Mental health responses to the COVID-19 pandemic: a latent class trajectory analysis using longitudinal UK data

Matthias Pierce, Sally McManus, Holly Hope, Matthew Hotopf, Tamsin Ford, Stephani Hatch, Ann John, Evangelos Kontopantelis, Roger T. Webb, Simon Wessely, Kathryn Abel

Research output: Contribution to journalArticlepeer-review

Abstract

Background

The UK population’s mental health declined at the pandemic onset. Convenience sample surveys indicate recovery began soon after. Using a probability sample, we tracked average mental health during the pandemic, characterised distinct mental health trajectories, and identified predictors of deterioration.

Methods

Secondary analysis of five waves of UK Household Longitudinal Survey from late April-early October 2020 and pre-pandemic data, 2018-2019. Mental health was assessed in 19,763 adults (≥16 years, 11,477 women and 3,453 from ethnic minority groups) using 12-item General Health Questionnaire. Latent class mixed models identified discrete mental health trajectories and fixed-effects regression identified predictors of change in mental health.

Findings

Average population mental health deteriorated with onset of the pandemic and did not begin improving until July 2020. Latent class analysis identified five distinct mental health trajectories up to October 2020. The majority had consistently good (39·3%) or very good (37·5%) mental health. A ‘recovery’ group (12·0%) initially experienced a marked decline in mental health, improving to their pre-pandemic levels by October. For 7·0%, mental health steadily deteriorated during the pandemic and for 4·1% it initially declined then remained very poor throughout. These two groups were more likely to have pre-existing mental or physical ill-health, to live in deprived neighbourhoods and be non-white. Infection with SARS-CoV-2, local lockdown, and financial difficulties all predicted subsequent deterioration in mental health.

Interpretation

Between April-October 2020, the mental health of most UK adults remained resilient or returned to pre-pandemic levels. One-in-ten experienced deteriorating or consistently poor mental health. People living in areas affected by lockdown, struggling financially, with pre-existing conditions or infection with SARS-CoV-2 might benefit most from early intervention.

Evidence before this study

We searched Embase, Psychinfo and Medline for articles published in English between Jan 1 2020 and Jan 31, 2021 that contained terms relating to mental illness (`psychiatr*’ or ‘mental’ or `distress’ or `depression’ or `anxiety’), COVID, and longitudinal analysis (‘trajector*’ or `longitudinal’ or `latent curve’). Of 496 studies retrieved, only 13 conducted a trend analysis. Studies with a pre-pandemic baseline showed that population mental health deteriorated with the onset of the pandemic in the UK, US, China and other European countries. Most studies were drawn from convenience samples where participants are recruited according to ease of access. UK studies conducted on trends since the beginning of the pandemic indicated a pattern of immediate recovery in the population overall and in all subgroups (gender, age, employment status and other deprivation measures). However, studies that rely on follow-up from convenience samples might be biased towards a positive trend in mental health because study attrition is more likely among those with poor or deteriorating mental health.

Added value of this study

This study used a longitudinal, probability sample survey to map the overall mental health trajectory in the first five months of the pandemic and to distinguish the different mental health trajectories individuals tended to follow. Overall, we found the elevated rates of poor mental health were sustained, with significant improvements occurring only from July 2020 (when UK schools reopened, infection rates fell, and significant relaxation of lockdown measures occurred). This study revealed that, while most of the population either remained resilient, or reacted and recovered within the first six months of the pandemic, there are two groups of continuing concern. In one, individuals’ mental health deteriorated rapidly at the onset of the pandemic and showed no sign of recovery; the other group comprised people whose mental health progressively worsened month on month during the pandemic. Infection with SARS-CoV-2, prior poor physical and/or mental health conditions, and financial difficulties predicted subsequent deterioration in mental health during the pandemic.

Implications of all the available evidence

While the mental health of the population as a whole improved after the initial reaction to the pandemic, this recovery took some months and the overall trend masks sustained and dynamic distinct patterns of change. This is in contrast to information presented from convenience samples that showed an immediate improvement. We conclude that this difference is because convenience samples are likely biased because they have high levels of attrition and participants with poor or deteriorating mental health more commonly drop out. Two groups showed no signs of recovery and manifested symptom severity potentially warranting clinical intervention. Socioeconomic pressures - both area-level deprivation and individual financial struggles - emerged as risk factors for deteriorating mental health during the pandemic, highlighting the need for policies aimed at socioeconomic inequalities in the recovery response. Confirmed infection with SARS-CoV-2 also strongly predicted subsequent decline in mental health. These findings provide valuable information for policymakers and planners about the likelihood of changing need for mental health services as a result of the pandemic.

Original languageEnglish
JournalThe Lancet Psychiatry
DOIs
Publication statusAccepted/In press - 6 May 2021

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