Pre-pandemic distress levels predict risk for health care, economic disruptions

Individuals with psychological distress before the COVID-19 pandemic had increased risk for experiencing disruptions related to health care and economics, according to study results published in The British Journal of Psychiatry.

“Our findings highlight that the wider health and economic impacts of the pandemic have been disproportionately experienced by those with mental health difficulties, potentially leading to worsening longer term outcomes, even post-pandemic, for those already experiencing poor mental health,” co-author Praveetha Patalay, PhD, associate professor at the MRC Unit for Lifelong Health and Ageing, University College London, U.K., said in a press release.

Patalay and colleagues aimed to elucidate mental health inequalities in life disruptions among 59,482 participants of 12 U.K. longitudinal studies. Data collection occurred prior to and during the COVID-19 pandemic. The researchers looked at each study to assess the relationship between psychological distress pre-pandemic and disruptions that started since the pandemic’s onset related to health care, including medication access, procedures or appointments; economic activity, including employment, income or working hours; and housing, including change of address or household composition. They pooled estimates across studies.

Results showed between 28% and 77% of participants across the analyzed datasets experienced one or more disruptions. A total of between 2.3% and 33.2% experienced disruptions in at least two domains. The researchers noted an association between one standard deviation higher pre-pandemic psychological distress and increased risk for health care disruptions (OR = 1.3; 95% CI, 1.2-1.4), with fully adjusted ORs ranging from 1.24 (95% CI, 1.09-1.41) for procedure disruptions to 1.33 (95% CI, 1.2-1.49) for prescription or medication access disruptions. This psychological distress increase also appeared associated with loss of employment (OR = 1.13; 95% CI, 1.06–1.21) and income (OR = 1.12; 95% CI, 1.06 –1.19) and reduced working hours/furlough (OR = 1.05; 95% CI, 1–1.09). Further, it extended to increased risk for a disruption in at least two domains (OR = 1.25; 95% CI, 1.18–1.32) or in one domain (OR = 1.11; 95% CI, 1.07–1.16) compared with no disruptions.

The researchers reported no associations with housing disruptions (OR = 1; 95% CI, 0.97-1.03).

“Policymakers should take these findings into account in the provision of future health care and economic support, as failing to address these disruptions risks widening health inequalities further,” Giorgio Di Gessa, PhD, of the Institute of Epidemiology and Health Care, University College London, U.K., said in the release. “Special care should be taken by pharmacists and primary care staff to ensure people with mental health difficulties do not miss appointments, procedures and prescriptions.

“It is also important to note that pre-pandemic psychological distress was generally more common among women, younger generations, ethnic minorities and those with fewer qualifications, meaning the overall impact of disruption on these groups is larger,” Di Gessa added.