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Mental health responses to the COVID-19 pandemic: a latent class trajectory analysis using longitudinal UK data
Open accessAbstract
Background The mental health of the UK population declined at the onset of the COVID-19 pandemic. Convenience sample surveys indicate that recovery began soon after. Using a probability sample, we tracked mental health during the pandemic to characterise mental health trajectories and identify predictors of deterioration.Methods This study was a secondary analysis of five waves of the UK Household Longitudinal Study (a large, national, probability-based survey that has been collecting data continuously since January, 2009) from late April to early October, 2020 and pre-pandemic data taken from 2018-19. Mental health was assessed using the 12-item General Health Questionnaire (GHQ-12). We used latent class mixed models to identify discrete mental health trajectories and fixed-effects regression to identify predictors of change in mental health.Findings Mental health was assessed in 19 763 adults (≥16 years; 11 477 [58·1%] women and 8287 [41·9%] men; 3453 [17·5%] participants from minority ethnic groups). Mean population mental health deteriorated with the 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. Most individuals in the population had either consistently good (7437 [39·3%] participants) or consistently very good (7623 [37·5%] participants) mental health across the first 6 months of the pandemic. A recovering group (1727 [12·0%] participants) showed worsened mental health during the initial shock of the pandemic and then returned to around pre-pandemic levels of mental health by October, 2020. The two remaining groups were characterised by poor mental health throughout the observation period; for one group, (523 [4·1%] participants) there was an initial worsening in mental health that was sustained with highly elevated scores. The other group (1011 [7·0%] participants) had little initial acute deterioration in their mental health, but reported a steady and sustained decline in mental health over time. These last two groups were more likely to have pre-existing mental or physical ill-health, to live in deprived neighbourhoods, and be of Asian, Black or mixed ethnicity. Infection with SARS-CoV-2, local lockdown, and financial difficulties all predicted a subsequent deterioration in mental health.Interpretation Between April and October 2020, the mental health of most UK adults remained resilient or returned to pre-pandemic levels. Around one in nine individuals had 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.Funding None.
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“The prevalence of mental illness increased in children, adolescents, and young adults during the COVID-19 pandemic, while at the same time, access to treatment facilities has been restricted, resulting in a need for the quick implementation of remote or online interventions.”
From Effectiveness of Online and Remote Interventions for Mental Health in Children, Adolescents, and Young Adults After the Onset of the COVID-19 Pandemic: Systematic Review and Meta-Analysis (2024) · cites this paper as [14]
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Impact of COVID-19 pandemic on mental health in the general population: a systematic review
Xiong, J., Lipsitz, O., Nasri, F., Lui, L. M. W., Gill, H., Phan, L., Chen-Li, D., Iacobucci, M., Ho, R., Majeed, A., et al. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.08.001 · Cited by 5,204
The Validity of Two Versions of the GHQ in the WHO Study of Mental Illness in General Health Care
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Pierce, M., Hope, H., Ford, T., Hatch, S., Hotopf, M., John, A., Kontopantelis, E., Webb, R., Wessely, S., McManus, S., et al. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30308-4 · Cited by 2,621
Self-citationTaquet, M., Geddes, J. R., Husain, M., Luciano, S., & Harrison, P. J. (2021) · The Lancet Psychiatry · doi:10.1016/s2215-0366(21)00084-5 · Cited by 2,189
Fancourt, D., Steptoe, A., & Bu, F. (2021) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30482-x · Cited by 1,161
Daly, M., Sutin, A. R., & Robinson, E. (2020) · Psychological Medicine · doi:10.1017/s0033291720004432 · Cited by 780
Psychological distress and adaptation to the COVID-19 crisis in the United States
Daly, M., & Robinson, E. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.10.035 · Cited by 470
Bu, F., Steptoe, A., & Fancourt, D. (2020) · Social Science & Medicine · doi:10.1016/j.socscimed.2020.113521 · Cited by 462
Fixed effects analysis of repeated measures data
Gunasekara, F. I., Richardson, K., Carter, K. N., & Blakely, T. A. (2013) · International Journal of Epidemiology · doi:10.1093/ije/dyt221 · Cited by 428
Says who? The significance of sampling in mental health surveys during COVID-19.
Pierce, M., McManus, S., Jessop, C., John, A., Hotopf, M., Ford, T., Hatch, S., Wessely, S., & Abel, K. M. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30237-6 · Cited by 399
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- Czeisler, 2021, Uncovering survivorship bias in longitudinal mental health surveys, medRxiv
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Manchia, M., Gathier, A. W., Eser, H. Y., Schmidt, M. V., de Quervain, D. J. ‐., van Amelsvoort, T., Bisson, J. I., Cryan, J. F., Howes, O. D., Pinto, L., et al. (2021) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2021.10.864 · Cited by 532
Zaninotto, P., Iob, E., Demakakos, P., & Steptoe, A. (2021) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2021.3749 · Cited by 227
Patel, K., Robertson, E., Kwong, A. S. F., Griffith, G. J., Willan, K., Green, M. J., Gessa, G. D., Huggins, C. F., McElroy, E., Thompson, E. J., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.7629 · Cited by 210
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Salanti, G., Peter, N. L., Tonia, T., Holloway, A., White, I. R., Darwish, L., Low, N. N., Egger, M., Haas, A. D., Fazel, S., et al. (2022) · Annals of Internal Medicine · doi:10.7326/m22-1507 · Cited by 183
Metadata
- Authors
- Pierce, M., McManus, S., Hope, H., Hotopf, M., Ford, T., Hatch, S. L., John, A., Kontopantelis, E., Webb, R. T., Wessely, S., & Abel, K. M.
- Affiliations
- University of Manchester (GB)
- University of London (GB)
- King's College London (GB)
- University of Cambridge (GB)
- Swansea University (GB)
- Greater Manchester Mental Health NHS Foundation Trust (GB)
- Corresponding author
- Pierce, Matthias
- ORCID
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2021-07
- Volume
- 8
- Issue
- 7
- Pages
- 610-619
- ISSN
- 2215-0366 (ISSN-L)
- PMC
- PMC9764381
- OpenAlex
- W3157550210
- Cited by
- 387
- References
- 31
- Citations by year
- 2026: 20 · 2025: 41 · 2024: 57 · 2023: 107 · 2022: 120 · 2021: 42
- FWCI
- 55.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- City Research Online (City University London) (acceptedVersion)
- Apollo (University of Cambridge) (submittedVersion, cc-by-nc-nd)
- Apollo
- Funders
- National Institute for Health Research
- University of Sussex
- Wellcome Trust
- Economic and Social Research Council
- Medical Research Council
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- COVID-19 pandemic, mental health trajectories, mental health deterioration, latent class analysis, GHQ-12, UK Household Longitudinal Study, neighborhood disadvantage, ethnicity, lockdown, financial hardship, pre-existing mental illness, physical illness
- MeSH terms
- COVID-19, Adolescent, Adult, Mental Disorders, Ethnicity, Female, United Kingdom, Humans, Longitudinal Studies, Male, Mental Health, Middle Aged, Surveys and Questionnaires, Models, Statistical, Young Adult
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