Depressive and anxiety symptoms in adults during the COVID-19 pandemic in England: A panel data analysis over 2 years

• Published in: PLoS medicine 2023-04, Vol.20 (4), p.e1004144-e1004144
• Main Authors: Bu, Feifei, Steptoe, Andrew, Fancourt, Daisy
• Format: Article
• Language: English
• Subjects: Adult; Adults; Analysis; Anxiety; Anxiety - epidemiology; Anxiety disorders; Biology and Life Sciences; Communicable Disease Control; Coronaviruses; COVID-19; COVID-19 - epidemiology; COVID-19 vaccines; Data Analysis; Data collection; Depression - epidemiology; England - epidemiology; Entropy; Epidemics; Ethnicity; Female; Glutamate decarboxylase; Health aspects; Health care; Humans; Immunization; Longitudinal studies; Male; Medical research; Medicine and Health Sciences; Medicine, Experimental; Mental depression; Mental disorders; Mental health; Middle Aged; Minority Groups; Pandemics; People and places; Public health; Questionnaires; Social interactions; Social Sciences; Social support; Stress; United Kingdom; World health
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1004144

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. 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