Understanding different trajectories of mental health across the general population during the COVID-19 pandemic
Open accessAbstract
BACKGROUND: The COVID-19 pandemic and nationally mandated restrictions to control the virus have been associated with increased mental health issues. However, the differential impact of the pandemic and lockdown on groups of individuals, and the personal characteristics associated with poorer outcomes are unknown. METHOD: Data from 21 938 adults in England who participated in a stratified cohort study were analysed. Trajectories of depression and anxiety symptoms were identified using growth mixture modelling. Multinomial and logistic regression models were constructed to identify sociodemographic and personality-related risk factors associated with trajectory class membership. RESULTS: Four trajectories of depression and five for anxiety were identified. The most common group presented with low symptom severity throughout, other classes were identified that showed: severe levels of symptoms which increased; moderate symptoms throughout; worsening mental health during lockdown but improvements after lockdown ended; and for anxiety only, severe initial anxiety that decreased quickly during lockdown. Age, gender, ethnicity, income, previous diagnoses, living situation, personality factors and sociability were associated with different trajectories. CONCLUSIONS: Nearly 30% of participants experienced trajectories with symptoms in the clinical range during lockdown, and did not follow the average curve or majority group, highlighting the importance of differential trajectories. Young, female, outgoing and sociable people and essential workers experienced severe anxiety around the announcement of lockdown which rapidly decreased. Younger individuals with lower incomes and previous mental health diagnoses experienced higher and increasing levels of symptoms. Recognising the likely symptom trajectories for such groups may allow for targeted care or interventions.
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Pierce et al found that the mental health of the general population steadily improved through to October 2020, but not to pre-pandemic levels.
“A slightly different picture was provided by Pierce et al who found that the mental health of the general population steadily improved through to October 2020, but not to pre-pandemic levels.26”
From Changes in mental health problems and suicidal behaviour in students and their associations with COVID-19-related restrictions in Norway: a national repeated cross-sectional analysis (2022) · cites this paper as [26]
The Discussion (page unavailable) reports average improvements in depression and anxiety symptoms during lockdown and the following weeks. It does not establish improvement through October 2020 or a comparison with pre-pandemic levels; the Limitations state that pre-pandemic severity scores were unavailable. The cited paper is by Saunders et al., not Pierce et al. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe latter study identified vulnerable subgroups who did not experience overall improvements in mental health, but reported a steadily worsening to levels far worse than before the pandemic.
“the latter study also identified vulnerable subgroups who did not experience the overall improvements in mental health, but rather reported a steadily worsening to levels far worse than before the pandemic.”
From Changes in mental health problems and suicidal behaviour in students and their associations with COVID-19-related restrictions in Norway: a national repeated cross-sectional analysis (2022) · cites this paper as [26]
The Discussion reports vulnerable subgroups whose symptoms did not follow the overall improvement, including a group with severe symptoms that continued to increase. But the Limitations section says severity scores before the pandemic were unavailable, so the study cannot establish that symptoms reached levels far worse than before the pandemic. (LLM, conf=0.91)
Experimental — accuracy not yet measuredBeing young was associated both with having a recovering and with a deteriorating mental health trajectory.
“being young was associated both with having a recovering and with a deteriorating trajectory.”
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Cites
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765 · see citing works
The psychological impact of quarantine and how to reduce it: Rapid review of the evidence
Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30460-8 · Cited by 16,378 · see citing works
Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60240-2 · Cited by 6,972 · see citing works
Holmes, E. A., O'Connor, R. C., Perry, V. H., Tracey, I., Wessely, S., Arseneault, L., Ballard, C., Christensen, H., Cohen Silver, R., Everall, I., et al. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30168-1 · Cited by 5,715 · see citing works
Testing the number of components in a normal mixture
Lo, Y. (2001) · Biometrika · doi:10.1093/biomet/88.3.767 · Cited by 4,640 · see citing works
Wang, J., Mann, F., Lloyd-Evans, B., Ma, R., & Johnson, S. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1736-5 · Cited by 1,494 · see citing works
Shevlin, M., McBride, O., Murphy, J., Miller, J. G., Hartman, T. K., Levita, L., Mason, L., Martinez, A. P., McKay, R., Stocks, T. V. A., et al. (2020) · BJPsych Open · doi:10.1192/bjo.2020.109 · Cited by 770 · cited 6× · see citing works
“General population studies have found that both psychological distress and the proportion of adults with clinically significant mental illness increased in the early weeks of the pandemic (Every-Palmer et al., 2020; Layard et al., 2020; Shevlin et al., 2020).”
InfluentialSex and gender differences in mental disorders
Riecher-Rössler, A. (2017) · The Lancet Psychiatry · doi:10.1016/s2215-0366(16)30348-0 · Cited by 560 · cited 1× · see citing works
“Many of these also reiterate risk factors for poorer mental health outside of pandemic circumstances (Allen, Balfour, Bell, & Marmot, 2014; Barnett et al., 2012; Riecher-Rössler, 2017).”
Life events and affective disorders
Paykel, E. S. (2003) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.108.s418.13.x · Cited by 368 · see citing works
Life stress and major depression: The mysteries of recurrences.
Monroe, S. M., Anderson, S. F., & Harkness, K. L. (2019) · Psychological Review · doi:10.1037/rev0000157 · Cited by 102 · cited 1× · see citing works
“All of these are associated with a greater likelihood of experiencing depression and other common mental health problems (Paykel, 2003), and a greater likelihood of recurrences of depression among those that have had prior depressive episodes (Monroe, Anderson, & Harkness, 2019).”
Flagged first, then by citations
Research works printed but not linked: 22
- Allen, J., Balfour, R., Bell, R., & Marmot, M. (2014). Social determinants of mental health. International Review of Psychiatry, 26(4), 392– 407. 10.3109/09540261.2014.928270 25137105 · DOI · Paper page
- Bu, F., Steptoe, A., & Fancourt, D. (2020). Loneliness during lockdown: trajectories and predictors during the COVID-19 pandemic in 35712 adults in the UK, 1– 19. 10.1101/2020.05.29.20116657 PMC7768183 33257177 · DOI
- Burton, A., McKinlay, A., Aughterson, H., & Fancourt, D. (2020). Impact of the COVID-19 pandemic on the mental health and wellbeing of adults with mental health conditions in the UK: A qualitative interview study. MedRxiv. 10.1101/2020.12.01.20241067 PMC12094262 34323635 · DOI
- Dempster, A. P., Laird, N. M., & Rubin, D. B. (1977). Maximum likelihood from incomplete data via the EM algorithm. Journal of the Royal Statistical Society, Series B (Statistical Methodology), 39(1), 1– 38. 10.2307/2984875 · DOI
- Every-Palmer, S., Jenkins, M., Gendall, P., Hoek, J., Beaglehole, B., Bell, C., … Stanley, J. (2020). Psychological distress, anxiety, family violence, suicidality, and wellbeing in New Zealand during the COVID-19 lockdown: A cross-sectional study. PLoS ONE, 15(11), e0241658. 10.1371/journal.pone.0241658 33147259 PMC7641386 · DOI
- Fancourt, D., Steptoe, A., & Bu, F. (2020a). Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: A longitudinal observational study. The Lancet Psychiatry, 8(2), 141– 149. 10.1016/S2215-0366(20)30482-X 33308420 PMC7820109 · DOI · Paper page
- Fancourt, D., Steptoe, A., & Wright, L. (2020b). The Cummings effect: Politics, trust, and behaviours during the COVID-19 pandemic. The Lancet, 396(10249), 464– 465. 10.1016/S0140-6736(20)31690-1 PMC7613216 32771083 · DOI
- Greenberg, N., Docherty, M., Gnanapragasam, S., & Wessely, S. (2020). Managing mental health challenges faced by healthcare workers during COVID-19 pandemic. BMJ, 368, m1211. 10.1136/bmj.m1211 32217624 · DOI · Paper page
- Gunnell, D., Appleby, L., Arensman, E., Hawton, K., John, A., Kapur, N., … Yip, P. S. (2020). Suicide risk and prevention during the COVID-19 pandemic. The Lancet Psychiatry, 2019(20), 2019– 2021. 10.1016/S2215-0366(20)30171-1 PMC7173821 32330430 · DOI · Paper page
- Hall, K. S., Samari, G., Garbers, S., Casey, S. E., Diallo, D. D., Orcutt, M., … McGovern, T. (2020). Centring sexual and reproductive health and justice in the global COVID-19 response. The Lancet, 395(10231), 1175– 1177. 10.1016/S0140-6736(20)30801-1 PMC7146687 32278371 · DOI
- Kohli, N., & Harring, J. R. (2013). Modeling growth in latent variables using a piecewise function. Multivariate Behavioral Research, 48(3), 370– 397. 10.1080/00273171.2013.778191 26741847 · DOI
- Luykx, J. J., Vinkers, C. H., & Tijdink, J. K. (2020). Psychiatry in times of the coronavirus disease 2019 (COVID-19) pandemic: An imperative for psychiatrists to Act Now. JAMA Psychiatry, 77(11), 1097– 1098. 10.1001/jamapsychiatry.2020.1225 32459359 · DOI
- McGinty, E. E., Presskreischer, R., Anderson, K. E., Han, H., & Barry, C. L. (2020). Psychological distress and COVID-19-related stressors reported in a longitudinal cohort of US adults in April and July 2020. JAMA - Journal of the American Medical Association, 324(24), 2555– 2557. 10.1001/jama.2020.21231 33226420 PMC7684524 · DOI
- Muthén, B. O., Brown, C. H., Masyn, K., Jo, B., Khoo, S.-T., Yang, C.-C., … Liao, J. (2002). General growth mixture modeling for randomized preventive interventions. Biostatistics (Oxford, England), 3(4), 459– 475. 10.1093/biostatistics/3.4.459 12933592 · DOI
- Muthén, L. K., & Muthén, B. O. (2015). Mplus user's guide. Mplus user's guide (7th ed.). Los Angeles, CA: Muthén & Muthén.
- Rubel, J., Lutz, W., Kopta, S. M., Köck, K., Minami, T., Zimmermann, D., … Saunders, S. M. (2015). Defining early positive response to psychotherapy: An empirical comparison between clinically significant change criteria and growth mixture modeling. Psychological Assessment, 27(2), 478– 488. 10.1037/pas0000060 25496087 · DOI
- Saunders, R., Buckman, J. E. J., Leibowitz, J., Cape, J., & Pilling, S.. (2021) Trends in depression & anxiety symptom severity in mental health service attendees during the COVID-19 pandemic. 10.31219/osf.io/eprqn PMC8374083 33962366 · DOI
- Soto, C. J., & John, O. P. (2017). The next Big Five Inventory (BFI-2): Developing and assessing a hierarchical model with 15 facets to enhance bandwidth, fidelity, and predictive power. Journal of Personality and Social Psychology, 113(1), 117– 143. 10.1037/pspp0000096 27055049 · DOI · Paper page
- Takian, A., Raoofi, A., & Kazempour-Ardebili, S. (2020). COVID-19 battle during the toughest sanctions against Iran. The Lancet, 395(10229), 1035– 1036. 10.1016/S0140-6736(20)30668-1 PMC7138170 32199073 · DOI
- Tromans, S., Chester, V., Harrison, H., Pankhania, P., Booth, H., & Chakraborty, N. (2020). Patterns of use of secondary mental health services before and during COVID-19 lockdown: Observational study. BJPsych Open, 6(6), E117. 10.1192/bjo.2020.104 33040771 PMC7550872 · DOI
- Woolhandler, S., & Himmelstein, D. U. (2020). Intersecting U.S. epidemics: COVID-19 and lack of health insurance. Annals of Internal Medicine, 173, 63– 64. 10.7326/M20-1491 32259195 PMC7143156 · DOI
- Xiong, J., Lipsitz, O., Nasri, F., Lui, L. M. W., Gill, H., Phan, L., … McIntyre, R. S. (2020). Impact of COVID-19 pandemic on mental health in the general population: A systematic review. Journal of Affective Disorders, 277, 55– 64. 10.1016/j.jad.2020.08.001 32799105 PMC7413844 · DOI · Paper page
Cited by
Sorted by citations
Pierce, M., McManus, S., Hope, H., Hotopf, M., Ford, T., Hatch, S. L., John, A., Kontopantelis, E., Webb, R. T., Wessely, S., et al. (2021) · The Lancet Psychiatry · doi:10.1016/s2215-0366(21)00151-6 · Cited by 387 · see citing works
The mental health of university students during the COVID-19 pandemic: an online survey in the UK
Chen, T., & Lucock, M. (2022) · PLOS ONE · doi:10.1371/journal.pone.0262562 · Cited by 369 · see citing works
Foulkes, L., & Andrews, J. L. (2023) · New Ideas in Psychology · doi:10.1016/j.newideapsych.2023.101010 · Cited by 329 · see citing works
Landi, G., Pakenham, K. I., Crocetti, E., Tossani, E., & Grandi, S. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.03.067 · Cited by 74 · see citing works
Benke, C., Autenrieth, L. K., Asselmann, E., & Pané-Farré, C. A. (2023) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-022-01400-0 · Cited by 69 · see citing works
Sivertsen, B., Knapstad, M., Petrie, K., O’Connor, R., Lønning, K. J., & Hysing, M. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-057492 · Cited by 49 · see citing works
Reffi, A. N., Drake, C. L., Kalmbach, D. A., Jovanovic, T., Norrholm, S. D., Roth, T., Casement, M. D., & Cheng, P. (2023) · Journal of Sleep Research · doi:10.1111/jsr.13709 · Cited by 10 · see citing works
- Authors
- Saunders, R., Buckman, J. E. J., Fonagy, P., & Fancourt, D.
- Affiliations
- University College London (GB)
- Corresponding author
- Saunders, Rob
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2021-03-03
- Volume
- 52
- Issue
- 16
- Pages
- 4049-4057
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC8007951
- OpenAlex
- W3135604018
- Cited by
- 156
- References
- 11
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 22 · 2023: 46 · 2022: 58 · 2021: 14
- FWCI
- 23.87
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychological Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Wellcome Trust (221400/Z/20/Z, 201292/Z/16/Z, 205407/Z/16/Z)
- Health and Care Research Wales
- UK Research and Innovation
- Nuffield Foundation
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- COVID-19 pandemic, lockdown, depression, anxiety, mental health trajectories, growth mixture modeling, sociodemographic risk factors, personality traits, sociability, essential workers, income, gender differences, ethnicity, mental health diagnoses
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