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

Kishan Patel, Elaine Robertson, Alex SF Kwong, Gareth J Griffith, Kathryn Willan, Michael J Green, Giorgio Di Gessa, Charlotte F Huggins, Eoin Mc Elroy, Ellen J Thompson, Jane Maddock, Claire L Niedzwiedz, Morag Henderson, Marcus Richards, Andrew Steptoe, George B Ploubidis, Bettina Moltrecht, Charlotte Booth, Emla Fitzsimons, Richard SilverwoodPraveetha Patalay, David Porteous, Srinivasa Vittal Katikireddi

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Importance: How population mental health has evolved across the COVID-19 pandemic under varied lockdown measures is poorly understood, and the consequences for health inequalities are unclear. Objective: To investigate changes in mental health and sociodemographic inequalities from before and across the first year of the COVID-19 pandemic in 11 longitudinal studies. Design, Setting, and Participants: This cohort study included adult participants from 11 UK longitudinal population-based studies with prepandemic measures of psychological distress. Analyses were coordinated across these studies, and estimates were pooled. Data were collected from 2006 to 2021. Exposures: Trends in the prevalence of poor mental health were assessed in the prepandemic period (time period 0 [TP 0]) and at 3 pandemic TPs: 1, initial lockdown (March to June 2020); 2, easing of restrictions (July to October 2020); and 3, a subsequent lockdown (November 2020 to March 2021). Analyses were stratified by sex, race and ethnicity, education, age, and UK country. Main Outcomes and Measures: Multilevel regression was used to examine changes in psychological distress from the prepandemic period across the first year of the COVID-19 pandemic. Psychological distress was assessed using the 12-item General Health Questionnaire, the Kessler 6, the 9-item Malaise Inventory, the Short Mood and Feelings Questionnaire, the 8-item or 9-item Patient Health Questionnaire, the Hospital Anxiety and Depression Scale, and the Centre for Epidemiological Studies-Depression across different studies. Results: In total, 49993 adult participants (12323 [24.6%] aged 55-64 years; 32741 [61.2%] women; 4960 [8.7%] racial and ethnic minority) were analyzed. Across the 11 studies, mental health deteriorated from prepandemic scores across all 3 pandemic periods, but there was considerable heterogeneity across the study-specific estimated effect sizes (pooled estimate for TP 1: standardized mean difference [SMD], 0.15; 95% CI, 0.06-0.25; TP 2: SMD, 0.18; 95% CI, 0.09-0.27; TP 3: SMD, 0.21; 95% CI, 0.10-0.32). Changes in psychological distress across the pandemic were higher in women (TP 3: SMD, 0.23; 95% CI, 0.11, 0.35) than men (TP 3: SMD, 0.16; 95% CI, 0.06-0.26) and lower in individuals with below-degree level education at TP 3 (SMD, 0.18; 95% CI, 0.06-0.30) compared with those who held degrees (SMD, 0.26; 95% CI, 0.14-0.38). Increased psychological distress was most prominent among adults aged 25 to 34 years (SMD, 0.49; 95% CI, 0.14-0.84) and 35 to 44 years (SMD, 0.35; 95% CI, 0.10-0.60) compared with other age groups. No evidence of changes in distress differing by race and ethnicity or UK country were observed. Conclusions and Relevance: In this study, the substantial deterioration in mental health seen in the UK during the first lockdown did not reverse when lockdown lifted, and a sustained worsening was observed across the pandemic period. Mental health declines have been unequal across the population, with women, those with higher degrees, and those aged 25 to 44 years more affected than other groups.

Original languageEnglish
Article numbere227629
Pages (from-to)1-15
Number of pages15
JournalJAMA Network Open
Issue number4
Early online date22 Apr 2022
Publication statusPublished online - 22 Apr 2022

Bibliographical note

Funding Information:
TwinsUK: TwinsUK receives funding from the Wellcome Trust (WT212904/Z/18/Z), the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. The TwinsUK COVID-19 personal experience study was funded by the King's Together Rapid COVID-19 Call award, under the projects original title ‘Keeping together through coronavirus: The physical and mental health implications of self-isolation due to the Covid-19 TwinsUK is also supported by the Chronic Disease Research Foundation and Zoe Global Ltd. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Funding Information:
ALSPAC: The UK Medical Research Council and Wellcome (Grant Ref: 217065/Z/19/Z) and the University of Bristol provide core support for ALSPAC. A comprehensive list of grants funding is available on the ALSPAC website ( We are extremely grateful to all the families who took part in this study, the midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses. Part of this data was collected using REDCap, see the REDCap website for details: This work was supported by Wellcome through the Wellcome Longitudinal Population Studies COVID-19 Secretariat and Steering Group (UK LPS COVID co-ordination, Grant Ref: 221574/Z/20/Z) and supported by the Elizabeth Blackwell Institute, University of Bristol, Wellcome Trust Institutional Strategic Support Fund and Rosetrees Trust (Grant Ref: 204813/Z/16/Z; R105121). ASFK is funded by an Economics and Social Research Council (ESRC) Postdoctoral Fellowship (ES/V011650/1).

Funding Information:
GS: Generation Scotland received core support from the Chief Scientist Office of the Scottish Government Health Directorates [CZD/16/6] and the Scottish Funding Council [HR03006]. Genotyping of the GS:SFHS samples was carried out by the Genetics Core Laboratory at the Wellcome Trust Clinical Research Facility, Edinburgh, Scotland and was funded by the Medical Research Council UK and the Wellcome Trust (Wellcome Trust Strategic Award “STratifying Resilience and Depression Longitudinally” (STRADL) Reference 104036/Z/14/Z). Generation Scotland is (216767/Z/19/Z).

Funding Information:
MCS, NS, BCS, NCDS, NSHD: The Millennium Cohort Study, Next Steps, 1970 British Cohort Study and 1958 National Child Development Study are supported by the Centre for Longitudinal Studies, Resource Centre 2015-20 grant (ES/M001660/1) and a host of other co-funders. The 1946 NSHD cohort is hosted by the the MRC Unit for Lifelong Health and Ageing funded by the Medical Research Council (MC_UU_00019/1Theme 1: Cohorts and Data Collection). The COVID-19 data collections in these five cohorts were funded by the UKRI grant Understanding the economic, social and health impacts of COVID-19 using lifetime data: evidence from 5 nationally representative UK cohorts (ES/V012789/1) ELSA: The English Longitudinal Study of Ageing was developed by a team of researchers based at University College London, NatCen Social Research, the Institute for Fiscal Studies, the University of Manchester and the University of East Anglia. The data were collected by NatCen Social Research. The funding is currently provided by the National Institute on Aging in the US, and a consortium of UK government departments coordinated by the National Institute for Health Research. Funding has also been received by the Economic and Social Research Council. The English Longitudinal Study of Ageing Covid-19 Substudy was supported by the UK Economic and Social Research Grant (ESRC) ES/V003941/1.

Funding Information:
BiB: Born in Bradford has received funding from the Wellcome Trust [101597] a joint grant from the UK Medical Research Council (MRC) and UK Economic and Social Science Research Council (ESRC) [MR/N024391/1] the National Institute for Health Research under its Applied Research Collaboration Yorkshire and Humber [NIHR200166]. This study has been funded through The Health foundation COVID-19 Award [2301201].

Funding Information:
USOC: Understanding Society is an initiative funded by the Economic and Social Research Council and various Government Departments, with scientific leadership by the Institute for Social and Economic Research, University of Essex, and survey delivery by NatCen Social Research and Kantar Public. The Understanding Society COVID-19 study is funded by the Economic and Social Research Council (ES/K005146/1) and the Health Foundation (2076161). The research data are distributed by the UK Data Service.

Funding Information:
Conflict of Interest Disclosures: Ms Robertson reported receiving grants from the Medical Research Council (MRC) and the Scottish Government Chief Scientist Office during the conduct of the study. Dr Griffith reports holding a postdoctoral post funded by the MRC and receiving a postdoctoral fellowship from grants from the Economic and Social Research Council (ESRC) during the conduct of the study. Dr Green reported receiving grants from the MRC during the conduct of the study. Dr Huggins reported receiving grants from the Wellcome Trust during the conduct of the study. Dr Niedzwiedz reported receiving grants from the MRC during the conduct of the study and outside the submitted work. Dr Henderson reported grants from ESRC during the conduct of the study. Dr Katikireddi reported receiving grants from the MRC and the Scottish Government Chief Scientist Office during the conduct of the study; serving as cochair of the Scottish Government’s Expert Reference Group on Ethnicity and COVID-19; being a member of the UK Government’s Scientific Advisory Group on Emergencies subgroup on ethnicity; and being a member of the UK Cabinet Office’s International Best Practice Advisory Group. No other disclosures were reported. Funding/Support: This work was supported by the National Core Studies, an initiative funded by UK Research and Innovation, the National Institute for Health Research, and the Health and Safety Executive. The COVID-19 Longitudinal Health and Wellbeing National Core Study was funded by the MRC (MC PC 20059). Full funding acknowledgements for each individual study can be found as part of eAppendix 6 in the Supplement. Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Additional Contributions: The contributing studies have been made possible because of the tireless dedication, commitment and enthusiasm of the many people who have taken part. We would like to thank the participants and the numerous team members involved in the studies including interviewers, technicians, researchers, administrators, managers, health professionals, and volunteers. We are additionally grateful to our funders for their financial input and support in making this research happen. Specifically, we thank Claire Steves, Ruth C. E. Bowyer, Deborah Hart, María Paz García, and Rachel Horsfall (Twins UK); Nicholas J. Timpson, Kate Northstone, and Rebecca M. Pearson (Avon Longitudinal Study of Parents and Children; more information in eAppendix 7 in the Supplement); Drew Altschul, Chloe Fawns-Ritchie, Archie Campbell, and Robin Flaig (Generation Scotland); Michaela Benzeval (Understanding Society); Andrew Wong, Maria Popham, Karen MacKinnon, Imran Shah, and Philip Curran (1946 National Survey of Health and Development); our colleagues in survey, data, and cohort maintenance teams (the Millennium Cohort Study, Next Steps, 1970 British Cohort Study, National Child Development Study); John Wright and Dan Mason and other colleagues in cohort, survey, data maintenance teams (Born in Bradford).

Publisher Copyright:
© 2022 Patel K et al. JAMA Network Open.


  • Adult
  • COVID-19/epidemiology
  • Cohort Studies
  • Communicable Disease Control
  • Depression/epidemiology
  • Ethnicity
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Minority Groups
  • Pandemics
  • Psychological Distress
  • United Kingdom/epidemiology


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