Effects on mental health of a UK welfare reform, Universal Credit: a longitudinal controlled study
Open accessAbstract
BACKGROUND: Universal Credit, a welfare benefit reform in the UK, began to replace six existing benefit schemes in April, 2013, starting with the income-based Job Seekers Allowance. We aimed to determine the effects on mental health of the introduction of Universal Credit. METHODS: In this longitudinal controlled study, we linked 197 111 observations from 52 187 individuals of working age (16-64 years) in England, Wales, and Scotland who participated in the Understanding Society UK Longitudinal Household Panel Study between 2009 and 2018 with administrative data on the month when Universal Credit was introduced into the area in which each respondent lived. We included participants who had data on employment status, local authority area of residence, psychological distress, and confounding variables. We excluded individuals from Northern Ireland and people out of work with a disability. We used difference-in-differences analysis of this nationally representative, longitudinal, household survey and separated respondents into two groups: unemployed people who were eligible for Universal Credit (intervention group) and people who were not unemployed and therefore would not have generally been eligible for Universal Credit (comparison group). Using the phased roll-out of Universal Credit, we compared the change in psychological distress (self-reported via General Health Questionnaire-12) between the intervention group and the comparison group over time as the reform was introduced in the area in which each respondent lived. We defined clinically significant psychological distress as a score of greater than 3 on the General Health Questionnaire-12. We tested whether there were differential effects across subgroups (age, sex, and education). FINDINGS: The prevalence of psychological distress increased in the intervention group by 6·57 percentage points (95% CI 1·69-11·42) after the introduction of Universal Credit relative to the comparison group, after accounting for potential confounders. We estimate that between April 29, 2013, and Dec 31, 2018, an additional 63 674 (95% CI 10 042-117 307) unemployed people will have experienced levels of psychological distress that are clinically significant due to the introduction of Universal Credit; 21 760 of these individuals might reach the diagnostic threshold for depression. INTERPRETATION: Our findings suggest that the introduction of Universal Credit led to an increase in psychological distress, a measure of mental health difficulties, among those affected by the policy. Future changes to government welfare systems should be evaluated not only on a fiscal basis but on their potential to affect health and wellbeing. FUNDING: Wellcome Trust, UK National Institute for Health Research, and Medical Research Council.
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The 'proportional' policy means that trustees receiving less will have reduced capacity to reciprocate, further diminishing their subsequent allocation - and thus locking them into a cycle of ever-diminishing resources.
“However, this “proportional” policy means that trustees receiving less will have reduced capacity to reciprocate, further diminishing their subsequent allocation – and thus locking them into a cycle of ever-diminishing resources.”
From Deep reinforcement learning can promote sustainable human behaviour in a common-pool resource problem (2025) · cites this paper as [31]
Cutting unemployment benefits may itself create circumstances unfavourable to reemployment, such as long-term ill-health, leading to workers being permanently excluded from the labour market.
“For example, cutting unemployment benefits may itself create circumstances unfavourable to reemployment30, such as long-term ill-health31, leading to workers being permanently excluded from the labour market.”
From Deep reinforcement learning can promote sustainable human behaviour in a common-pool resource problem (2025) · cites this paper as [31]
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Guo, X., Mao, R., Cui, L., Wang, F., Zhou, R., Wang, Y., Huang, J., Zhu, Y., Yao, Y., Zhao, G., et al. (2021) · General Psychiatry · doi:10.1136/gpsych-2020-100440 · Cited by 6 · see citing works
Adams, R., Atkin, H., Lee, R. P., Hackett, S., & Hackett, K. L. (2022) · British Journal of Occupational Therapy · doi:10.1177/03080226221092689 · Cited by 7 · see citing works
“The United Nations and Human Rights Watch have declared the inequality in Britain an abuse of human rights (Human-RightsWatch, 2019; OHCHR, 2012) with its effects linked to a crisis in mental health (Wickham et al., 2020).”
BackgroundDomestic violence and depression among Chinese adolescents: The role of self-evaluation
Fu, W., Zhang, S., Zhu, Y., & Liu, R. (2025) · International Journal of Social Psychiatry · doi:10.1177/00207640241288215 · Cited by 5 · see citing works
“…including depressive symptoms, subsyndromal clinical depression, and depressive disorders, usually manifests as significant and persistent low mood (Wickham et al., 2020), accompanied by somatic and cognitive changes, which seriously affects their mental health as well as the formation and…”
Marimpi, M., Barr, B., Baxter, A. J., Hugh-Jones, S., Taylor-Robinson, D. C., Katikireddi, S. V., Brown, H., Cheetham, M., Morris, S. L., Munford, L. A., et al. (2025) · Public Health · doi:10.1016/j.puhe.2025.105821 · Cited by 5 · see citing works
Self-citationCraig, P., Campbell, M., Deidda, M., Dundas, R., Green, J., Katikireddi, S. V., Lewsey, J., Ogilvie, D., de Vocht, F., & White, M. J. (2025) · Public Health Research · doi:10.3310/jtyw6582 · Cited by 5 · see citing works
Cash Welfare and Health Spending
Hicks, J. (2026) · The Journal of Human Resources · doi:10.3368/jhr.0623-12964r2 · Cited by 4 · see citing works
Wickham, S. L. (2023) · Nature Medicine · doi:10.1038/s41591-023-02508-z · Cited by 5 · see citing works
Self-citationBeck, D., Peters, R., Bridge, G., Poitier, F. K., & Pearson, B. (2024) · Social Policy and Administration · doi:10.1111/spol.13002 · Cited by 4 · see citing works
Stevelink, S. A. M., Bakolis, I., Dorrington, S., Downs, J. M., Leal, R., Madan, I., Phillips, A., Geiger, B. B., Hotopf, M. H., & Fear, N. T. (2024) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2023-221593 · Cited by 4 · see citing works
“30 The initial analyses presented here outline the mental disorders UC claimants have been diagnosed with, and the extent to which mental health service users are subject to conditionality.”
BackgroundKerr, R., Lightfoot, K., Moss, R. H., Sawsaa, A. F., McEachan, R., & Dogra, S. A. (2025) · Journal of Poverty · doi:10.1080/10875549.2025.2548774 · Cited by 3 · see citing works
Bai, Y., Kim, C., Xia, X., & Chum, A. (2024) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2024-222651 · Cited by 3 · see citing works
Greenburgh, A., Baldwin, H., Weir, H., Asif, Z., Laporte, D., Bertram, M., Crawford, A., Duberry, G., Lauter, S., Lloyd‐Evans, B., et al. (2025) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-025-02984-3 · Cited by 7 · see citing works
“These interventions spanned the domains of vic - timisation, debt and finances, employment, and family relationships; and sample sizes ranged from 166 to 250.”
Albani, V., Brown, H., Vera‐Toscano, E., Kingston, A., Eikemo, T. A., & Bambra, C. L. (2022) · Social Science & Medicine · doi:10.1016/j.socscimed.2022.115316 · Cited by 3 · see citing works
“This approach has been widely applied to study the impact of policy reforms to estimate causal effects in observational studies, i.e., when it is not possible to randomly assign individuals to a new policy/policy change (treatment) (Wickham et al., 2020; Wing et al., 2018).”
InfluentialCommunity mental health through a complex systems lens
Adisa, O., & McManus, S. (2023) · The Lancet Public Health · doi:10.1016/s2468-2667(23)00080-4 · Cited by 3 · see citing works
Gascoigne, C., Jeffery, A., Shao, Z., Geneletti, S., Kirkbride, J. B., Baio, G., & Blangiardo, M. (2024) · Spatial and Spatio-temporal Epidemiology · doi:10.1016/j.sste.2024.100662 · Cited by 3 · see citing works
“Nevertheless, our results are overall in line with Wickham et al. (2020), which reported a 1.28 (0.61 – 1.95) increase in GHQ-12 score in the exposed due to an introduction to UC.”
InfluentialExploring the mental health effects of Universal Credit: a journey of co-production
Cheetham, M., Atkinson, P., Gibson, M., Katikireddi, S. V., Moffatt, S. M., Morris, S. L., Munford, L. A., Shenton, F., Wickham, S. L., & Craig, P. (2022) · Perspectives in Public Health · doi:10.1177/17579139221103178 · Cited by 3 · see citing works
Self-citationSimpson, J., Bambra, C. L., & Brown, H. (2023) · International Journal of Social Determinants of Health and Health Services · doi:10.1177/27551938231185948 · Cited by 2 · see citing works
Cheetham, M., Zerbi, C. E., Bidmead, E., Morris, S. L., & Dodd, T. (2024) · Journal of Social Policy · doi:10.1017/s0047279424000333 · Cited by 2 · see citing works
“Overall UC has been shown to increase psychological distress and decrease life satisfaction among claimants, particularly those not in paid work (Wickham et al., 2022; Thornton & Iacoella, 2024).”
Guide to recent advances in difference-in-differences methodology for population health studies
Sutton, M., Francetic, I. N. ;., O’Neill, S., Hugh-Jones, S., & Munford, L. A. (2026) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2025-225449 · Cited by 2 · see citing works
Tzanou, M. (2022) · IEEE Technology and Society Magazine · doi:10.1109/mts.2022.3173347 · Cited by 2 · see citing works
Gebremariam, A. G., Piroddi, R., Daras, K., Rachel, A. D. C., Abba, K., Gabbay, M., Corcoran, R., Granger, R., Ezeofor, V. ‘., Edwards, R. T., et al. (2025) · SSM - Population Health · doi:10.1016/j.ssmph.2025.101785 · Cited by 2 · see citing works
“Several national welfare policies and cuts to public services in the UK have also increased the risk of poverty for some groups, adversely affecting health (Barr et al., 2016; Taylor-Robinson et al., 2019; The Living Standards Outlook, 2022, 2022, 2022; Wickham et al., 2020).”
Self-citationPybus, K. J., Page, G., Dalton, L., & Patrick, R. (2021) · Journal of Poverty and Social Justice · doi:10.1332/175982721x16184951904307 · Cited by 2 · see citing works
“The impact on mental health of welfare reforms has been well-documented prior to COVID-19 (see for example, Dwyer et al, 2018; Wickham et al, 2020).”
Wickham, S. L., & Fancourt, D. E. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.764559 · Cited by 2 · see citing works
Self-citationSimpson, J., Bambra, C. L., & Brown, H. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4114495 · Cited by 2 · see citing works
Changing social and political attitudes in Ireland and Northern Ireland
ESRI, Laurence, J., Sprong, S. L., McGinnity, F., Russell, H., & Hingre, G. (2023) · doi:10.26504/rs170 · Cited by 2 · see citing works
Jordan, U., & Sage, D. J. (2023) · Critical Social Policy · doi:10.1177/02610183231199674 · Cited by 1 · see citing works
“The intensi fi cation of sanctioning has also been associated with an increase in psychological distress amongst bene fi t claimants (Wickham et al., 2020).”
Phillips, A., Leal, R., Jewell, A., Madan, I., Downs, J. M., Broadbent, M. T. M., Hotopf, M. H., Dorrington, S., Fear, N. T., & Stevelink, S. A. M. (2024) · International Journal for Population Data Science · doi:10.23889/ijpds.v9i1.2377 · Cited by 1 · see citing works
“Research has shown that people experience further distress and, therefore, a reduced likelihood of employment [6, 7].”
Sutton, M., Hugh-Jones, S., & Wilding, A. (2025) · Social Science & Medicine · doi:10.1016/j.socscimed.2025.117952 · Cited by 1 · see citing works
Price, T. (2025) · Social Science & Medicine · doi:10.1016/j.socscimed.2025.118451 · Cited by 1 · see citing works
“…that has documented how post-2010 welfare reforms, particularly the rollout of Universal Credit and the expansion of benefit sanctions, have not only deepened poverty but intensified stigma and psychological distress (Wickham et al., 2020; Barr et al., 2016; Beatty et al., 2013; Wamsley, 2024).”
Mansfield, R., Richards, M., Ploubidis, G. B., Henderson, M., & Patalay, P. (2026) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-025-03041-9 · Cited by 1 · see citing works
Chen, Y., Black, M., Bennett, D. L., McGovern, R., Sharp, H. M., Rehkopf, D. H., Taylor-Robinson, D. C., & Adjei, N. K. (2026) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-026-01023-6 · Cited by 2 · see citing works
“Moreover, findings from income support and anti-poverty initiatives suggest that improving household finances can enhance parental mental health and children’s emotional well-being [57, 58], which may in turn help reduce the risk of self-harm behaviours.”
Self-citationSong, H., Piroddi, R., McHale, P., & Barr, B. (2026) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2025-225477 · Cited by 1 · see citing works
Self-citationBaxter, A. J., Tindall, M., Wickham, S. L., Marimpi, M., Brown, H., Munford, L. A., Sutton, M., Richiardi, M. G., Cheetham, M., Amo-Agyei, S., et al. (2026) · BMJ Public Health · doi:10.1136/bmjph-2025-003762 · Cited by 1 · see citing works
Self-citation
- Authors
- Wickham, S., Bentley, L., Rose, T., Whitehead, M., Taylor-Robinson, D., & Barr, B.
- Affiliations
- University of Liverpool (GB)
- University of Copenhagen (DK)
- Corresponding author
- Wickham, Sophie
- Venue
- The Lancet Public Health
- Publisher
- Elsevier BV
- Published
- 2020-03
- Volume
- 5
- Issue
- 3
- Pages
- e157-e164
- ISSN
- 2468-2667 (ISSN-L)
- PMC
- PMC7208537
- OpenAlex
- W3007476043
- Cited by
- 151
- References
- 19
- Citations by year
- 2026: 17 · 2025: 21 · 2024: 21 · 2023: 28 · 2022: 26 · 2021: 18 · 2020: 20
- FWCI
- 24.01
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Wellcome Trust (200335/Z/15/Z)
- Medical Research Council (MR/P008577/1)
- Topics
- Health Sciences › Health Professions › General Health Professions › Employment and Welfare Studies
- Social Sciences › Political Science and International Relations › Social Policy and Reform Studies
- Health Sciences › Health Professions › General Health Professions › Food Security and Health in Diverse Populations
- Keywords
- Universal Credit, welfare reform, psychological distress, mental health, unemployment, welfare benefits, policy impact, depression, working-age adults, GHQ-12, policy evaluation
- MeSH terms
- Psychological Distress, Adolescent, Adult, Female, United Kingdom, Humans, Longitudinal Studies, Male, Mental Health, Middle Aged, Social Welfare, Young Adult
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