Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population

Probably not a substantial claim: may not pass S3 (load-bearing).

Waves 6-9 of the UK Household Longitudinal Study included 53,351 participants.

“Waves 6–9 of the UKHLS had 53 351 participants.”

The quote only partly states this claim.

Within-person GHQ-12 increases were greatest in people living with young children, with an increase of 1.45 points.

“people living with young children (1·45, 0·79–2·12)”

• AssumptionRests on an assumption: The GHQ-12 administered by self-completion in the COVID-19 web survey is comparable to its administration in previous waves.

Probably not a substantial claim: may not pass S3 (load-bearing).

Among 42,330 eligible people from households in Waves 8 or 9, 17,452 (41.2%) took part in the COVID-19 web survey.

“Eligible participants for the COVID-19 web survey were from households that took part in Waves 8 or 9, and 17 452 (41·2%) of 42 330 eligible people participated in the web survey.”

May combine two claims.

New inequalities in mental distress emerged, with people employed at the start of the pandemic at risk of larger increases.

“have emerged, with those living with young children and those in employment at the start of the pandemic being at risk of larger increases in mental distress.”

• AssumptionRests on an assumption: The observed changes in mental distress are attributable to the COVID-19 pandemic rather than to other contemporaneous factors.
• AssumptionRests on an assumption: The GHQ-12 administered by self-completion in the COVID-19 web survey is comparable to its administration in previous waves.
• AssumptionRests on an assumption: The UKHLS sample and COVID-19 web survey respondents are representative of the UK adult population.

May combine two claims.

New inequalities in mental distress emerged, with people living with young children at risk of larger increases.

“have emerged, with those living with young children and those in employment at the start of the pandemic being at risk of larger increases in mental distress.”

• AssumptionRests on an assumption: The observed changes in mental distress are attributable to the COVID-19 pandemic rather than to other contemporaneous factors.
• AssumptionRests on an assumption: The GHQ-12 administered by self-completion in the COVID-19 web survey is comparable to its administration in previous waves.
• AssumptionRests on an assumption: The UKHLS sample and COVID-19 web survey respondents are representative of the UK adult population.

May combine two claims.

Inequalities widened, with pronounced increases in women but not men.

“and in women (but not men)”

• AssumptionRests on an assumption: The observed changes in mental distress are attributable to the COVID-19 pandemic rather than to other contemporaneous factors.
• AssumptionRests on an assumption: The GHQ-12 administered by self-completion in the COVID-19 web survey is comparable to its administration in previous waves.
• AssumptionRests on an assumption: The UKHLS sample and COVID-19 web survey respondents are representative of the UK adult population.

May combine two claims.

Inequalities widened, with pronounced increases in younger but not older age groups.

“Other sources of inequalities have widened, with pronounced increases in younger (but not older) age groups”

• AssumptionRests on an assumption: The observed changes in mental distress are attributable to the COVID-19 pandemic rather than to other contemporaneous factors.
• AssumptionRests on an assumption: The GHQ-12 administered by self-completion in the COVID-19 web survey is comparable to its administration in previous waves.
• AssumptionRests on an assumption: The UKHLS sample and COVID-19 web survey respondents are representative of the UK adult population.

May combine two claims.

There was some evidence in mean scores of widening inequalities for both ethnic minorities and those in the lowest income quintiles, but within-person adjusted analyses did not find significant effects for these characteristics.

“We found some evidence in mean scores of widening inequalities for both ethnic minorities and those in lowest income quintiles. However, within-person adjusted analyses did not find significant effects for these characteristics.”

May combine two claims.

Although rates of mental distress were higher in people who were unemployed or economically inactive before lockdown, the increase in mental distress relative to previous trends was greater among those employed before the pandemic.

“Although rates of mental distress were higher in people who, before lockdown, were unemployed or in other economically inactive roles such as being a full-time student, the increase in mental distress relative to previous trends was greater among those who were employed before the pandemic.”

• AssumptionRests on an assumption: In the absence of the COVID-19 pandemic, pre-pandemic trends in GHQ-12 scores from 2014–19 would have continued.

May combine two claims.

Mean GHQ-12 scores were higher in London and among urban populations than in rural populations in late April 2020.

“Mean scores were higher in London (13·3, 95% CI 12·8–13·8) and among urban populations (12·8, 12·6–13·0) than in rural populations (12·2, 11·9–12·4).”

May combine two claims.

Key workers had a similar mean GHQ-12 score to the rest of the population but were more likely to exceed the clinically significant threshold.

“Key workers had a similar mean score to the rest of the population, but were more likely to exceed the clinically significant threshold score.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Mental distress was more common among people living in low-income households.

“However, consistent with established patterns, mental distress was more common among people living in low-income households.”

May combine two claims.

After adjustment, there was clear evidence for heterogeneous effects by age and gender (both p<0.0001).

“There was clear evidence, after adjustment, for heterogeneous effects by age and gender (both effect modifiers, p<0·0001).”

• AssumptionRests on an assumption: In the absence of the COVID-19 pandemic, pre-pandemic trends in GHQ-12 scores from 2014–19 would have continued.

The quote only partly states this claim.

Mean GHQ-12 scores were higher for women than for men in late April 2020.

“Mean GHQ-12 scores were higher for women (13·6, 95% CI 13·4–13·8) than for men (11·5, 11·3–11·7)”

May combine two claims.

Asian people had higher mean GHQ-12 scores than White British people in late April 2020, while variation by other ethnic groups was not significant.

“Asian people had a higher mean score (13·7, 95% CI 13·0–14·5) than did White British people (12·5, 12·4–12·7); variation by other ethnic groups was not significant.”

May combine two claims.

The mean GHQ-12 score in April 2020 was higher than in 2018-19, 2017-18, and earlier waves.

“Between April 23 and April 30, 2020, the mean score for the overall population was 12·6 (95% CI 12·5–12·8); higher than the mean scores in 2018–19 (11·5, 11·3–11·6), 2017–18 (11·4, 11·3–11·4), and for earlier waves”

May combine two claims.

People not cohabiting with a partner, those cohabiting with young children, and those who received a shielding letter had high GHQ-12 scores in late April 2020.

“People not cohabiting with a partner (13·8, 95% CI 13·6–14·1) and those cohabiting with young children in the household (13·7, 13·2–14·3) also had high scores; as did those who received a shielding letter from the government because of a pre-existing health condition (13·7, 13·1–14·3).”

May combine two claims.

There was a steady upward trend in clinically significant distress from 16.7% in 2014-15 to 18.9% in 2018-19, followed by a marked step-change increase in 2020.

“Although a steady upward trend had already been evident over recent years (from 16·7%, 95% CI 16·1–17·3 in 2014–15 to 18·9%, 17·8–20·0 in 2018–19), a marked step-change increase occurred in 2020 (appendix p 5).”

• AssumptionRests on an assumption: A GHQ-12 score of four or more indicates a clinically significant level of mental distress.

May combine two claims.

There was some variation in score increase by household income (p=0.0008), but no clear trend was discernible.

“There was some variation in score increase by household income (p=0·0008), although no clear trend was discernible.”

• AssumptionRests on an assumption: In the absence of the COVID-19 pandemic, pre-pandemic trends in GHQ-12 scores from 2014–19 would have continued.

May combine two claims.

Increases in GHQ-12 scores were significant in both women and men overall and in most age groups, with steepest increases for women aged 16-44 and men aged 16-24.

“The increases were significant (as shown by their non-overlapping confidence intervals) in both women and men overall and in most age groups. Increases were steepest for women aged 16–44 years, and men aged 16–24 (appendix p 4).”

May combine two claims.

Living with children significantly modified the effect (p=0.0003); those with children younger than 5 had a 1.45 (0.79-2.12) point increase in GHQ-12 score after adjustment.

“Living with children in the house significantly modified the effect (p=0·0003): those with children younger than 5 years had a 1·45 (0·79 to 2·12) point increase in GHQ-12 score after adjustment for other factors.”

• AssumptionRests on an assumption: In the absence of the COVID-19 pandemic, pre-pandemic trends in GHQ-12 scores from 2014–19 would have continued.

May combine two claims.

The mean GHQ-12 score in 18-24-year-olds was 2.69 points (95% CI 1.89-3.48) higher than expected from pre-pandemic trends, and in 25-34-year-olds it was 1.57 points (0.96-2.18) higher.

“The mean score in 18–24-year-olds was 2·69 points (95% CI 1·89 to 3·48) higher than would have been expected from the trends observed before the pandemic, and in 25–34-year-olds was 1·57 points (0·96 to 2·18) higher.”

• AssumptionRests on an assumption: In the absence of the COVID-19 pandemic, pre-pandemic trends in GHQ-12 scores from 2014–19 would have continued.

May combine two claims.

Adjusted estimates indicated that women experienced an increase of 0.92 points (95% CI 0.50-1.35), while there was no evidence of higher than expected scores for men (0.06, −0.37 to 0.48).

“Adjusted estimates indicated that women experienced an increase of 0·92 points (95% CI 0·50 to 1·35) whereas there was no evidence of higher than expected scores for men (0·06, −0·37 to 0·48).”

• AssumptionRests on an assumption: In the absence of the COVID-19 pandemic, pre-pandemic trends in GHQ-12 scores from 2014–19 would have continued.

Classified as probably not a substantial claim.

The longitudinal analysis used a weighting variable that adjusted for unequal selection probabilities and differential non-response to the COVID-19 web survey.

“a weighting variable was used for the longitudinal analysis, which adjusted for unequal selection probabilities and differential non-response to the COVID-19 web survey.”

Probably not a substantial claim: may not pass S3 (load-bearing).

These results reflect the UK situation after one month in lockdown.

“These results reflect the UK situation after one month in lockdown.”

May combine two claims.

Effects pertinent to lockdown include acute financial strain, household dynamics, and having an underlying mental or physical health condition.

“Effects pertinent to lockdown include acute financial strain (low income, unemployment), household dynamics (domestic violence, living alone or with young children not attending nursery or school),9 and having an underlying mental or physical health condition”

• cites [9] sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

As of May 2020, the weighting variable was a beta-version, and later refinements are unlikely to substantially change the results.

“As of May, 2020, this weight was released as a beta-version and slight future refinements of the weighting models are possible, but unlikely to have a substantial effect on results.14”

• cites [14] sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Waves 6-9 of the UKHLS contained 53,351 participants, and 42,330 people from households in Waves 8 or 9 were eligible for the COVID-19 web survey.

“Waves 6–9 of the UKHLS had 53 351 participants, and 42 330 people from households that took part in Waves 8 or 9 were eligible for invitation to take part in the COVID-19 web survey.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In the study data, all covariates except GHQ-12 had less than 1% missing values, while GHQ-12 was missing for 4.2% of respondents.

“All covariates had less than 1% missing data except for the GHQ-12 scores, which were positioned at the end of the web-survey, and which were missing for 4·2% of respondents.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Specific effects include being a keyworker exposed to potential infection.

“specific effects include being a keyworker exposed to potential infection.10”

• cites [10]Not checked yet

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Classified as probably not a substantial claim.

Changes in mental health during the public health emergency might not be evenly distributed across the population.

“However, changes in mental health during the public health emergency might not be evenly distributed across the population.8”

• cites [8]Not checked yet

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May combine two claims.

The COVID-19 web-survey sample comprised 17,452 participants aged 16 years and older and was weighted to be representative of the UK population.

“The COVID-19 web-survey sample comprised 17 452 participants, aged 16 years and older, weighted to be representative of the UK population (table 1 )”

May combine two claims.

Mental health was assessed with the 12-item General Health Questionnaire (GHQ-12), a validated measure of non-specific mental distress over the past 2 weeks that performs well in longitudinal samples.

“The 12-item General Health Questionnaire (GHQ-12) is a validated measure of non-specific mental distress in the past 2 weeks, which performs well in longitudinal samples.16”

• cites [16] sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Web-survey interviews were completed by 15,835 of 32,596 Wave 9 participants, a response rate of 48.6%; including Wave 8 participants, 17,452 of 42,330 (41.2%) took part.

“Web-survey interviews were completed (full and partial) by 15 835 of the 32 596 participants of Wave 9, representing a response rate of 48·6%. When also including those who took part in Wave 8 (but not Wave 9), 17 452 (41·2%) participated of the total sample of 42 330”

Classified as probably not a substantial claim. May combine two claims.

Of the 17,452 participants, 1,556 were excluded for missing GHQ-12 outcome data and 520 for lacking a matched previous GHQ-12 measure, leaving 15,376 in the fixed-effects regression.

“Of the 17 452 participants, 1556 were excluded because of missing GHQ-12 outcome data, and 520 because they were unmatched to a previous GHQ-12 measure, with 15 376 included in the fixed-effects regression analysis.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Anxieties about infection risk could be particularly high for some people.

“For others, anxieties about infection risk could be particularly high.11”

• cites [11]Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The probability sample was drawn from postal addresses.

“The probability sample was drawn from postal addresses.”

Classified as probably not a substantial claim.

The threshold for clinically significant mental distress was a GHQ-12 score of 4 or more, following the Health Survey for England Official Statistics indicator.

“The cutoff for the threshold measure was a score of 4 or more, as used on the Health Survey for England Official Statistics indicator.17”

• cites [17]Not checked yet

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Classified as probably not a substantial claim.

Fixed-effects regression models were fitted to identify within-person change compared with preceding trends.

“Fixed-effects regression models were fitted to identify within-person change compared with preceding trends.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The study protocol was pre-registered on OSF Registries before any outcome data analysis.

“The study protocol was pre-registered on OSF Registries before any outcome data analysis.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

One study found increased rates of psychological distress among US adults in April 2020 compared with 2018, with the increase greatest in young people aged 18-24 years and women.

“One study found increased rates of psychological distress among US adults in April, 2020, compared with those in 2018, and that the increase was greatest in young people aged 18–24 years and women.6”

• cites [6]Not checked yet

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May combine two claims.

Although COVID-19 poses the greatest physical health risk to older people, the mental health of young people might be disproportionately affected by transmission mitigation strategies and government pandemic responses.

“Although COVID-19 presents the greatest physical health risk to older people, the mental health of the young might be disproportionately affected by transmission mitigation strategies and the pandemic response of governments.”

• AssumptionRests on an assumption: The observed changes in mental distress are attributable to the COVID-19 pandemic rather than to other contemporaneous factors.

May combine two claims.

Response to the COVID-19 wave questionnaire was less than 50% and varied by age, gender, ethnic group, health status, and other characteristics; non-response was adjusted for via survey weights, but attrition remains a potential source of bias.

“However, although the UKHLS is a high-quality probability sample cohort study, response to the COVID-19 wave questionnaire was less than 50%, and varied by age, gender, ethnic group, health status, and other characteristics (appendix p 1). Non-response was adjusted for via application of survey weights, but attrition remains a potential source of bias.”

May combine two claims.

The higher than projected increase in mental distress did not affect all groups equally; some subgroups showed little or no additional distress while others showed marked increases.

“This higher than projected increase in mental distress did not affect all groups equally, with people in some demographic subgroups showing little (or no) additional mental distress after lockdown, while other subgroups showed marked increases.”

• AssumptionRests on an assumption: In the absence of the COVID-19 pandemic, pre-pandemic trends in GHQ-12 scores from 2014–19 would have continued.

May combine two claims.

Some inequalities decreased; those employed before the pandemic experienced a marked deterioration in mental health.

“However, some inequalities decreased—for example, those in employment pre-pandemic experienced a marked deterioration in their mental health.”

• AssumptionRests on an assumption: In the absence of the COVID-19 pandemic, pre-pandemic trends in GHQ-12 scores from 2014–19 would have continued.

May combine two claims.

For these categories, established pre-pandemic inequalities in mental health were maintained, but they had not significantly increased by the end of the first month of lockdown.

“For these categories, established pre-pandemic inequalities in mental health were maintained, but they had not significantly increased by the end of the first month of the lockdown period.”

• AssumptionRests on an assumption: In the absence of the COVID-19 pandemic, pre-pandemic trends in GHQ-12 scores from 2014–19 would have continued.

May combine two claims.

No contemporaneous control group was available, so secular changes cannot be ruled out, aside from those predicted from previous data.

“Finally, no contemporaneous control group was available so we cannot rule out secular changes, aside from those predicted from previous data, which would have occurred anyway.”

May combine two claims.

Although the sample was large, it was underpowered to detect change for some groups, specifically lacking scope to examine significant change by different ethnic groups and for men and women separately within ethnic groups.

“Although the sample was large, it was underpowered to detect change for some groups. Specifically, a major limitation was the lack of scope to examine significant change by different ethnic groups, and for men and women separately within ethnic groups, particularly when considering the high prevalence of mental distress evident in the descriptive analysis.”

May combine two claims.

The GHQ-12 underestimates both socioeconomic and ethnic disparities.

“The GHQ-12 underestimates both socioeconomic and ethnic disparities.18”

• cites [18]Not checked yet

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May combine two claims.

Between Wave 9 and the COVID-19 survey, the mode of questionnaire administration changed from face-to-face with an interviewer present to online, which could have affected reporting and introduced bias.

“Between Wave 9 and the COVID-19 survey, necessary changes were introduced in the mode of the questionnaire administration that could have affected reporting: in Wave 9 the GHQ-12 was self-completed with the interviewer present as part of a face-to-face interview, whereas the COVID-19 questionnaire was completed online.”

May combine two claims.

Certain groups experienced higher mental distress than others, indicating persistence of ethnic and socioeconomic health inequalities.

“Certain groups experienced higher mental distress than did others, indicating persistence of ethnic and socioeconomic health inequalities.”

May combine two claims.

Some groups experienced higher than expected increases in mental distress, widening pre-existing age and gender inequalities.

“Some experienced higher than expected increases in mental distress, which widened pre-existing age and gender inequalities.”

• AssumptionRests on an assumption: In the absence of the COVID-19 pandemic, pre-pandemic trends in GHQ-12 scores from 2014–19 would have continued.

Probably not a substantial claim: may not pass S3 (load-bearing).

This finding supports previous reports of high prevalence of common mental disorder and self-harm in girls and women aged 16-24 years.

“This supports results of previous reports of high prevalence of common mental disorder and self-harm in girls and women aged 16–24 years;7, 25, 26, 27”

• cites [7]Not checked yet

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• cites [25]Not checked yet

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• cites [26]Not checked yet

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May combine two claims.

Women, young people, and those with preschool-aged children are experiencing the greatest increase in mental distress.

“Women, young people, and those with preschool aged children are experiencing the greatest increase in mental distress.”

• AssumptionRests on an assumption: In the absence of the COVID-19 pandemic, pre-pandemic trends in GHQ-12 scores from 2014–19 would have continued.