Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study

Abstract

Background There is currently major concern about the impact of the global COVID-19 outbreak on mental health. A number of studies suggest that mental health deteriorated in many countries prior to and during enforced isolation (“lockdown”), but it remains unknown how mental health has changed week by week over the course of the COVID-19 pandemic. Aims This study explored trajectories of anxiety and depression over the 20 weeks after lockdown was announced using data from England, and compared the growth trajectories by individual characteristics. Methods Data from 36,520 adults in the UCL COVID -19 Social Study (a well-stratified panel study weighted to population proportions collecting data weekly during the COVID-19 pandemic) were analysed from 23/03/2020-09/08/2020. Latent growth models were fitted accounting for socio-demographic and health covariates. Results 22.6% of the sample had scores indicating moderate-severe anxiety, and 25.1% indicating moderate-severe depressive symptoms. Anxiety and depression levels both declined across the first 20 weeks following the introduction of lockdown in the England. The fastest decreases were seen across the strict lockdown period, with symptoms plateauing as further lockdown easing measures were introduced. Being female or younger, having lower educational attainment, lower income or pre-existing mental health conditions, and living alone or with children were all risk factors for higher levels of anxiety and depression at the start of lockdown. Many of these inequalities in experiences were reduced as lockdown continued, but differences were still evident 20 weeks after the start of lockdown. Conclusions As countries face potential future lockdowns, these data suggest that the highest levels of depression and anxiety are in the early stages of lockdown but decline fairly rapidly as individuals adapt to circumstances. They also suggest the importance of supporting individuals in the lead-up to lockdown measures being brought in to try and reduce distress and highlight that emotionally vulnerable groups have remained at risk throughout lockdown and its aftermath. Research in context Evidence before this study Data from representative cohort studies have highlighted the substantial impact of the COVID-19 pandemic on levels of depression, anxiety and mental distress, showing increases in average scores of symptoms of psychological distress from before to during the pandemic as well as a rise in the proportion of people experiencing clinically significant levels of mental illness. But it remains unknown how mental health has changed week by week over the course of the COVID-19 pandemic. Added value of this study This study finds that anxiety and depression levels both declined across the first 20 weeks following the introduction of lockdown in the England. The fastest decreases were seen across the strict lockdown period, with symptoms plateauing as further lockdown easing measures were introduced. Specific risk factors for poorer trajectories of mental health during the pandemic are identified. Implications of all the available evidence: This study is the first globally to look longitudinally at trajectories of anxiety and depression across the COVID-19 pandemic. Overall, these findings suggest that the highest levels of depression and anxiety in England were in the early stages of lockdown but declined fairly rapidly following the introduction of lockdown. Many known risk factors for poorer mental health were apparent at the start of lockdown, but some groups experienced faster improvements in symptoms, thereby reducing the differences over time. Nevertheless, many inequalities in mental health experiences did remain and emotionally vulnerable groups have remained at risk throughout lockdown and its aftermath. This has implications for planning and support for individuals during potential future waves of the virus.

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• Follow-up Survey of US Adult Reports of Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic, September 2020 · 2021
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• Refuting the myth of a ‘tsunami’ of mental ill-health in populations affected by COVID-19: evidence that response to the pandemic is heterogeneous, not homogeneous · 2021
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• The mental health impact of COVID-19 and lockdown-related stressors among adults in the UK · 2020
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