Research and analysis

1. About COVID-19 mental health and wellbeing surveillance

Updated 12 April 2022

Applies to England

This report presents close to real time intelligence on the mental health and wellbeing of the population in England during the coronavirus (COVID-19) pandemic.

It compiles routinely updated indicators from multiple sources and summarises important recent findings from a pre-defined set of studies.

It aims to inform policy, planning and commissioning in health and social care and is designed to assist stakeholders at both national and local level.

Delivering close to real time surveillance is logistically challenging and the approach should be viewed as experimental. However, the approach is expected to provide value in situations where:

• the ability to respond to a changing environment is needed and decisions may need to be made quickly

• the certainty in existing evidence is limited, posing a barrier to decision-making

• there is likely to be new research evidence emerging that would inform decisions

The report is produced quarterly and aims to include the latest available data and intelligence. It will enable the identification and consideration of changes in mental health and wellbeing during the pandemic.

Introduction

The report includes:

• this document, which introduces the overall report
• summary of important findings so far
• measures of anxiety, loneliness, depression and life satisfaction
• chapter dedicated to the experiences of children and young people

There is also a Spotlight section which includes a series of reports describing different aspects of inequality. New reports are added regularly.

This report should be viewed together with the Wider Impacts of COVID-19 on Health (WICH) tool.

Note: This report does not consider or include data on referrals and access to NHS funded mental health services.

Two useful sources of information on this are the Mental Health Services Monthly Statistics and Psychological Therapies, Report on the use of Adult Improving Access to Psychological Therapies (IAPT) Services.

This report draws upon close to real time data and evidence. This is important in the context of a rapidly evolving pandemic, but comes with strengths and weaknesses.

It is important to explain the basis for the inclusion of evidence and analysis in this report. A methodology document outlines how sources of intelligence have been identified for inclusion and the process undertaken for intelligence synthesis and presentation of findings.

For comments or questions, please email mhdnin@phe.gov.uk

Strengths and caveats

It is important to recognise what this surveillance report can and cannot provide.

Strengths

The strengths of the report are that:

• it includes regular and frequent updates, which provide a timely flow of intelligence for users during the COVID-19 pandemic, based on identification of near to real-time evidence

• the content of the tracker report will improve over time, in line with the improvements in the evidence base

• the collation of a set of studies which include validated survey questionnaires (for example PHQ-9 symptoms of depression, GAD-7 symptoms of anxiety, GHQ-12 symptoms of mental distress) and self-reported experiences and impacts of COVID-19 on mental health and wellbeing

• the inclusion of data prior to the COVID-19 lockdown enables understanding of changes (where data is available)

• information about vulnerable groups is included (where data is available)

Caveats

There are a number of important points and limitations which the user should consider when reading the report, including that:

• some trends reported are based on repeated cross section data, for example the survey is carried out with a new sample of participants at each successive time point, therefore, variation may not reflect changes for the same group of participants

• in order to provide as close to real time surveillance as possible, studies included in the tracker report may be working papers or awaiting publication, and as such may not have been subject to peer review

• there is a delay in publishing more robust analytical studies due to the time it takes to collect, clean and analyse the data and then make available to the public

• the report is not exhaustive, it is the result of a pragmatic approach to the gathering of and provision of useful evidence during the COVID-19 pandemic

• the report is not a systematic review – see Methodology for the evidence-assessment approach

• judgement about significance or accuracy of findings is not part of the review process, as a light-touch appraisal is carried out

• the mention of specific studies does not imply that they are endorsed or recommended by the Office of Health Improvement and Disparities (OHID) in preference to others of a similar nature that are not mentioned

• the evidence provided within the report should not be viewed as final, definitive or authoritative

• findings taken from the various data sources have not been verified by OHID

• the report contains information which should be classed as ‘experimental statistics’

• changes in incidence and prevalence of severe mental illness (SMI) during the pandemic are not covered in detail within the intelligence materials that this document reports on

Wider Impacts of COVID-19 on Health (WICH) tool

This tool is produced by the Office of Health Improvement and Disparities and brings together a range of data relating to the impacts of the COVID-19 pandemic. Data on mental health and wellbeing, and related risk factors, are included.

To view the data:

1. Go to the WICH tool.
2. Click on the “Mental Health and Wellbeing” tab (top row, far right).
3. Explore available metrics and the cuts of data for each by clicking on the “Theme” (and “Sub-theme”), “Indicator” and “Breakdown” drop down menus (on the left of the page).

This will present the data in charts - scroll down the page to view all the content. Data tables and metadata are also available.

Authors and acknowledgements

Authors

This report has been produced and authored by the National Mental Health Intelligence Network with particular input from Victoria Abolarin, Sue Foster, Alex Jones, Cam Lugton, Sandy Miller, Jianhe Peng and Shehla Shamsuddin.

Acknowledgements

The COVID-19 mental health and wellbeing surveillance report relies on extensive collaboration across government, academia and the third sector.

We are particularly thankful for contributions from James Bell, Catherine Newsome, Marguerite Adewoye, Elizabeth Winstanley and Lucy Gilbert at the Department for Education, and Ian Walker and Neha Shah at OHID. We would also like to thank other colleagues at OHID as well as colleagues at the Department of Health and Social Care (DHSC), NHS England and the Office for National Statistics.

In addition, we would like to acknowledge the contribution from academic research teams working across the country on the following projects:

• Understanding Society
• Avon Longitudinal Study of Parents and Children
• PROTECT
• Born in Bradford
• Twins Early Development Study
• Coronavirus Outbreak Psychological Experience
• Catalogue of Mental Health Measures
• Repeated Assessment of Mental Health in Pandemics
• COVID-19 Social Study
• 1958 National Child Development Study
• 1970 British Cohort Study, Next Steps
• Millennium Cohort Study
• COVID-19 Psychological Research Consortium
• COVID-19 Stress and Health study
• UK Biobank
• South London and Maudsley NHS Foundation Trust
• Optimising Wellbeing During Social Isolation study

We would also like to thank the following private and charity sector organisations for providing regular data and analysis:

• The Mental Health Foundation
• YouGov
• Anxiety UK
• Young Minds
• Kooth plc
• Citizens Advice
• Rethink Mental Illness
• Mind
• Togetherall

Without all of your input, this ongoing surveillance report would not be possible.

Glossary of terms

Term	Acronym	Description
Adult Psychiatric Morbidity Survey	APMS	A nationwide survey, last carried out in 2014, which provides data on prevalence of both treated and untreated psychiatric disorders.	#
Age-standardised rate	ASR	A calculation that allows the comparison of rates (of disease or other event) in 2 populations even if the populations have different underlying age distributions. The age-standardised rate is the rate that you would observe if every population had the same age distribution.
Annual population survey	APS	A continuous household survey of people in the United Kingdom designed to provide information on important social and socio-economic variables. Some of the topics include employment, housing, health and education.
Anxiety (generalised anxiety disorder)	–	A disorder in which anxiety is experienced about a wide range of issues to the extent that it interferes with daily life.
Autistic spectrum disorder	ASD	A neurodevelopmental disorder that is characterised by impairments in communication and socialisation, as well as repetitive or unusual behaviours.
Black, Asian and minority ethnic	BAME	This is terminology widely used in the United Kingdom to describe people who do not self-identify as ‘White British’.
Child and Adolescent Mental Health Services	CAHMS	A term for all services that work with children and young people who have difficulties with their emotional or behavioural wellbeing
Children and young people	CYP	Generally refers to people aged 4 to 19 in this report. Different age ranges are detailed where they are used.
Children in need	CIN	Defined as a child who has been referred to, and is assessed as requiring, social care services.
Cognitive behavioural therapy	CBT	An evidence-based talking therapy that helps people change their patterns of thought or behaviour.
Common mental disorders	CMD	Includes mood disorders such as depression, and anxiety disorders such as generalised anxiety disorder and post-traumatic stress disorder.
Confidence interval	CI	This is a statistical indicator of how closely measurements are likely to reflect a ‘true’ or underlying pattern. A wide confidence interval means that chance variations in what we are looking at could result in a big difference in the reported number, while a narrow confidence interval suggests that chance variations would not change the reported number by very much.
Coronavirus disease 2019	COVID-19	COVID-19 is a new coronavirus which had previously not been detected in humans. The first case was detected in the city of Wuhan in China at the end of 2019. The rate of transmission of the virus is high, and its spread has become global.
Crude rate	–	This is the rate (of disease or other event) with no adjustments made to take into account any differences in the underlying population.
Department for Education	DfE	Responsible for child protection, education apprenticeships and wider skills in England.
Department of Health and Social Care	DHSC	The government department led by the Secretary of State for Health and Social Care responsible for the health and social care budget and top level priority setting.
Department of Work and Pensions	DWP	DWP is responsible for welfare, pensions and child maintenance policy. As the UK’s biggest public service department it administers the State Pension and a range of working age, disability and ill health benefits.
Depression	–	A mood disorder with a range of physical and mental symptoms, which can include loss of appetite, changes in sleeping patterns, low mood, hopelessness and suicidal ideation.
General Health Questionnaire 12	GHQ-12	A 12-question screening device for identifying common psychiatric disorders. It is widely used in health care and in population health research.
Generalised anxiety disorder 7	GAD-7	A self-reported panel of 7 questions used for identifying, and measuring the severity of, generalized anxiety disorder. It is widely used in health care and in population health research.
Global burden of disease	GBD	GBD is a worldwide study of the major causes of death and illness at global, national and regional level.
Increasing Access to Psychological Therapies	IAPT	This is a programme offering short courses of talking therapies to people with mild to moderate common mental health disorders.
Index of Multiple Deprivation	IMD	The Index of Multiple Deprivation (IMD) uses indicators across seven domains (income, employment, health and disability, education skills and training, barriers to housing, crime, and living environment) to provide an overall measure of deprivation for each area, relative to other areas within England. Areas have been ranked according to their IMD score and split into 10 groups – from the most deprived 10% of areas (1) to the least deprived 10% of areas. (10).
Learning disability	LD	Having a reduced intellectual ability which inhibits learning of new, complex information and developing new skills, and having reduced social and adaptive functioning, which leads to reduced ability to cope independently. Onset is in childhood and has a lasting effect.
Lesbian, gay, bisexual, transgender, and other sexual and gender minority.	LGBT+	This is terminology normally used to describe people who are not exclusively heterosexual or may identify as a non-binary gender or a gender not assigned to them at birth.
Long-term condition	LTC	A chronic disease for which there is currently no cure. Long-term conditions are managed with drugs or other treatment.
Looked after children	LAC	Children in foster care or the care of the state.
Mean	–	The mean of a collection of values is the sum of all the values divided by the number of values. It is also referred to as the ‘average’. See also ‘median’.
Median	–	The median of a collection of values is the number in the middle. That is, it is higher than half the values and lower than half the values. It is used instead of the mean (see above) when a few very high or very low values might skew the mean and give a misleading picture. For instance, if 9 people earn £10 per hour and one person earns £200 per hour, the mean wage would be £29 per hour while the median would be £10 per hour, which gives a more representative picture of all the wages.
Mental Health Intelligence Network	MHIN	Team within OHID responsible for providing access to information and intelligence to support the commissioning, planning and provision of mental health and wellbeing services.
Obsessive-compulsive disorder	OCD	A disorder in which someone experiences repeated unwanted and unpleasant thoughts (obsessions) and feels that they need to carry out certain acts (compulsions) in order to relieve the negative feelings these thoughts trigger.
Office for National Statistics	ONS	The ONS is the main independent producer of statistics relating to the economy, population and society for the United Kingdom.
Older people	–	Older people are generally referred to as people who are aged 65 and over. Different age ranges are detailed where they are used.
Pandemic	–	The World Health Organization has described a pandemic as the worldwide spread of a new disease.
Patient Health Questionnaire 9	PHQ-9	A self-reported panel of 9 questions used for identifying, and measuring the severity of, depression. It is widely used in health care and in population health research.
Personal, Social and Health Education	PSHE	PSHE is a subject taught in the English curriculum across key stages 1 to 5.
Post-traumatic stress disorder	PTSD	An anxiety disorder developed following a traumatic experience. Symptoms can include insomnia, difficulty concentrating, irritability and flashbacks.
Office for Health Improvement and Disparities	OHID	OHID is part of the DHSC who provide scientific expertise and support to improve the nation’s health and reduce inequalities.
Severe acute respiratory syndrome coronavirus 2	SARS‑CoV‑2	The technical name for the virus which is responsible for the COVID-19 pandemic.
Severe mental illness	SMI	This is a technical term which refers to bipolar disorder, schizophrenia and other psychosis.
Special educational needs (and disability)	SEN(D)	Children identified in school as having a need including broadly (1) Communication and interaction (2) Cognition and learning (3) Social, emotional and mental health difficulties (4) Sensory and/or physical needs.
University College London	UCL	The lead institution for the COVID-19 Social Study.
UK Household Longitudinal Study	UKHLS	A large study following UK adults over time, which provides information for researchers and policymakers on the changes and stability of people’s lives in the UK. Also called ‘Understanding Society’.