Mental health responses to the COVID-19 pandemic: a latent class trajectory analysis using longitudinal UK data.

Background: The mental health of the UK population declined at the onset of the COVID-19 pandemic. Convenience sample surveys indicate that recovery began soon after. Using a probability sample, we tracked mental health during the pandemic to characterise mental health trajectories and identify predictors of deterioration.
Methods: This study was a secondary analysis of five waves of the UK Household Longitudinal Study (a large, national, probability-based survey that has been collecting data continuously since January, 2009) from late April to early October, 2020 and pre-pandemic data taken from 2018-19. Mental health was assessed using the 12-item General Health Questionnaire (GHQ-12). We used latent class mixed models to identify discrete mental health trajectories and fixed-effects regression to identify predictors of change in mental health.
Findings: Mental health was assessed in 19 763 adults (≥16 years; 11 477 [58·1%] women and 8287 [41·9%] men; 3453 [17·5%] participants from minority ethnic groups). Mean population mental health deteriorated with the onset of the pandemic and did not begin improving until July, 2020. Latent class analysis identified five distinct mental health trajectories up to October 2020. Most individuals in the population had either consistently good (7437 [39·3%] participants) or consistently very good (7623 [37·5%] participants) mental health across the first 6 months of the pandemic. A recovering group (1727 [12·0%] participants) showed worsened mental health during the initial shock of the pandemic and then returned to around pre-pandemic levels of mental health by October, 2020. The two remaining groups were characterised by poor mental health throughout the observation period; for one group, (523 [4·1%] participants) there was an initial worsening in mental health that was sustained with highly elevated scores. The other group (1011 [7·0%] participants) had little initial acute deterioration in their mental health, but reported a steady and sustained decline in mental health over time. These last two groups were more likely to have pre-existing mental or physical ill-health, to live in deprived neighbourhoods, and be of Asian, Black or mixed ethnicity. Infection with SARS-CoV-2, local lockdown, and financial difficulties all predicted a subsequent deterioration in mental health.
Interpretation: Between April and October 2020, the mental health of most UK adults remained resilient or returned to pre-pandemic levels. Around one in nine individuals had deteriorating or consistently poor mental health. People living in areas affected by lockdown, struggling financially, with pre-existing conditions, or infection with SARS-CoV-2 might benefit most from early intervention.
Funding: None.
Competing Interests: Declaration of interests MH reports grants from Innovative Medicines Initiative, outside the submitted work. SLH reports grants from the National Institute for Health Research, grants from the Economic and Social Research Council (ESRC), grants from Wellcome Trust, grants from the Medical Research Council, and grants from Guy's and St Thomas' Charity, outside the submitted work; is a member of the following advisory groups: ethnic inequalities in health care among people with multiple conditions (University of Sussex), Advisory Board NHS Race and Health Observatory, Co-Chair Academic Reference Group and Board Member The Royal Foundation, Mental Health Research Group NHS England and NHS Improvement, The Mental Health Equalities Data Quality and Research Subgroup NHS England and NHS Improvement, Patient and Carers Race Equalities Framework Steering Group NHS England and NHS Improvement, Advancing Mental Health Equalities Taskforce Health Education England, Mental Health Workforce Equalities Subgroup Maudsley Learning, Maudsley Learning Advisory Board South London and Maudsley NHS Foundation Trust (SLaM), Independent Advisory Groups, the SLaM Partnership Group, Lambeth Public Health, Serious Youth Violence Public Health Task and Finish Group Thrive London, Thrive London Advisory Board Black Thrive, Black Thrive Advisory Board NHS England and NHS Improvement, The Mental Health Workforce Equalities Subgroup Commissions: Welsh Government's Race Equality Plan; and contributed to the evidence review for Health and Social Care and Employment and Income policy areas. All other authors declare no competing interests.
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