Living alone and mental health: parallel analyses in UK longitudinal population surveys and electronic health records prior to and during the COVID-19 pandemic

Eoin McElroy, Emily Herrett, Kishan Patel, Dominik M Piehlmaier, Giorgio Di Gessa, Charlotte Huggins, Michael J Green, Alex Kwong, Ellen J Thompson, Jingmin Zhu, Kathryn E Mansfield, Richard J Silverwood, Rosie Mansfield, Jane Maddock, Rohini Mathur, Ruth E Costello, Anthony Matthews, John Tazare, Alasdair Henderson, Kevin WingLucy Bridges, Sebastian Bacon, Amir Mehrkar, Richard J Shaw, Jacques Wels, Srinivasa Vittal Katikireddi, Nish Chaturvedi, Laurie Tomlinson, Praveetha Patalay

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Background: People who live alone experience greater levels of mental illness, however it is unclear whether the COVID-19 pandemic had a disproportionately negative impact on this demographic.

Objective: To describe the mental health gap between those who live alone and with others in the UK prior to and during the COVID-19 pandemic.

Methods: Self-reported psychological distress and life satisfaction in ten prospective longitudinal surveys (LPS) assessed in the nearest pre-pandemic sweep, and three periods during the pandemic. Recorded diagnosis of common and severe mental illnesses between March 2018 and January 2022 in electronic healthcare records (EHRs) within the OpenSAFELY TPP.

Findings: In 37,544 LPS participants pooled models showed greater psychological distress (standardised mean difference [SMD]:0.09(95%CI:0.04;0.14; relative risk [RR]:1.25(95%CI: 1.12;1.39) and lower life satisfaction (SMD:-0.22 (95% CI:-0.30;-0.15) for those living alone pre-pandemic. This gap did not change during the pandemic. In the EHR analysis of c.16 million records, mental health conditions were more common in those who lived alone (e.g., depression 26 [95% CI:18-33] and severe mental illness 58 [95% CI:54-62] more cases more per 100,000). For common mental health disorders the gap in recorded cases in EHRs narrowed during pandemic.

Conclusions: People living alone have poorer mental health, and lower life satisfaction. During the pandemic this gap in self-reported distress remained, however, there was a narrowing of the gap in service use.

Clinical Implications: Greater mental health need and potentially greater barriers to mental healthcare access for those who live alone need to be considered in healthcare planning.
Original languageEnglish
Article numbere300842
Pages (from-to)1-10
Number of pages10
JournalBMJ Mental Health
Issue number1
Early online date10 Aug 2023
Publication statusPublished (in print/issue) - Aug 2023

Bibliographical note

Funding Information:
This work was funded by UK Research and Innovation (UKRI) (COV0076;MR/V015737/1), and the Longitudinal Health and Wellbeing strand of the National Core Studies Programme (MC_PC_20030: MC_PC_20059: COV-LT-0009). EH was funded by an NIHR postdoctoral fellowship (PDF-2016-09-029). DMP was funded by an MRC fellowship (MR/W02148X/1). MJG, RJSh and SVK acknowledge funding from the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). RJSh additionally acknowledges funding from Health Data Research UK (SS005). SVK additionally acknowledges funding from an NRS Senior Clinical Fellowship (SCAF/15/02). RM is supported by Barts Charity (MGU0504). This research will also use data assets made available as part of the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (grant ref MC_PC_20058). In addition, the OpenSAFELY platform is supported by grants from the Wellcome Trust (222097/Z/20/Z), MRC (MR/V015757/1, MC_PC-20059, MR/W016729/1), NIHR (NIHR135559) and Health Data Research UK (HDRUK2021.000, 2021.0157).

Publisher Copyright:
© 2023 Author(s). Published by BMJ.


  • COVID-19
  • anxiety disorders
  • psychiatry


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