Depression, anxiety and PTSD symptoms before and during the COVID-19 pandemic in the UK

Abstract

Background: The COVID-19 pandemic is a novel population-level stressor. As such, it is important to examine pandemic-related changes in mental health and to identify which individuals are at greatest risk of worsening symptoms.Methods: Online questionnaires were administered to 34,465 individuals in the UK, recruited from existing cohorts or via social media. Around one third (n = 12,718) with prior diagnoses of depression or anxiety completed pre-pandemic mental health assessments, allowing prospective investigation of symptom change. We examined changes in depression, anxiety and PTSD symptoms using prospective, retrospective and global ratings of change assessments. We also examined the effect of key risk factors on changes in symptoms. Research in contextEvidence before this study We conducted a literature search (PubMed, Scopus) with the terms "mental*" or "psychiatr*" and "covid*" or "coronavirus" published before 8th February 2021. This resulted in 4,573 unique references, but only 15 longitudinal studies examining changes in symptoms of mental health conditions from before to during the COVID-19 pandemic. Results to date are mixed. Some studies found increases in mental distress, some found increases in either depression or anxiety, and others saw no observable change in symptoms.Examining individual-level risk factors, heightened vulnerability to worsening mental health during the pandemic has been demonstrated among young people, females, individuals with lower incomes/financial problems and among health care or key workers. Only one previous study used a large sample with prior mental health diagnoses to examine changes in anxiety and depression. This study showed that having a prior mental health diagnosis was associated with higher levels of perceived worsening of mental health but, when examining actual prospectively measured symptoms, a prior mental health diagnosis was actually associated with a lower likelihood of symptom worsening, compared to no prior diagnosis. This discrepancy across measures requires further investigation in order to understand the nature of changing mental health during the COVID-19 pandemic. Added value of this studyThis study prospectively examined changes in symptoms of depression, anxiety and PTSD in a large UK-based sample of individuals with prior depression or anxiety. Analyses were supplemented with data from additional cohorts to examine individual difference risk factors with greater statistical power. Inclusion of both prospectively measured and retrospectively estimated changes in symptoms, as well as ratings of perceived change in mental health, allowed closer examination of discrepancies in subjective experience versus actual objective change in symptoms.people who are students or are unemployed. Additionally, discrepancies in estimated symptom change across prospective and retrospective measures highlight the importance of using prospectively collected data to examine longitudinal changes.

Different trajectories of depression, anxiety and anhedonia symptoms in the first 12 months of the COVID-19 pandemic in a UK longitudinal sample

“…Our findings of age effects, prior mental health diagnoses and employment are consistent with factors reported for the earlier time periods of the pandemic (e.g. Pierce et al, 2020Pierce et al, , 2021Saunders et al, 2021;Young et al, 2022). Female gender predicted membership of the high and stable anxiety group, but not the high and stable depression group, in line with our earlier report (Young et al, 2022).…”

“…Second, we explicitly model the effects of prior diagnoses and demographic variables in our analysis of factors predicting trajectory group membership. Third, our previous analyses of baseline data indicated that there were comparable predictors of symptoms in the two cohorts (Young et al, 2022). Finally, combining the two cohorts maximises statistical power and we did not have any hypotheses about between-cohort differences.…”

“…For the full list of measures collected during the study see the RAMP Open Science Framework repository (https://osf.io/ 7p2ek/). Further details of the RAMP and COPING study procedures are available elsewhere (Young et al, 2022).…”

“…3. We assess whether predictors of short-term changes in mental health identified in this sample (Young et al, 2022) were also associated with longer-term changes in symptoms of depression, anxiety and anhedonia.…”

Use of substances to cope predicts posttraumatic stress disorder symptom persistence: Investigating patterns of interactions between symptoms and its maintaining mechanisms.

“…Several explanations for elevated PTSD rates and distress levels have been put forward, including concerns about infecting others, feelings of stigmatization, and unreliable access to protective equipment (Greene et al, 2021). Risk factors for worsening PTSD symptoms during the pandemic include prior mental health diagnoses and sociodemographic risk factors (e.g., young age; Young et al, 2023).…”