Locked down in distress: how did the initial Covid-19 wave affect mental health in the UK?

The Covid-19 pandemic is the most significant combined public health and economic crisis in the last century. To try and control the pandemic and protect public health, governments in the UK and across the world took unprecedented steps, such as the imposition of lockdowns and other social distancing requirements. The implementation of physical distancing measures profoundly impacted the way people lived their lives and such changes will inevitably have mental health consequences.

In research funded by the Economic and Social Research Council (ESRC), we have been looking to quantify the reductions in mental health observed during the first lockdown period coupled with an exploration of the major reasons why people experienced such substantive increases in psychological distress.

Understanding the full welfare consequences of policy interventions in this area will help us to make more informed choices about the scope and nature of government intervention in response to this and future pandemics. In addition, ascertaining the extent of the impact on different socio-demographic groups will inform targeted policies to help mitigate these detrimental impacts.

It can be challenging to estimate the specific mental health impacts associated with the Covid-19 pandemic, as simply comparing the changes in well-being of people before the pandemic with that experienced during the pandemic may confound the impact of the pandemic with seasonal patterns or longer-term trends in well-being.

To get around this problem, we took advantage of a large-scale longitudinal survey, which tracked the well-being of the same people over time. We then compared the changes in mental health observed for people interviewed pre and post-March 23rd 2020 with that of those interviewed before and after the same date in the year before the first lockdown. The latter serves as a control group of sorts. We selected May 31st 2020 as our endpoint as the first nationwide lockdown measures reduced significantly thereafter. Notably, the findings discussed below did not change if we selected different start and endpoints.

A further valuable feature of our analysis is that, because of the large sample size, we could also explore potential moderating factors behind the detrimental effects of the pandemic on mental health.

How big were the effects?

Our findings show that people experienced a considerable increase in psychological distress during the initial wave of the pandemic. The measure of psychological distress used in this study was the General Health Questionnaire. It consists of a 12-item scale designed to assess stress, anxiety and happiness and is commonly recorded in surveys. Our analysis suggests that, on average, people witnessed a 0.91 unit increase in this measure of psychological distress during the first wave of the pandemic.

To put this into context, this would be approximately one-half to two-thirds of the estimated adverse effects associated with unemployment and significantly larger than the typical estimated effects associated with divorce and widowhood for mental health. Therefore, the population-level mental health impacts were substantive.

Who suffered more?

The average estimated population effects did mask considerable differences across groups however. For example, the levels of psychological distress experienced during the first wave of the pandemic were much more pronounced for women, younger age groups, people of BAME background and people born outside the UK. To illustrate, the average levels of psychological distress experienced during the first wave were about twice as substantive for women as opposed to men. The same was true when we compared people of a BAME background relative to non‐BAME ethnicity.

Who was the least resilient?

Having established that the pandemic is associated with a significant and substantial decline in mental health, and that these impacts were not uniformly distributed according to socio-demographic characteristics, we next looked to identify if we could predict who was least resilient to the pandemic. The factors we focused on were the presence of financial worries, loneliness, and household density (i.e. the number of people living in one house) as we hypothesised that these would all play an important role in shaping resilience.

Our results pointed to the importance of how well individuals feel they can manage their finances and loneliness (based on their previous experiences and own thoughts) in shaping the degree to which people experienced psychological distress during the first wave of the pandemic. This probably captures the fact that people who feel best in control of their finances and least likely to be lonely, are more likely to have the financial resources and social support in place to help deal with the challenges brought on by the pandemic.

We showed how household density also plays an important moderating role. Our proposed explanation is that being constrained to one's home for long periods, as was required during the first wave of the pandemic, will result in what psychologists refer to as crowding stress. Crowding stress in turn is likely to be more apparent in higher-density households.

Conclusion

Our research reveals significant rises in psychological distress in the UK during the initial phase of the Covid-19 pandemic. While substantive for all groups, the impact on mental health was more notable among females, younger individuals, Black, Asian, and minority ethnic communities, as well as individuals born outside the UK. Additionally, individuals' perceptions of their financial situation, whether they were experiencing loneliness before the pandemic, and household size all played a substantive role in determining their resilience to the pandemic.

The potential long-term effects on mental health, stemming from the economic and social disruptions caused by the pandemic, are yet to be fully understood. Just as there will undoubtedly be enduring consequences for some individuals' physical health, it remains uncertain whether there will be lasting repercussions for mental well-being. We know for instance that for some adverse life events there can be long‐term psychological scarring meaning that recovery is not always complete.

Read the article. “Locked down in distress: A quasi-experimental estimation of the mental-health fallout from the COVID-19 pandemic”, Lina Anaya, Peter Howley, Muhammad Waqas, Gaston Yalonetzky. Economic Inquiry. https://doi.org/10.1111/ecin.13181