Two subgroups at increased risk for sustained pandemic-related mental health effects

Most individuals displayed resiliency or psychological recovery within the first 6 months of the pandemic, but two groups of people continued to experience significant mental health effects, according to an analysis of data from the U.K.

“As the pandemic develops, interest is turning to how changing circumstances have affected people’s mental health and whether early indicators herald persistently poor mental health and subsequent increasing unmet clinical need,” Matthias Pierce, PhD, of the Centre for Women’s Mental Health at the University of Manchester, and colleagues wrote. “Studies assessing mental health trends since the beginning of the pandemic have reported symptoms of anxiety disorder, depression and loneliness steadily improving since May 2020. However, these studies have methodological problems relating to sampling, adjustment and mental health measures.”

Problems from prior studies included their use of convenience samples, meaning they were unable to properly adjust for sampling bias; many had significant attrition over time, and people with poor mental health were more likely to drop out, which led to an “overoptimistic” evaluation of mental health trends; and many used indicators of mental health that were limited to symptoms that occurred only in the past week, according to the researchers. In the current study, they conducted a secondary analysis from late April 2020 to early October 2020 of five waves of a large, national, probability-based U.K. survey that has gathered continuous data since January 2009. They also analyzed pre-pandemic data collected between 2018 and 2019. They analyzed data on mental health collected via the 12-item General Health Questionnaire (GHQ-12). Further, they used latent class mixed models to pinpoint discrete mental health trajectories and fixed-effects regression, which allowed them to predict mental health change.

Data were available from 19,763 individuals aged 16 years or older (58.1% women; 17.5% from underrepresented ethnic groups). Results showed a deterioration in mean population mental health that coincided with the beginning of the pandemic and did not start to improve until July 2020. The researchers observed five distinct mental health trajectories up to October 2020 in latent class analysis. A total of 39.3% of individuals exhibited consistently good mental health and 37.5% exhibited consistently very good mental health across the pandemic’s initial 6 months. A total of 12% of participants who were considered the recovering group exhibited worsened mental health during the pandemic’s initial phase and then returned to mental health levels consistent with pre-pandemic levels by October 2020.

Pierce and colleagues noted that two remaining groups had poor mental health during the entire observation period. One group, which consisted of 4.1% of total study participants, exhibited an initial worsening in mental health that continued with significantly elevated scores. The other group, which consisted of 7% of total study participants, exhibited little initial acute mental health deterioration; however, they reported a steady and sustained mental health decline over time. The two groups with sustained worsened mental health exhibited higher likelihoods for pre-existing mental or physical ill-health, living in deprived neighborhoods and being of Asian, Black or mixed ethnicity. Predictors of subsequent mental health deterioration included infection with SARS-CoV-2, local lockdown and financial difficulties.

“Preventive interventions might usefully be targeted at the vulnerable groups of people whom we have identified,” Pierce and colleagues wrote. “In advance of further lockdowns or future pandemics, public mental health should be a priority and support should be focused on deprived communities, while local authority public health measures and social welfare should target deprived families and individuals.”