had been attended by 19/07/99). Of these initial pregnancies, there was a total of 14,676 foetuses, resulting in 14,062 live births and 13,988 children who were alive at 1 year of age. When the oldest children were approximately 7 years of age, an attempt was made to bolster the initial sample with eligible cases who had failed to join the study originally. As a result, when considering variables collected from the age of seven onwards (and potentially abstracted from obstetric notes) there are data available for more than the 14,541 pregnancies mentioned above. The number of new pregnancies not in the initial sample (known as Phase I enrolment) that are currently represented on the built files and reflecting enrolment status at the age of 24 is 913 (456, 262 and 195 recruited during Phases II, III and IV respectively), resulting in an additional 913 children being enrolled. The phases of enrolment are described in more detail in the cohort profile paper and its update (see footnote 4 below). The total sample size for analyses using any data collected after the age of seven is therefore 15,454 pregnancies, resulting in 15,589 foetuses. Of these 14,901 were alive at 1 year of age. A 10% sample of the ALSPAC cohort, known as the Children in Focus (CiF) group, attended clinics at the University of Bristol at various time intervals between 4 to 61 months of age. The CiF group were chosen at random from the last 6 months of ALSPAC births (1432 families attended at least one clinic). Excluded were those mothers who had moved out of the area or were lost to follow-up, and those partaking in another study of infant development in Avon12.