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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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“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]
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“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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“Clinical staff should also understand that issues relating to housing and welfare benefits, for example, can exacerbate mental health problems and responses to previous traumas, or even constitute traumatic experiences themselves [106, 107].”
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“6% increase in psychological distress among the unemployed from 2013 to 2018 (Wickham et al. 2020).”
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Metadata
- 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 › Medicine › Public Health, Environmental and Occupational Health › Employment and Welfare Studies
- Social Sciences › Political Science and International Relations › Social Policy and Reform Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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