Association between psychological distress trajectories from adolescence to midlife and mental health during the pandemic: evidence from two British birth cohorts

Abstract

Background This paper examined whether distinct life-course trajectories of psychological distress from adolescence to midlife were associated with poorer mental health outcomes during the pandemic. Methods We present a secondary analysis of two nationally representative British birth cohorts, the 1958 National Child Development Study (NCDS) and 1970 British Cohort Study (BCS70). We used latent variable mixture models to identify pre-pandemic longitudinal trajectories of psychological distress and a modified Poisson model with robust standard errors to estimate associations with psychological distress, life satisfaction and loneliness at different points during the pandemic. Results Our analysis identified five distinct pre-pandemic trajectories of psychological distress in both cohorts. All trajectories with prior symptoms of psychological distress irrespective of age of onset, severity and chronicity were associated with a greater relative risk of poorer mental health outcomes during the pandemic and the probability of poorer mental health associated with psychological distress trajectories remained fairly constant. The relationship was not fully attenuated when most recent pre-pandemic psychological distress and other midlife factors were controlled for. Conclusions Whilst life-course trajectories with any prior symptoms of psychological distress put individuals at greater risk of poor mental health outcomes during the pandemic, those with chronic and more recent occurrences were at highest risk. In addition, prior poor mental health during the adult life-course may mean individuals are less resilient to shocks, such as pandemics. Our findings show the importance of considering heterogeneous mental health trajectories across the life-course in the general population in addition to population average trends.

Pre-pandemic trajectories of depressive symptomatology and their relation to depression during the COVID-19 pandemic: longitudinal study of English older people

“…Third, in this study, although we controlled for baseline age, we did not investigate whether trajectories of depressive symptomatology (and their relationships with depression during the COVID-19 pandemic) differed across different age groups. Although Moulton and colleagues 22 found very similar trajectories and memberships across the two birth cohorts that they investigated, future studies could investigate this issue further. Last, our data were derived from observational longitudinal studies and there may be bias due to unmeasured confounding; also, our results can only be interpreted as associations, rather than causality.…”

“… 21 However, although the authors examined overall trajectories of distress in each birth cohort, they did not address the issue of heterogeneity of trajectories within cohorts. Extending this work, Moulton et al 22 examined patterns of distress within each birth cohort using NCDS and BSC70. Their study, which considered longitudinal mental health during the 30 years preceding the COVID-19 pandemic, highlighted the importance of both the severity and chronicity of psychological distress history, as both higher frequency of pre-pandemic episodes of poor mental health and poor mental health episodes occurring closer to the pandemic increased the risk of poor mental health during the pandemic.…”

“…Their study, which considered longitudinal mental health during the 30 years preceding the COVID-19 pandemic, highlighted the importance of both the severity and chronicity of psychological distress history, as both higher frequency of pre-pandemic episodes of poor mental health and poor mental health episodes occurring closer to the pandemic increased the risk of poor mental health during the pandemic. 22 However, the sample used by Moulton and colleagues was restricted to those born in two specific years (1958 or 1970) and focused mostly on early adulthood and early- to midlife trajectories of psychological distress. As such, a research gap remains with regard to trajectories of pre-pandemic mental health occurring from middle age and throughout old age, particularly as older adults were disproportionately affected by stay-at-home policies during the COVID-19 pandemic.…”