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Background: There has been much research into the mental health impact of the Coronavirus Disease 2019 (COVID-19) pandemic and how it is related to time-invariant individual characteristics. However, there is still a lack of research showing long-term trajectories of mental health across different stages of the pandemic. And little is known regarding the longitudinal association of time-varying factors with mental health outcomes. This study aimed to provide a longitudinal profile of how mental health in adults changed across different stages of the COVID-19 pandemic and to examine their longitudinal associations with time-varying contextual (e.g., COVID-19 policy response and pandemic intensity) and individual level factors. Methods and findings: This study used data from a large panel study of over 57,000 adults living in England, who were followed up regularly for 2 years between March 2020 and April 2022. Mental health outcomes were depressive and anxiety symptoms. Depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-9) and anxiety symptoms by the Generalized Anxiety Disorder assessment (GAD-7). Entropy balancing weights were applied to restore sample representativeness. After weighting, approximately 50% of participants were female, 14% from ethnic minority backgrounds, with a mean age of 48 years. Descriptive analyses showed that mental health changes were largely in line with changes in COVID-19 policy response and pandemic intensity. Further, data were analysed using fixed-effects (FE) models, which controlled for all time-invariant confounders (observed or not). FE models were fitted separately across 3 stages of the COVID-19 pandemic, including the first national lockdown (21/03/2020–23/08/2020), second and third national lockdowns (21/09/2020–11/04/2021), and "freedom" period (12/04/2021–14/11/2021). We found that more stringent policy response (measured by stringency index) was associated with increased depressive symptoms, in particular, during lockdown periods (β = 0.23, 95% confidence interval (CI) = [0.18 to 0.28], p < 0.001; β = 0.30, 95% CI = [0.21 to 0.39], p < 0.001; β = 0.04, 95% CI = [−0.03 to 0.12], p = 0.262). Higher COVID-19 deaths were also associated with increased depressive symptoms, but this association weakened over time (β = 0.29, 95% CI = [0.25 to 0.32], p < 0.001; β = 0.09, 95% CI = [0.05 to 0.13], p < 0.001; β = −0.06, 95% CI = [−0.30 to 0.19], p = 0.655). Similar results were also found for anxiety symptoms, for example, stringency index (β = 0.17, 95% CI = [0.12 to 0.21], p < 0.001; β = 0.13, 95% CI = [0.06 to 0.21], p = 0.001; β = 0.10, 95% CI = [0.03 to 0.17], p = 0.005), COVID-19 deaths (β = 0.07, 95% CI = [0.04 to 0.10], p < 0.001; β = 0.04, 95% CI = [0.00 to 0.07], p = 0.03; β = 0.16, 95% CI = [−0.08 to 0.39], p = 0.192). Finally, there was also evidence for the longitudinal association of mental health with individual level factors, including confidence in government/healthcare/essentials, COVID-19 knowledge, COVID-19 stress, COVID-19 infection, and social support. However, it is worth noting that the magnitudes of these longitudinal associations were generally small. The main limitation of the study was its non-probability sample design. Conclusions: Our results provided empirical evidence on how changes in contextual and individual level factors were related to changes in depressive and anxiety symptoms. While some factors (e.g., confidence in healthcare, social support) clearly acted as consistent predictors of depressive and/or anxiety symptoms, other factors (e.g., stringency index, COVID-19 knowledge) were dependent on the specific situations occurring within society. This could provide important implications for policy making and for a better understanding of mental health of the general public during a national or global health crisis. Author summary: Why was this study done?: There is increasing research showing worsening mental health during the Coronavirus Disease 2019 (COVID-19) pandemic. There is some evidence for mental health changes across different stages of the pandemic, but there is a lack of long-term longitudinal research with regular follow-ups. Few studies have examined how changes in contextual and individual factors are related to mental health outcomes. What did the researchers do and find?: Drawing data from over 57,000 participants, we showed descriptively how depressive and anxiety symptoms changed over time between March 2020 and April 2022. Using fixed-effects (FE) analyses, we found evidence for longitudinal associations of depressive and anxiety symptom with both contextual (e.g., stringency index, COVID-19 cases) and individual factors (e.g., COVID-19 knowledge, social support). Some of these longitudinal associations (e.g., stringency index, COVID-19 knowledge) differed across different stages of the COVID-19 pandemic, and differential relationships were also found between depressive and anxiety symptoms. What do these findings mean?: These findings from observational data provide empirical evidence for the longitudinal association between contextual factors and people's mental health, offering important implications for policy making. Our study highlights the importance of individual level factors such as confidence in healthcare services and perceived social support in supporting better mental health. Further research is needed to monitor mental health changes over longer periods and to use alternative mental health assessment tools. [ABSTRACT FROM AUTHOR]

Background: There are concerns that keyworkers may be at a greater risk for psychological distress than non-keyworkers during the COVID-19 pandemic. However, little research has included keyworkers outside of the healthcare sector or has disaggregated keyworkers into different subgroups. Aims: To examine longitudinal changes in mental health over 12 months during the COVID-19 pandemic comparing four different groups of keyworkers with non-keyworkers. Method: Longitudinal data were from 21 874 adults living in England (21 March 2020 to 22 February 2021). Latent growth modelling was utilised to compare growth trajectories of depressive and anxiety symptoms in non-keyworkers and four types of keyworkers: (a) health and social care workers, (b) teachers and child care workers, (c) public service workers, and (d) essential services keyworkers (such as food chain or utility workers). Results: When accounting for both time-invariant and time-varying covariates, keyworkers in the essential services category had consistently higher levels of depressive and anxiety symptoms than non-keyworkers across the whole of the study period. There was little difference in the mental health trajectories between health/social care, teachers/child care and public service worker categories and non-keyworkers. Conclusions: Our findings suggest that the risk for poorer mental health during the COVID-19 pandemic varies within the broad category of keyworkers generally, and that those working in utility, food chain and transport roles are especially at risk. Future research should focus on identifying which aspects of working conditions may be contributing to occupational stress in these groups. [ABSTRACT FROM AUTHOR]

Recent studies have shown reduced physical activity at early stages of the COVID-19 pandemic. However, there is a lack of investigation on longitudinal changes in physical activity beyond lockdowns and stay-at-home orders. Moreover, it is unclear if there is heterogeneity in physical activity growth trajectories. This study aimed to explore longitudinal patterns of physical activity and factors associated with them. Data were from the UCL COVID-19 Social Study. The analytical sample consisted of 35,915 adults in England who were followed up for 22 weeks from 24th March to 23rd August 2020. Data were analysed using growth mixture models. Our analyses identified six classes of growth trajectories, including three stable classes showing little change over time (62.4% in total), two classes showing decreasing physical activity (28.6%), and one class showing increasing physical activity over time (9%). A range of factors were found to be associated the class membership of physical activity trajectories, such as age, gender, education, income, employment status, and health. There is substantial heterogeneity in longitudinal changes in physical activity during the COVID-19 pandemic. However, a substantial proportion of our sample showed persistent physical inactivity or decreasing physical activity. Given the well-established link between physical activity and health, persistent or increased physical inactivity is likely to have both immediate and long-term implications for people's physical and mental health, as well as general wellbeing. More efforts are needed to promote physical activity during the pandemic and beyond. [ABSTRACT FROM AUTHOR]

This study examined the association between greenspace and the growth trajectories of anxiety symptoms during the COVID-19 pandemic. Using data from 19,848 urban residents in England who were followed for 20 months between March 2020 and October 2021, we found that living in an area with higher greenspace coverage (exposure) was associated with fewer anxiety symptoms independent of population density, area deprivation levels, socio-demographics, and health profiles. There was limited evidence that greenspace was related to the change of anxiety symptoms over time. No association with anxiety trajectories was found when considering distance to nearest greenspace (proximity), highlighting potentially differential mental health effects of simply having access to local parks and recreation areas versus living in areas of greater natural environment land cover. These findings have important implications for mental health intervention and policymaking. [ABSTRACT FROM AUTHOR]