Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study

May combine two claims.

Inequalities by gender, age, education, income, and mental health were all still present at the end of the 20 weeks.

“Inequalities by gender, age, education, income, and mental health were all still present at the end of the 20 weeks.”

• Also stated in: § Discussion · plain

  “Nevertheless, many inequalities in mental health experiences (such as inequalities by age and gender) did remain and emotionally vulnerable groups (such as individuals with existing mental health conditions or individuals living alone) have remained at risk throughout lockdown and its aftermath.”

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

In the weighted sample, 20% reported having a diagnosed mental illness.

“7270 (20%) participants of the weighted sample reported having a diagnosed mental illness.”

May combine two claims.

The slopes varied across stages: there was a sharp decline in depressive symptoms and anxiety between weeks 2 and 5 during strict lockdown, but little change between weeks 16 and 20 after substantial easing.

“For instance, there was a sharp decline in depressive symptoms and anxiety between weeks 2 and 5 during the strict lockdown period, but little change was observed between weeks 16 and 20 after substantial easing of lockdown had taken place.”

May combine two claims.

Among participants with pre-existing diagnosed mental illness, 61% had moderate or severe depression (average 12.3) and 54% had at least moderate anxiety (average 10.6).

“Among the 3168 participants with a pre-existing diagnosed mental illness, 1929 (61%) had a score of 10 or higher indicating moderate or severe depression (average score 12·3 [SD=6·7]) and 1703 (54%) had a score of 10 or higher indicating at least moderate anxiety (average score 10·6 [SD=5·8]; table 2).”

May combine two claims.

Among participants without pre-existing diagnosed mental illness, 16% had anxiety (average 4.6) and 17% had depression (average 5.1).

“Among the 13 923 participants without a pre-existing diagnosed mental illness, 2153 (16%) had anxiety (average score 4·6 [SD=4·9]) and 2356 (17%) depression (average score 5·1 [SD=5·0]).”

May combine two claims.

Individuals living with children had higher anxiety (b=0.70, p<0.0001) but lower depressive symptoms (b=-0.37, p=0.029) than individuals living alone.

“Individuals living with children had higher levels of anxiety (b=0·70, p<0·0001) but lower levels of depressive symptoms (b=–0·37, p=0·029) than individuals living alone, whereas individuals living alone had higher levels of depressive symptoms but similar levels of anxiety to people living with other adults but without children.”

May combine two claims.

Individuals living alone had higher depressive symptoms but similar anxiety to people living with other adults without children.

“Individuals living with children had higher levels of anxiety (b=0·70, p<0·0001) but lower levels of depressive symptoms (b=–0·37, p=0·029) than individuals living alone, whereas individuals living alone had higher levels of depressive symptoms but similar levels of anxiety to people living with other adults but without children.”

May combine two claims.

Over the 20 weeks following lockdown, anxiety symptoms significantly decreased (b=-1.93, SE=0.26, p<0.0001) and depressive symptoms significantly decreased (b=-2.52, SE=0.28, p<0.0001).

“Over the 20 weeks following the introduction of lockdown, there was a significant decrease in both anxiety (b=–1·93, SE=0·26, p<0·0001) and depressive symptoms (b=–2·52, SE=0·28, p<0·0001) both during the strict lockdown period and the period in which restrictions were eased from May 10, 2020 (figure 1).”

• Also stated in: § Discussion · plain

  “Results show that anxiety and depressive symptoms both declined across the first 20 weeks following the introduction of lockdown in England.”

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

In the unweighted sample, 76% were women, 70% had an undergraduate degree or above, and 5% were from BAME backgrounds.

“27 699 (76%) of the 36 520 participants were women and there was an over-representation of people with an undergraduate degree or above (n=25 653, 70%) and an under-representation of people from BAME backgrounds (n=1839, 5%; table 1 ).”

May combine two claims.

Anxiety and depressive symptom trajectories were positively associated, with significant covariance between intercepts (20.46, p<0.0001) and slopes (18.64, p<0.0001).

“The growth trajectories of anxiety and depressive symptoms were positively associated with each other as evidenced by the significant covariance between the two intercepts (20·46, p<0·0001) and slopes (18·64, p<0·0001; appendix p 11).”

May combine two claims.

At the beginning of lockdown, women, younger adults, people with lower educational attainment, people from lower-income households, and people with pre-existing mental health conditions reported higher levels of anxiety and depressive symptoms.

“At the beginning of the lockdown, women, younger adults, people with lower levels of educational attainment, people from lower-income households, and people with pre-existing mental health conditions reported higher levels of anxiety and depressive symptoms (table 3 ).”

• Also stated in: § Discussion · plain

  “Being female or younger, having lower educational attainment, lower income, or pre-existing mental health conditions, and living alone or with children were all risk factors for higher levels of anxiety and depressive symptoms at the start of lockdown.”

May combine two claims.

There was no evidence that the rate of change was associated with ethnicity, household income, or pre-existing mental health conditions.

“There was no evidence that the rate of change was associated with ethnicity, household income, or pre-existing mental health conditions.”

May combine two claims. The quote only partly states this claim.

Across the 20 weeks, women, younger adults, people with lower educational attainment, and people living with children had faster improvements in anxiety and depressive symptoms than men, older adults, people with higher educational attainment, and people living without children, narrowing some gaps present at the start.

“However, some groups, including women, younger adults, and individuals with lower educational attainment, had faster improvements in symptoms, thereby reducing the differences between these vulnerable groups and other groups over time.”

May combine two claims.

People living alone had the same trajectories of depressive symptoms as people living with other adults but no children (b=0.04, p=0.77), but their overall levels of depressive symptoms were consistently higher.

“People living alone had the same trajectories of depressive symptoms as did people living with other adults but no children (living with other adults but no children vs living alone: b=0·04, p=0·77), but their overall levels of depressive symptoms were consistently higher.”

May combine two claims.

Many inequalities in anxiety and depression experiences narrowed as lockdown continued, but differences remained evident 20 weeks after lockdown started.

“Many of these inequalities in experiences were reduced as lockdown continued, but differences were still evident 20 weeks after the start of lockdown.”

• Also stated in: § Introduction · plain

  “As mental health improved, the difference between these vulnerable groups and people without these risk factors reduced but was still evident 20 weeks after the start of lockdown.”

• AssumptionRests on an assumption: The unspecified latent growth model with free time scores correctly represents the shape of anxiety and depressive symptom trajectories.

May combine two claims.

Some groups, including women, younger adults, and individuals with lower educational attainment, had faster improvements in symptoms, thereby reducing the differences between these vulnerable groups and other groups over time.

“However, some groups, including women, younger adults, and individuals with lower educational attainment, had faster improvements in symptoms, thereby reducing the differences between these vulnerable groups and other groups over time.”

May combine two claims.

Although individuals with mental illness had higher levels of depressive symptoms and anxiety at the start of lockdown, they had the same trajectories over the subsequent weeks.

“Although we found that individuals with mental illness had higher levels of depressive symptoms and anxiety at the start of lockdown (which is echoed in COVID-19 studies33, 34, 35 from various countries), they had the same trajectories over the subsequent weeks.”

• cites [33] Newby, 2020, Acute mental health responses during the COVID-19 pandemic in Australia, PLoS One sourceNot checked yet

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• cites [34] Asmundson, 2020, Do pre-existing anxiety-related and mood disorders differentially impact COVID-19 stress responses and coping?, J Anxiety Disord sourceNot checked yet

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• cites [35] Xiong, 2020, Impact of COVID-19 pandemic on mental health in the general population: a systematic review, J Affective Disord sourceNot checked yet

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

Pre-existing psychiatric conditions appear to be a risk factor for poorer mental health outcomes, and COVID-19 data have echoed this.

“Similarly, there has been some indication that pre-existing psychiatric conditions are a risk factor for poorer mental health outcomes,22 which has also been echoed by data from the COVID-19 pandemic.16, 17”

• cites [22] Jeong, 2016, Mental health status of people isolated due to Middle East Respiratory Syndrome, Epidemiol Health sourceNot checked yet

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• cites [16] Kwong, 2020, Mental health during the COVID-19 pandemic in two longitudinal UK population cohorts, medRxivNot checked yet

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• cites [17] Solomou, 2020, Prevalence and predictors of anxiety and depression symptoms during the COVID-19 pandemic and compliance with precautionary measures: age and sex matter, Int J Environ Res Public Health sourceNot checked yet

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

The study was approved by the UCL Research Ethics Committee and all participants gave written informed consent.

“The study was approved by the UCL Research Ethics Committee and all participants gave written informed consent.”

May combine two claims.

The analytic sample comprised 36,520 participants providing 436,522 observations, with an average of 12 repeated measures per participant (range 3 to 20).

“After excluding participants with less than two follow-ups or with missing values, our analytic sample comprised 36 520 participants, providing 436 522 observations (12 repeated measures per participant on average, ranging from three to 20).”

May combine two claims.

Before the pandemic, women, younger adults, people with less education or lower socioeconomic position, Black, Asian, and minority ethnic individuals, and people living alone were more likely to have higher depression and anxiety than their comparison groups.

“Women, younger adults, individuals with lower educational attainment and socioeconomic position, individuals from Black, Asian, and minority ethnic (BAME) backgrounds, and individuals living alone are more likely to experience higher levels of depression and anxiety than men, older adults, individuals with higher educational attainment and socioeconomic position, individuals from white backgrounds”

• cites [13] Ansseau, 2008, Socioeconomic correlates of generalized anxiety disorder and major depression in primary care: the GADIS II study (Generalized Anxiety and Depression Impact Survey II), Depress Anxiety sourceNot checked yet

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• cites [14] Hölzel, 2011, Risk factors for chronic depression—a systematic review, J Affect Disord sourceNot checked yet

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

COVID-19 pandemic data have echoed those findings about risk factors for worse mental health.

“and data about the COVID-19 pandemic have echoed these findings.16, 17, 18, 19, 20, 21”

• cites [16] Kwong, 2020, Mental health during the COVID-19 pandemic in two longitudinal UK population cohorts, medRxivNot checked yet

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• cites [17] Solomou, 2020, Prevalence and predictors of anxiety and depression symptoms during the COVID-19 pandemic and compliance with precautionary measures: age and sex matter, Int J Environ Res Public Health sourceNot checked yet

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• cites [18] Pieh, 2020, The effect of age, gender, income, work, and physical activity on mental health during coronavirus disease (COVID-19) lockdown in Austria, J Psychosom Res sourceNot checked yet

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• cites [19] Pierce, 2020, Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population, Lancet Psychiatry sourceNot checked yet

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• cites [20] Wang, 2020, Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China, Int J Environ Res Public HealthNot checked yet

  Not checked in the free run.

• cites [21] Ausín, 2020, Gender-related differences in the psychological impact of confinement as a consequence of COVID-19 in Spain, J Gend StudNot checked yet

  Not checked in the free run.

May combine two claims.

Levels of mental health did not continue to worsen in this period, which is slightly at odds with data from previous epidemics where mental health was found to worsen during quarantine.

“The fact that levels of mental health did not continue to worsen in this period is slightly at odds with data from previous epidemics, in which mental health was found to worsen during (or as a result of) quarantine.15”

• cites [15] Brooks, 2020, The psychological impact of quarantine and how to reduce it: rapid review of the evidence, Lancet sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The UCL COVID-19 Social Study is a panel study weighted to population proportions.

“we analysed data from the UCL COVID-19 Social Study, a panel study weighted to population proportions”

• Also stated in: § Statistical analysis · plain

  “To account for the non-random nature of the sample, the sample was weighted by the proportions of gender, age, ethnicity, and education obtained from the Office for National Statistics.26”

• cites [26]Not checked yet

  Not checked in the free run.

• AssumptionRests on an assumption: Weighting the sample by gender, age, ethnicity, and education proportions from the Office for National Statistics adequately corrects for the non-random sample and makes the estimates representative.

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

Fear of missing out might also have been reduced because of the global nature of this pandemic, compared with the restricted nature of quarantines in previous pandemics.

“Indeed, fear of missing out (which is associated with depression, distraction, and somatic symptoms28) might also have been reduced because of the global nature of this pandemic, compared with the restricted nature of quarantines in previous pandemics.”

• cites [28] Baker, 2016, Fear of missing out: relationships with depression, mindfulness, and physical symptoms, Transl Issues Psychol Sci sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

The study provides detailed time series data on trajectories of mental health during lockdown.

“However, this study does give detailed time series data on trajectories of mental health during lockdown.”

• AssumptionRests on an assumption: The weighted sample, despite non-random recruitment, yields trajectories that are informative about the general population's mental health during lockdown in England.

Classified as probably not a substantial claim.

Depressive symptoms were measured with the PHQ-9, a standard 9-item instrument for diagnosing depression in primary care.

“Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9), a standard 9-item instrument for diagnosing depression in primary care,24”

• cites [24] Löwe, 2004, Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9), J Affect Disord sourceNot checked yet

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• AssumptionRests on an assumption: The GAD-7 and PHQ-9 remain valid when respondents report symptoms over the past week instead of the past two weeks.

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

Four thousand participants (10%) who withheld demographic data or preferred not to self-identify on gender and income were excluded from the analysis.

“4000 (10%) of these participants withheld data or preferred not to self-identify on demographic factors including gender and income and were therefore excluded from our analysis”

• AssumptionRests on an assumption: Excluding the 4000 participants who withheld demographic data does not materially bias the analytic sample.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Measures to safeguard jobs and finances taken in the UK might have helped reduce specific anxieties.

“It is further possible that measures to safeguard jobs and finances taken in the UK might have helped to reduce specific anxieties.”

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

Previous studies during the COVID-19 pandemic have highlighted that women and younger adults had higher levels of anxiety and depression than men and older adults.

“Previous studies during the COVID-19 pandemic have already highlighted that women and younger adults had higher levels of anxiety and depression than men and older adults,4, 17, 18 but our data show that these groups have also had faster improvements in their symptoms.”

• cites [4] Pierce, 2020, Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population, Lancet Psychiatry sourceNot checked yet

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• cites [17] Solomou, 2020, Prevalence and predictors of anxiety and depression symptoms during the COVID-19 pandemic and compliance with precautionary measures: age and sex matter, Int J Environ Res Public Health sourceNot checked yet

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• cites [18] Pieh, 2020, The effect of age, gender, income, work, and physical activity on mental health during coronavirus disease (COVID-19) lockdown in Austria, J Psychosom Res sourceNot checked yet

  Not checked in the free run.

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

All listed authors are independent from the funders, and final decisions about the research were taken by the investigators without restriction.

“All researchers listed as authors are independent from the funders and all final decisions about the research were taken by the investigators and were unrestricted.”

Classified as probably not a substantial claim.

The analyses used latent growth models that adjusted for sociodemographic and health covariates.

“Analyses were done using latent growth models, which were fitted to account for sociodemographic and health covariates.”

• Also stated in: § Statistical analysis · plain

  “Data were analysed using latent growth modelling.”

• AssumptionRests on an assumption: The unspecified latent growth model with free time scores correctly represents the shape of anxiety and depressive symptom trajectories.

May combine two claims.

The study did not use a random population sample, so reported statistics are not presented as prevalence levels for anxiety or depressive symptoms.

“The study did not use a random population sample, and therefore our reported statistics are not presented as prevalence levels for anxiety or depressive symptoms.”

Classified as probably not a substantial claim.

Anxiety was measured with the GAD-7, a validated 7-item tool.

“Anxiety was measured using the Generalised Anxiety Disorder assessment (GAD-7), a well validated 7-item tool used to screen and diagnose generalised anxiety disorder in clinical practice and research23”

• cites [23] Spitzer, 2006, A brief measure for assessing generalized anxiety disorder: the GAD-7, Arch Intern Med sourceNot checked yet

  Not checked in the free run.

• AssumptionRests on an assumption: The GAD-7 and PHQ-9 remain valid when respondents report symptoms over the past week instead of the past two weeks.

May combine two claims.

After weighting, the sample reflected population proportions: 51% women, 35% with a degree or above, and 14% BAME.

“After weighting, the sample reflected population proportions, with 18 643 (51%) women, 12 670 (35%) participants with a degree or above, and 5311 (14%) participants with BAME ethnicity.”

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

The funders had no role in the study's design, data collection, analysis, interpretation, or writing.

“The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.”

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

All authors had full access to all data and final responsibility for the decision to submit for publication.

“All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.”

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

Some sources indicate that mental health worsened during the COVID-19 pandemic before stay-at-home orders were introduced.

“However, some sources suggest that during the COVID-19 pandemic, mental health deteriorated before the stay-at-home orders (ie, lockdowns) were introduced.10, 11, 12”

• cites [10]Not checked yet

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• cites [11] LayardNot checked yet

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• cites [12]Not checked yet

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

The proliferation of online and home-based leisure activities and extensive use of virtual and digital communication during the COVID-19 pandemic might have helped ease the burden of lockdown.

“Finally, the proliferation of online and home-based leisure activities and the extensive use of virtual and digital communication during the COVID-19 pandemic might have helped to ease the burden of lockdown itself, in contrast to previous epidemics in which the fear of missing out was reported to be a challenge.27”

• cites [27] Brooks, 2020, The psychological impact of quarantine and how to reduce it: rapid review of the evidence, Lancet sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The study involved repeated weekly assessment of mental health, so regression to the mean is a possible source of bias.

“Additionally, this study involved repeated weekly assessment of mental health, so regression to the mean is a possible source of bias.”

May combine two claims.

Overall, the highest levels of depression and anxiety in England were in the early stages of lockdown but declined fairly rapidly following the introduction of lockdown, with improvements continuing as lockdown easing measures were introduced and then plateauing after the first 4 months.

“Overall, these findings suggest that the highest levels of depression and anxiety in England were in the early stages of lockdown but declined fairly rapidly following the introduction of lockdown, with improvements continuing as lockdown easing measures were introduced and then plateauing after the first 4 months.”

May combine two claims.

Because of substantial overlap between participants reporting diagnoses of depression and anxiety, the study did not look at the unique contribution of each condition to trajectories of symptoms across lockdown, or at how specific symptoms might have been affected.

“Because of the substantial overlap between participants reporting diagnoses of depression and diagnoses of anxiety, we did not look at the unique contribution of each condition to trajectories of symptoms across lockdown, or at how specific symptoms (such as thoughts of death) might have been affected.”

May combine two claims.

The study followed people from spring to summer in England, so the contribution of seasonality to findings remains to be explored, although the results suggest effects above and beyond usual fluctuations.

“Our study followed people across the period from spring to summer in England so the contribution of seasonality to findings remains to be explored, although the results presented here suggest effects above and beyond usual fluctuations.37”

• cites [37] Harmatz, 2000, Seasonal variation of depression and other moods: a longitudinal approach, J Biol Rhythms sourceNot checked yet

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May combine two claims.

Individuals living with children had higher levels of anxiety and depressive symptoms initially than individuals living with other adults, but a faster rate of improvement, potentially due to growing public awareness that children were less affected by COVID-19.

“However, individuals living with children had higher levels of anxiety and depressive symptoms initially than individuals living with other adults, but a faster rate of improvement, potentially due to the growing public awareness of research suggesting that children were less affected by COVID-19.31”

• cites [31] Guan, 2020, Clinical characteristics of coronavirus disease 2019 in China, N Engl J Med sourceNot checked yet

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May combine two claims.

The study asked about symptoms of anxiety and depression over the past week rather than past 2 weeks because reassessments were weekly, which means precise values on the scale cannot be taken as national averages.

“We also asked about symptoms of anxiety and depression over the past week rather than past 2 weeks because our reassessments were weekly. Although this change has precedence both in previous studies and clinical screening, it underlines that the precise values on the scale cannot be taken as national averages for anxiety and depression during the pandemic.”

May combine two claims.

The study did not have sufficient statistical power to look at the experiences of specific ethnic groups, and the analysis did not explore the experiences of individuals with non-binary gender identities.

“As a result, we did not have sufficient statistical power to look at the experiences of specific ethnic groups and our analysis did not explore the experiences of individuals with non-binary gender identities, but we recognise the need for and encourage and support future research on these areas.”

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

It is possible that previous experience of mental illness or social isolation caused by previous mental illness meant individuals had experience of some of the requirements of lockdown or of applying coping strategies in stressful situations.

“It is possible that previous experience of mental illness or social isolation caused by previous mental illness meant individuals had experience of some of the requirements of lockdown or of applying coping strategies in stressful situations.”

May combine two claims.

Individuals with lower household income had consistently worse mental health than individuals with higher household income, which has been proposed to be linked to higher experiences of adversities such as job losses, decreases in household income, and challenges to pay bills.

“Similarly, individuals with lower household income had consistently worse mental health than individuals with a higher household income, which has been proposed to be linked to higher experiences of adversities such as job losses, decreases in household income, and challenges to pay bills.3”

• cites [3] Wright, 2020, Are we all in this together? Longitudinal assessment of cumulative adversities by socioeconomic position in the first 3 weeks of lockdown in the UK, J Epidemiol Community Health sourceNot checked yet

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May combine two claims.

Adults living alone had consistently worse levels of depressive symptoms, which could be related to higher levels of loneliness due to social restrictions.

“By contrast, adults living alone had consistently worse levels of depressive symptoms, which could be related to higher levels of loneliness due to social restrictions.30”

• cites [30] Bu, 2020, Who is lonely in lockdown? Cross-cohort analyses of predictors of loneliness before and during the COVID-19 pandemic, Public Health sourceNot checked yet

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May combine two claims.

The study relied on participants' self-report of diagnosed mental illness and was unable to confirm diagnoses or identify the specific type of problem.

“Additionally, we relied on participants’ self-report of diagnosed mental illness and were unable to confirm diagnoses, or identify specifically the type of problem with which participants had previously been diagnosed.”

• AssumptionRests on an assumption: Participants' self-reported diagnoses of mental illness are accurate enough for grouping.

May combine two claims.

The models adjusted simultaneously for multiple demographic factors including socioeconomic position, and socioeconomic position was related to poorer psychological experiences.

“But the models adjusted simultaneously for multiple demographic factors including socioeconomic position, and socioeconomic position was related to poorer psychological experiences.”

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

The study may not have adequately covered the full range of experiences, so it does not claim to provide data on prevalence of mental illness during the pandemic.

“It is possible that the study did not adequately cover the full range of experiences. Therefore, this study does not claim to provide data on prevalence of mental illness during the pandemic.”

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

Individuals from ethnic minority groups are disproportionately more likely to be from lower socioeconomic groups, so they might still have been disproportionately affected.

“Individuals from ethnic minority groups are disproportionately more likely to be from lower socioeconomic groups,36 so they might still have been disproportionately affected.”

• cites [36] Phillips, 2011, Institutional racism and ethnic inequalities: an expanded multilevel framework, J Soc Policy sourceNot checked yet

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May combine two claims.

If regression to the mean occurred, it might have been expected to work both ways, with higher scores declining and lower scores increasing, yet all groups showed decreases across the study period.

“However, if regression to the mean occurred, we might have expected it to work both ways, with the higher anxiety and depressive symptom scores declining and the lower scores increasing. Yet all groups showed decreases across the study period.”

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

The finding that women and younger adults had faster improvements could indicate a more challenging psychological experience early on in lockdown or a higher initial reactivity to events among these groups.

“This finding could indicate a more challenging psychological experience early on in lockdown (eg, as many women balanced child care and working from home) or a higher initial reactivity to events among these groups.”

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

The use of binary categories for ethnicity and other variables does not fully capture the experiences of different groups.

“We used some binary categories in our analyses for ethnicity (and for other variables such as gender), but we recognise that such labels do not fully capture the experiences of different groups.”

May combine two claims.

Many inequalities in mental health experiences, such as inequalities by age and gender, did remain, and emotionally vulnerable groups such as individuals with existing mental health conditions or individuals living alone have remained at risk throughout lockdown and its aftermath.

“Nevertheless, many inequalities in mental health experiences (such as inequalities by age and gender) did remain and emotionally vulnerable groups (such as individuals with existing mental health conditions or individuals living alone) have remained at risk throughout lockdown and its aftermath.”

May combine two claims.

A decrease in average scores due to non-random attrition is unlikely to have substantially biased results because all participants in the analysis provided at least three datapoints, so their trajectories were estimated even in the absence of complete data.

“Furthermore, a decrease in average scores due to non-random attrition is unlikely to have substantially biased results as all participants in the analysis provided at least three datapoints, so their trajectories were estimated even in the absence of complete data.”

May combine two claims.

Ethnic minority groups were under-represented in the data, although weighting was used to increase the proportion of their responses.

“Ethnic minority groups were under-represented in our data (although we did weight to increase the proportion of their responses).”