Pre-pandemic mental health and disruptions to healthcare, economic and housing outcomes during the COVID-19 pandemic: evidence from 12 UK longitudinal studies

Abstract

Background The COVID-19 pandemic has disrupted lives and livelihoods, and people already experiencing mental ill health may have been especially vulnerable. Aims Quantify mental health inequalities in disruptions to healthcare, economic activity and housing. Method We examined data from 59 482 participants in 12 UK longitudinal studies with data collected before and during the COVID-19 pandemic. Within each study, we estimated the association between psychological distress assessed pre-pandemic and disruptions since the start of the pandemic to healthcare (medication access, procedures or appointments), economic activity (employment, income or working hours) and housing (change of address or household composition). Estimates were pooled across studies. Results Across the analysed data-sets, 28% to 77% of participants experienced at least one disruption, with 2.3–33.2% experiencing disruptions in two or more domains. We found 1 s.d. higher pre-pandemic psychological distress was associated with (a) increased odds of any healthcare disruptions (odds ratio (OR) 1.30, 95% CI 1.20–1.40), with fully adjusted odds ratios ranging from 1.24 (95% CI 1.09–1.41) for disruption to procedures to 1.33 (95% CI 1.20–1.49) for disruptions to prescriptions or medication access; (b) loss of employment (odds ratio 1.13, 95% CI 1.06–1.21) and income (OR 1.12, 95% CI 1.06 –1.19), and reductions in working hours/furlough (odds ratio 1.05, 95% CI 1.00–1.09) and (c) increased likelihood of experiencing 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), relative to no disruption. There were no associations with housing disruptions (OR 1.00, 95% CI 0.97–1.03). Conclusions People experiencing psychological distress pre-pandemic were more likely to experience healthcare and economic disruptions, and clusters of disruptions across multiple domains during the pandemic. Failing to address these disruptions risks further widening mental health inequalities.

Perceived manageability of debt and mental health during the COVID-19 pandemic: A UK population analysis

“…For instance, a recent study [ 9 ] found that the risk of debt accumulation is greater among individuals who have previously suffered from mental health difficulties, while another [ 43 ] found that existing mental health difficulties at one time-point did not increase risk of debt at subsequent time points. Moreover, research has shown how those with poorer pre-pandemic mental health were more likely to encounter economic disruptions (i.e., usual economic activity, job loss, loss of income, changes to working hours) due to the pandemic [ 44 ]. Therefore, it may be that pre-existing mental health conditions prior to the pandemic coupled with the financial implications of the pandemic may have resulted in the substantial effect sizes observed in the association between perceptions of debt manageability on mental health outcomes in the current study.…”

Psychological Distress Before and During the COVID-19 Pandemic Among Adults in the United Kingdom: Coordinated Analyses of 11 Longitudinal Studies

“…The UK National Core Studies – Longitudinal Health and Wellbeing initiative aims to co-ordinate primary analyses across multiple UK longitudinal population-based studies. 13,14 Co-ordinating analyses across different datasets minimises methodological heterogeneity and maximises comparability, while appropriately accounting for the study design and characteristics of individual datasets.…”

Impact of first UK COVID-19 lockdown on hospital admissions: Interrupted time series study of 32 million people

“…There are therefore concerns that lockdown measures may have exacerbated these pre-existing inequalities in healthcare. 5,11 It is essential to investigate the performance of the healthcare system and assess its ability to manage non-COVID-19 health conditions during the pandemic. We envisage that such investigations will facilitate data-driven, evidence-based policy decisions to help mitigate adverse knock-on healthcare impacts of the pandemic and improve healthcare system resilience during any future pandemic or climaterelated stresses.…”