Research and analysis

2. Important findings

Updated 12 April 2022

Applies to England

Introduction

This is chapter 2 of the COVID-19: mental health and wellbeing surveillance report. It is a high-level summary of the COVID-19 pandemic’s impact on the mental health and wellbeing of the population in England.

This is the final version of this regularly updated chapter. It includes evidence and analysis that was released into the public domain up to 31 January 2022. After this release it will not be updated again.

To enable this chapter to be as up to date as possible some ‘pre-print’ academic research is presented. This research has not yet been peer reviewed. It is included here to enable timely reporting. Even with this approach there is still a time delay between data being gathered and findings reported.

The following information relates specifically to adults. The COVID-19 mental health and wellbeing surveillance report includes a separate chapter dedicated to the experiences of children and young people.

The basis for the intelligence included is presented in the Methodology document.

Note: Any short-term deteriorations in self-reported mental health should not automatically be interpreted as an increase in mental illness or need for mental health services. The period of the pandemic is recognised as a difficult and stressful time for many.

Changes in population mental health and wellbeing

Multiple studies revealed deteriorations in mental health and wellbeing between March and May 2020, followed by a period of improvement through July, August and September 2020 to a point where levels were comparable to before the pandemic. There was a second deterioration in population mental health and wellbeing between October 2020 and February 2021, which many studies showed to have gradually improved back to pre-pandemic levels through August, September and October 2021. There was also some evidence of deterioration in the population mental health and wellbeing around the Christmas period in 2021.

Analysis of data from the UK Household Longitudinal Study (UKHLS) has tracked changes in levels of psychological distress during the pandemic. It suggests the proportion of adults aged 18 and over reporting a clinically significant level of psychological distress increased from 20.8% in 2019 to 29.5% in April 2020, then falling back to 21.3% by September 2020. There was a subsequent increase to 27.1% in January 2021, followed by a further decrease to 24.5% in late March 2021.

These UKHLS findings have been broadly corroborated by other studies also looking at anxiety, depressive symptoms, loneliness, sleep and stress (references 2 to 8). However, the periods of ‘recovery’ in summer 2020 and autumn 2021 were either not observed or did not return to pre-pandemic levels in all studies. Examples include studies from the Office for National Statistics (ONS) looking at depression in adults and the English Longitudinal Study of Aging considering mental health and wellbeing of older adults (aged over 52).

Reporting from the UCL COVID-19 social study suggests a worsening of depression and anxiety symptoms in adults during the Christmas period in 2021 (PDF, 2.7MB). Analysis of life satisfaction and happiness data also reported a decrease over this period across all age groups, reaching the lowest level seen since the lifting of the third national lockdown in March 2021.

The ‘up and down’ nature of these changes coincides with the periods of national lockdown and high COVID-19 cases followed by easing of lockdown and reducing cases.

It is also important to monitor the prevalence of self-harm thoughts and behaviours. Another large study of adults aged 18 and over found that 26.1% of respondents reported self-harm thoughts and 7.9% self-harm behaviours at least once between March 2020 and May 2021. This study does not have a pre-pandemic comparison. The largest adversity contributing to increases in both self-harm thoughts and behaviours was having experienced physical or psychological abuse between April and August 2021. Having had COVID-19 and financial worries were also associated with increased likelihood of both outcomes. Early on in the pandemic it was reported that fewer than half of adults affected by abuse, self-harm and thoughts of suicide/self-harm accessed formal or informal support.

Variation within the population

The overall trends summarised above mask variation within the population. Evidence shows that the mental health and wellbeing impact of the COVID-19 pandemic has been different for different groups of people.

Studies looking at mental health trajectories for individuals suggest most of the population retained stable and good levels of mental health during the pandemic. However, some groups have been more likely to experience poor or deteriorating mental health during this time, especially the first part of the pandemic. These include women, young adults (aged between 18 and 34, depending on the study), adults with pre-existing mental or physical health conditions, adults experiencing loss of income or employment, adults in deprived neighbourhoods, some ethnic minority populations, adults with personality traits that were more ‘extraverted’ or ‘open to experience’, and those who experienced local lockdowns.

In addition, those who lived alone, felt lonely, felt a lack of control over their lives, who found uncertainty difficult or who were anxious about death were also more likely to experience worse or deteriorating mental health. However, women and young people, people with lower levels of education and people living with children, following initial deterioration, also reported greater improvements and recoveries in mental health when case numbers had fallen and lockdowns were eased (references 6, 13 to15).

Some emerging evidence suggests men experienced less distress in the first lockdown compared to women. However, their experience worsened over time and this gap reduced in the later lockdowns.

A population study looking at anxiety, depression and post-traumatic stress symptoms found that psychological responses to the pandemic were stable for most of the population between April 2020 and May 2021. Two-thirds of the respondents were classified as ‘resilient’ (stable and low distress throughout), about 15% as ‘moderate-stable’ (continuously mid-levels of distress), roughly 6% ‘chronic’ (continuously high distress), 4.7% ‘increasing mental distress’ and 6.5% ‘adaptive’ (starting with high levels of distress but then decreasing).

Analysis of UK Household Longitudinal Study (UKHLS) data between April 2020 and May 2021 found a larger proportion of the population experienced psychological distress than previous estimates suggest. Around two fifths of the population experienced severely elevated risks of distress during the pandemic, with 8% reporting an initial increase followed by a quick recovery, 14.8% experiencing persistently elevated risks, and 24% experienced mildly elevated distress and then recovery in the first wave, then greater increases in the second wave. This suggests that some groups may experience increasing mental distress from cumulative pandemic waves. Long-term distress was highest among younger people, women, people living without a partner, those who had no work or lost income, and those with previous health conditions or COVID-19 symptoms.

Reporting from UCL COVID Social Study corroborates this, suggesting that the cumulative effect of repeated pandemic waves/lockdowns may have led to an increased and prolonged negative effect on the mental health and wellbeing of some groups within the population. The study also suggests there was some change in the themes linked to poorer mental health and wellbeing over time. Within the first pandemic wave themes included unhappiness, playing a useful role and concentration, whereas, in the second wave they included depression and decision making, as well as unhappiness and concentration.

The following text summarises further evidence to date on mental health and wellbeing variation within the population during the pandemic. For more details, see the spotlight chapters (please note spotlights are up to date at their original time of publication).

Age and gender

Young adults and women have been more likely to report larger fluctuations in self-reported mental health and wellbeing than older adults and men. This was especially true between March and May 2020 (references 1 to 2, 5 to 8, 12 to 19).

Two studies sought to understand the differences in mental distress between men and women. They show evidence that family and caring responsibilities play a role, as do social factors. Women were more likely to have made larger adjustments to manage housework and childcare during the first lockdown than men. These adjustments were associated with increased distress (references 18 to 19). Women also reported having more close friends and a larger subsequent increase in loneliness than men during the first national lockdown.

Analysis of UKHLS data from a study during April 2020 and March 2021 compared the mental health experience of men and women over time. It suggested that women reported a higher level of psychological distress compared to men but a similar level of distress across all three lockdowns, whereas men reported higher levels of distress in the later lockdowns compared to the first one.

Analysis of UKHLS data between June and November 2020 found that young adults (aged 18 to 25) reported decreasing then rapidly increasing levels of loneliness. There was a sharp rise in self-reported loneliness during the winter months under the national lockdown. Young adults with long-standing physical or mental health conditions, lower household incomes or who were unemployed or not in school reported higher levels of loneliness than their peers.

A study investigating the association of loneliness with emotional support among young adults, using data from Understanding Society COVID-19 survey from June to November 2020, suggested that males who receive greater emotional support report less loneliness whereas, this was not the case for females.

Another study looking at the same age group between April and November 2020 found that alcohol consumption, smoking, being female, having a lower income, and having a pre-existing mental health condition were related to experiencing worse mental health during the pandemic. For young adult females, mental distress was highest in April 2020 but gradually improved until September, when it began to increase again. Young adult males, in contrast, had a comparatively stable trajectory of mental health across 2020.

Analysis of data from the English Longitudinal Study of Aging (ELSA), which includes adults aged 52 and over, found that the prevalence of clinically significant depressive symptoms increased from 12.5% pre-pandemic to 22.6% in June to July 2020, with a further rise to 28.5% in November to December. This was accompanied by increased loneliness and deterioration in quality of life. A further study using the same data identified that after taking covariates and pre-pandemic levels into account, clinically significant symptoms of depression and anxiety during the COVID-19 pandemic were significantly increased among people with a disability (as measured by the Activities of Daily Living scale) compared with people without a disability. Another study of the same data found that younger age (within the sample of adults over 52), female gender, higher depression scores before the pandemic, living alone and having a long-standing illness were also significant risk factors.

ELSA data also suggests some changing patterns over the 2 waves of the pandemic in 2020 (PDF, 341KB) for older adults. Respondents with poor physical health were more likely to report feeling socially isolated during the first wave (June to July 2020) than the second (November to December 2020). Conversely, respondents in the poorest wealth quintile were more likely to feel socially isolated and lonely during the second wave than the first or before the pandemic. Men experienced more social isolation in the second wave compared to the first.

Older adults who were recommended to shield (PDF, 297KB) were more likely to report higher levels of depression, anxiety and loneliness in June and July 2020 than people of a similar age but not recommended to shield. Rates were highest in those who were recommended to shield and strictly complied with that guidance. Another study of the same cohort showed that older adults with multi-morbidities (many of whom were self-isolating) reported higher levels of depression and loneliness than older adults without multi-morbidities. A further study, using data from the same cohort but from November to December 2020 suggested that this experience continued. It found that those who shielded experienced, on average, higher depression and anxiety symptoms, and lower levels of life satisfaction and quality of life.

A study focusing on adults aged over 60 in June 2020 observed a decline in general mental wellbeing following the outbreak of COVID-19. It also found that more frequent face-to-face contact during the pandemic was associated with better general mental wellbeing, but virtual contact, via means such as telephone and digital media, was not. Increases in loneliness following the outbreak of the pandemic were greater for older adults who reported more virtual contact.

A qualitative study of adults aged over 70 identified fears for mortality, grieving for normal life and concerns for the future as issues that may be impacting on mental health and wellbeing. Participants also highlighted a range of strategies they used to help and protect their mental health. These included adopting a slower pace of life, maintaining routine, socialising and drawing on resilience they had gained through life experience to manage the uncertainty and fear.

For more information please read the spotlights on age and gender.

Ethnicity

There is mixed evidence about the impact of the pandemic on mental health and wellbeing by ethnicity. The associations between ethnicity and mental health during the pandemic are influenced by other factors, such as employment and income protection, community, gender and deprivation. Many population based studies do not have sufficient ethnic minority respondents to enable a detailed look at experiences and outcomes of specific ethnic groups.

Data from the UKHLS has highlighted that those of non-white ethnicity (when grouped together) were at higher risk of reporting deteriorations in mental health that were sustained or worsened between March and September 2020.

Other studies of this same data set add more detail. Bangladeshi, Indian, Pakistani and white British men (PDF, 5.1MB) all reported declines in mental health during the first wave and national lockdown, with Bangladeshi and Pakistani men reporting the largest declines. In addition, the deterioration reported among black, Asian and Minority Ethnicity (BAME) women was similar to that reported among white British women, and among BAME adults there was no evidence of variation by gender. This suggests that the gender gap reported across a number of studies may be a phenomenon mostly seen within the white British population.

A separate population study, this time with a convenience sample but weighted to the population, reported that BAME respondents (when grouped together) were more likely to report higher levels of depression and anxiety between April and August 2020, but that the gap did not change over that time period.

A study of mothers in Bradford in 2020 found that clinically significant symptoms of depression and anxiety were more common among white British mothers than mothers of other ethnicities, and that clinically significant symptoms were more common among mothers with more economic insecurity (references 33 to 47).

For more information please read the spotlight on ethnicity.

Adults with pre-existing mental health problems

Adults with pre-existing mental health conditions have reported higher levels of anxiety, depression and loneliness than adults without pre-existing mental health conditions. One large study found no evidence that this gap changed between April and August 2020.

Another large study found that adults with pre-existing mental health conditions were more likely to report steady deterioration or very poor mental health between April and October 2020 than adults without. A further large study between May 2020 and March 2021 suggests that those individuals who have longstanding mental health conditions, or a recent occurrence of a mental health condition prior to the pandemic were in greater need of mental health support during the pandemic.

A range of analyses have found that people with severe mental illness have been more likely to die from COVID-19 than the general population (references 35 to 37).

Recent analysis has found that those suffering from psychological distress before the pandemic were more likely to experience disruptions related to healthcare, employment or loss of income. They were also more likely to experience multiple disruptions across different domains during the pandemic (such as delayed surgery and reduced working hours).

With respect to service use, an NHS Trust in London reported that their Community Mental Health Teams saw relatively stable caseloads and total contact numbers between March and May 2020. However, they saw a substantial shift from face-to-face to virtual contacts. Their Home Treatment Teams (providing more intensive support at home for acute mental health problems) saw the same shift to virtual contacts but reductions in caseloads and total contacts. Similar patterns were observed in a trust in East of England between March and August 2020, followed by a return towards volumes comparable to previous years.

A qualitative study of adults with mental health conditions identified a range of themes that may contribute to deteriorations in mental health and wellbeing during the pandemic. These were feeling safe but isolated at home, disruption to mental health services, cancelled plans and changed routines, uncertainty and lack of control and the rolling media coverage. The study also highlighted strategies that were used to cope and maintain good mental health. These included drawing on resilience from previous experiences of adversity, time for reflection, engaging in hobbies and activities, staying connected with others and appreciating the social support available.

Data about the use of secondary mental health and Increasing Access to Psychological Therapies (IAPT) is available.

For more information please read the spotlight on adults with pre-existing mental health conditions.

Employment and income

Unemployed adults and adults with lower household incomes have consistently reported higher levels of psychological distress, anxiety, depression and loneliness, and lower levels of happiness and life satisfaction during the pandemic than adults with higher incomes (references 4, 41 to 43).

There is mixed evidence about whether this gap has changed since before the pandemic. One large study found no evidence that deteriorations and recoveries were associated with household income between April and August 2020. Another found that adults living in more deprived areas were more likely to report steadily deteriorating or very bad mental health between April and October 2020.

Although not directly about mental health and wellbeing it is worth noting that a study from December 2021 has shown numbers of people reporting financial worries to have been increasing since mid-summer 2021 (PDF, 18MB). Young adults have been most affected and there has also been an impact on people who are key workers, with low household income, living in urban areas, living with children, having a pre-existing mental health condition and being from an ethnic minority group. A further study from November 2021 found that financial disparities are likely to be increasing and the socioeconomic gap widening (PDF, 18.6MB). It reported that the proportion of people struggling financially is increasing and those who experienced financial struggles early in the pandemic view their situation as worsening compared to those defined as ‘living comfortably’.

Loss of income and employment has been associated with worsening mental health during the pandemic. On average, any connection to a job or income (even if reduced compared to before the pandemic) has been better for mental health and wellbeing than none.

A 2020 study found that Furlough has protected mental health among people with long-term insecure jobs. On average, furloughed workers in long-term insecure jobs before and during the first national lockdown reported no increase in mental distress, unlike counterparts who had not been furloughed.

A later study from 2021 suggests that those who were furloughed were likely to report some level of deterioration in mental health, although, on average, of lesser intensity, compared to those who either became or remained unemployed. Whereas, those in stable employment had the least risk for deterioration in mental health.

One study suggests that those who sought help from self-employment support schemes and Universal Credit to cover losses in income experienced comparably large and sustained increases in mental distress during the pandemic.

A UKHLS study looking at income change between May 2020 and January 2021 found that 43% experienced stable, undisrupted income, 29% increased income and a further 20% were able to cope with use of savings or changing spending behaviours. 4% sought external help for finances and a further 4% had multiple struggles, needing many different types of non-work-based financial support (additional benefits, borrowing and use of savings). Around 14% of those with multiple struggles reported a new mental health diagnosis between May 2020 and January 2021, compared with 5% of those with undisrupted income and 4% of those with increased income.

Women in lower socioeconomic positions (PDF, 933KB) have been more likely than women in higher socioeconomic positions and men in general, to be furloughed, working as a key worker or working in a person facing role. Women in lower socioeconomic positions have been slightly more likely to report higher levels of psychological distress than women in higher socioeconomic positions, although this study did not observe a clear socioeconomic gradient.

A large study assessing population level changes (between pre-pandemic 2017 to March 2020 and April to November 2020) in mental health among people working in the UK highlighted that the pandemic has had a larger effect on the mental health of those working in technical, scientific, professional, manufacturing, construction and hospitality industries, sales, customer service and skilled trades, those who are self-employed or work with small employers, and workers who identify as women.

For more information please read the spotlight on employment and income.

Key workers

A study, with 21,874 participants, comparing non key workers with 4 types of key workers - health and social care, teachers and childcare, public service, and essential services key workers (for example food chain or utility) found that between March 2020 and February 2021 key workers have consistently reported higher levels of depressive and anxiety symptoms than non-key workers. However, there is no evidence that this gap has changed during the pandemic.

A qualitative study has reported that key workers experienced adverse psychological effects during the COVID-19 pandemic, including fears of COVID-19 exposure, contagion and subsequent transmission to others, especially their families. These concerns were often experienced in the context of multiple exposure risks, including insufficient PPE and a lack of workplace mitigation practices. Key workers also described multiple work-related challenges, including increased workload, a lack of public and organisational recognition and feelings of disempowerment.

The effect of the COVID-19 pandemic on mental health has been particularly pronounced for those working in professional and technical industries, hospitality, customer service occupations, small employers and the self-employed as well as female workers.

Place

One study covering the first national lockdown found adults living in urban areas reported worse and increasing loneliness. Another study found no evidence of a difference in depression and anxiety between urban and rural areas.

Between April and June 2020 levels of hedonic (feeling good) and evaluative (life satisfaction) wellbeing decreased. However, for those living in more deprived neighbourhoods the level of hedonic wellbeing decreased more than for those living in more affluent areas. No difference for evaluative wellbeing was found.

The effect of neighbourhood social stressors on psychological distress was stronger during lockdown compared to pre-pandemic. The difference in psychological distress associated with living in a neighbourhood with high numbers of social stressors (including lack of access to community resources, green space, littering, graffiti, vandalism) compared with living in a neighbourhood with a lower number of social stressors increased by 20% during the lockdown period compared to pre-pandemic. Meanwhile, the effect of neighbourhood property crime on mental health did not change during the lockdown.

For more information please read the spotlight on place.

Parents and carers

Adults living with children reported a rise in symptoms of anxiety, psychological distress and stress in April 2020, which subsided over the summer, but appeared to increase again over the winter and into 2021 (references 4, 9, 52). Initial evidence suggests that parents and carers of children reported largest deteriorations in mental health and wellbeing during the second wave and national lockdown. There may have been an increase in the proportion of parents reporting depressive symptoms during the first national lockdown, but prevalence of this has remained lower among adults living with children than adults living alone. Adults living with children have also been less likely to report feeling lonely, or increasing loneliness over time, than adults living alone. Financial and food insecurity, loneliness and increased time spent on childcare and home schooling have been associated with worsening mental health and wellbeing among parents (references 18, 35, 53).

In a qualitative study undertaken between June and November 2020, a group of 29 parents of young children described stress and exhaustion from navigating multiple pressures and conflicting responsibilities with home, schooling, and work, without their usual support networks and in the context of disrupted routines. Family roles and relationships were sometimes tested, however, many parents identified coping strategies that protected their wellbeing including access to outdoor space, spending time away from family, and avoiding conflict and pandemic-related media coverage. Data from a qualitative study of parents of young children (aged under 4) found that the most commonly reported worries were about financial insecurity and employment, COVID-19 health concerns and educating and caring for children. Parents also reported concerns about the wider impacts on society, child development and wellbeing, mental health and not seeing friends and family.

Home and informal carers have been more likely to report higher and increasing levels of psychological distress, anxiety, loneliness and depressive symptoms than non-carers throughout the pandemic. They were also more likely to report a greater sense of life being worthwhile than non-carers during the first national lockdown (references 55 to 57).

For more information please read the spotlight on parents and carers.

Long term health conditions and disabilities

One study found that during the pandemic, adults with long term physical health conditions reported worse levels of depressive symptoms than adults without long term physical health conditions.

A study specifically looking at adults with asthma found that they were more likely to report higher levels of anxiety and depression during the pandemic, particularly among young adults.

Another study has observed an increased risk of depression among adults with cancer of the breast, prostate and blood, but not other cancers (lung or melanoma for example). The authors also found that feelings of isolation helped to explain this risk.

A qualitative study has described aspects of the pandemic that may be impacting on mental health among adults with long term health conditions. The authors identified 4 overarching themes - high levels of fear and anxiety related to perceived consequences of catching COVID-19, the impact of shielding/isolation, the experience of healthcare during the pandemic and anxiety created by uncertainty about the future. Through all this, many participants stated that they had found trying to accept the situation to be the most protective coping mechanism for their mental health.

A study looking at differences in self-reported impacts of the pandemic on mental and physical health between people with and without intellectual impairment^{[footnote 1]} found no mental health related differences. A similar study looking at disability found that adults with a disability were more likely than adults without to report symptoms of psychological distress and loneliness in April/May 2020.

Seeking support for mental health during the pandemic

In one of the larger ongoing studies (26,740 adults in the UK) almost half of the respondents (aged over 18) reported talking to friends or family members to support their mental health during the pandemic, with 43% engaging in self-care activities (such as mindfulness and meditation). 20% of adults reported taking medication to support their mental health, 9% talking to mental health professionals, 8% talking to a GP or other health professional, and another 8% using helplines or online services. Older adults accessed fewer forms of support than younger adults. Women, people with higher educational levels, those who lived alone, those with a higher level of loneliness, those experiencing depression and anxiety, and people with a pre-existing mental health diagnosis used more approaches to support their mental health.

Particular groups within the population were likely to choose different mental health support strategies. Older adults and adults with less education were more likely than younger adults and adults with more education to take medication to help with their mental health, and less likely to speak to a mental health professional or use a helpline or online forum. Adults with lower incomes were also more likely to take medication. Black, Asian and minority ethnicity respondents were less likely to take medication, but more likely to use a helpline or online forum. Women were more likely than men to engage in self-care activities, or to speak to friends and family about their mental health. Adults who lived alone were also more likely to speak to health professionals, engage in self-care activities and talk to others about their mental health than adults who live with others.

A study analysing the link between social interaction and depressive symptoms during COVID-19 found that more frequent face-to-face or phone/video contact, as well as higher perceived social support, were associated with lower depressive symptoms. More face-to-face contact had an even stronger association with lower depressive symptoms in people who demonstrated a higher tendency towards empathy.

A study analysed internet use in people aged 55 to 75 in June and July 2020 while social distancing measures were in place. It found that frequent internet users had lower depression symptoms and higher quality of life scores. Impacts varied with purpose of internet use: those who reported using the internet for communication purposes had a higher quality of life. However, use for health-related or Government services information searching was associated with more symptoms of depression. It is not clear whether the mental health of individuals influenced internet use or the other way round.

An analysis of data covering April 2020 to May 2021 found that increases in the quality of social support decreased the likelihood of self-harm thoughts and behaviours, whereas greater loneliness increased the likelihood.

The provision of general emotional support can benefit levels of wellbeing within the population. A population study assessed the extent to which an individual has received any kind of emotional or physical support from others (PDF, 17.8MB) (using an adapted short version of (F-SozUK-6) questionnaire). It found that on average, support received throughout the pandemic has been fairly constant, with the trend slightly increasing from April 2021 onwards. However, some groups of people received lower levels of support, these included those living alone, having low household income, having an existing mental or physical health diagnosis, living in urban areas, from ethnic minority groups or having a low education background.

Impact of personality type and behaviours on mental health

Experiences of anxiety, depression, loneliness or mental distress may be linked with personality type, changes in lifestyle and adopting coping behaviours. Some of these behaviours have been studied in recent analyses. Overall, these studies suggest some association between experiencing mental distress during the pandemic and changes in diet or eating behaviours, exercise, alcohol use and sleep. Many people have also employed positive behaviours such as engaging in creative pursuits and hobbies and ‘thinking positively’.

One study reported on mental health during the pandemic through to January 2021 by personality type (‘conscientiousness’, ‘agreeableness’, ‘neuroticism’, ‘openness to experience’, and ‘extraversion’). It found that individuals who are more ‘open to experience’ or ‘extraverted’ were more likely to report experiencing symptoms of psychological distress during the pandemic. For ‘openness’ this effect was seen throughout the study period, whereas for ‘extraversion’ the effect was stronger earlier in the pandemic. Those with a high ‘agreeableness’ score were less likely to report experiencing psychological distress. A high neuroticism score is generally associated with poorer mental health, although, there was no obvious deterioration in mental health identified in this group during the pandemic.

Analysis of text responses from 11,000 UK adults about coping mechanisms between 14 October and 26 November 2020 identified a range of common topics. ‘Thinking positively’ was the most discussed coping strategy and involved themes of gratefulness and positivity. Other strategies included engaging in activities and hobbies (such as doing DIY, exercising, walking and spending time in nature), keeping routines, and focusing on one day at a time. Some participants reported more avoidant type coping strategies, such as drinking alcohol and binge eating. Coping strategies varied by respondent characteristics including age, personality traits and sociodemographic position. Some coping strategies, such as engaging in creative activities, were associated with more positive lockdown experiences.

A study analysing eating patterns during the pandemic found that most adults reported not changing the amount they eat. However, participants with greater depressive symptoms were more likely to report a change (eating either more or less). Adults with higher education were less likely to report a change. Reported loneliness was associated with persistently eating more, whereas being single or divorced or the experience of stressful life events was associated with consistently eating less.

A study looking at young adults in their 20s between May and July 2020 found that pre-existing disordered eating, self-harm and comorbid disordered eating and self-harm were all associated with depressive and anxiety symptoms, even when pre-pandemic symptoms of depression and anxiety were taken into account. Lifestyle changes and other coping behaviours did not affect these associations.

A study analysing alcohol use and its relationship to income and mental health between March and July 2020, found that use of alcohol to cope was predicted by experiences of anxiety and/or depression and low resilience levels, but not by loss of income or reduced working hours.

Another study across 4 adult UK cohorts looked at alcohol, diet, sleep and exercise in May and September 2020 compared to self-reported pre-pandemic behaviours (collected in May). For the sample overall, from pre-pandemic to May, there were positive improvements in exercise, diet and alcohol, but a deterioration in sleep. In September, levels had reverted to pre-pandemic for most health behaviours, except for sleep which had deteriorated further. This study found that poor mental health was associated with adverse health behaviours; especially in relation to sleep, but also exercise, and fruit and vegetable consumption, whereas for alcohol consumption the difference was small. Associations were stronger for current mental health problems than mental health problems before the pandemic.

A study looking at experiences of adversity and related worries found that the total number of adversity experiences and total number of adversity worries were associated with lower quality sleep. Illness with COVID-19, difficulties acquiring medication, difficulties accessing food, and threats to personal safety and related worries were related to poor sleep but adversity experiences relating to employment and finances were not. Having a larger social network provided some buffer to the association between adversities and worries and sleep quality.

Experience of COVID-19

One study found that adults who have had COVID-19-related symptoms were more likely to report high levels of mental distress and loneliness than adults who had not had symptoms. However, another study found no evidence of this after controlling for other factors. A more recent study found that people who report a probable COVID-19 infection also reported higher levels of psychological distress than people who do not report a probable COVID-19 infection. This is the case up to 3 months after the probable infection. This association was stronger among younger age groups and men, than older age groups and women.

As the pandemic has progressed, studies are now reporting on the experience of those living with ‘long COVID’. A paper summarising a number of studies reported that many people with ‘long COVID’ feel a sense of shame, guilt and reduced self-worth associated with returning to work. It also reported that those with ‘long COVID’ had concerns about functional difficulties, not being able to function at previous levels, and that those difficulties may not be visible to others.

Vaccination

Some studies have shown that vaccination may have some psychological benefits. However, there is a mixed picture with regards to how an individual’s mental health may be associated with vaccination hesitancy.

A study looking at vaccine uptake intentionality in November and December 2020 found that having a pre-pandemic diagnosis of anxiety or depression, or a high score on the distress symptom scale, were not related to the willingness to take up a vaccine.

Another study reported that vaccination is associated with an increase in psychological wellbeing. The study suggests that those who are vaccinated are more likely to perceive that they have reduced chances of catching the virus and are more engaged in social activities. This effect is suggested to last for at least 2 months.

Attitudes surrounding booster vaccine intentions were generally positive with around 1 in 8 people being unwilling or hesitant (PDF, 18.1MB). However, it is worth noting that booster vaccine intent may be lower in women compared to men, and those who have a mental health condition compared to those who do not.

Life after restrictions have been lifted

Analysis of UCL COVID-19 social study considered people’s ‘sense of control about different domains of life’, comparing October 2020 with October 2021. The analysis suggested there had been little change between the dates. There was improvement around feeling in control of ‘future plans’ from 26% in 2020 to 35% in 2021, however, this is still only one third of respondents (PDF, 18.6MB). There were also small increases in control over ‘contribution to others welfare and wellbeing’, and ‘work’. There were small decreases in a sense of control over ‘physical health’ and ‘marital/close relationships’ and no obvious change observed for ‘mental health and wellbeing’ and ‘finances’. Overall, the study suggests people’s ‘sense of control’ had improved in 2021 but that many people still felt that they did not have control over their life. This sense of a lack of control affected young adults the most across all domains.

An analysis on some stressors people have been experiencing during the pandemic (COVID-19, unemployment and finances covered elsewhere in this report) highlighted that concerns about accessing food has increased (PDF, 14.3MB) for some people since restrictions ended in July 2021. By October 2021 around 12.5% of respondents expressed these concerns and rates were higher among those with physical or mental health conditions and people with a low household income. It should be noted that the study highlights that there were food supply issues at that time, and also that similar worries were also observed around the end of second lockdown in November 2020.

A study reporting on UCL COVID-19 social study data from January 2022 reported on concerns about COVID-19 infections over the Christmas period (PDF, 2.7MB). Almost half of people reported being concerned about catching COVID-19 within the next 3 months, and more than half were worried about their loved ones catching the virus. Just less than half of people reported concerns about becoming seriously ill from COVID-19, and similar numbers were worried about developing long-term symptoms. There were also longer-term concerns expressed about, new variants of the virus emerging, and additional social restrictions being imposed. Many people were also concerned about non-COVID NHS treatment being affected (73%) and hospitals being overwhelmed (64%).

Weekly data and further available metrics

Recent weekly data is available in Chapter 3 Measures of anxiety, depression, loneliness and life satisfaction and in the Wider Impacts of COVID-19 on Health (WICH) tool. This data is not yet analysed in publicly available research, and therefore does not feature in this chapter.

The WICH tool is where data on risk factors and outcomes relating to mental health and wellbeing during the pandemic are presented. Many of these metrics are available by demographic or socio-economic group including Age, Gender, Parents, Ethnicity, Income group, and Pre-existing mental health condition.

Data on the use during the pandemic of some online and telephone support services relating to mental health and wellbeing are also presented within the WICH tool.

References

1. Daly M, Robinson E. Psychological distress associated with the second COVID-19 wave: Prospective evidence from the UK Household Longitudinal Study [Internet]. PsyArXiv; 2021 Sep [cited 2021 Oct 24].

2. Falkingham J, Evandrou M, Qin M, Vlachantoni A. Sleepless in Lockdown: unpacking differences in sleep loss during the coronavirus pandemic in the UK. medRxiv. 2020 Jul 21;2020.07.19.20157255.

3. Kwong ASF, Pearson RM, Adams MJ, Northstone K, Tilling K, Smith D, and others. Mental health during the COVID-19 pandemic in two longitudinal UK population cohorts. medRxiv. 2020 Jun 18;2020.06.16.20133116.

4. Shevlin M, McBride O, Murphy J, Miller JG, Hartman TK, Levita L, and others. STUDY: Anxiety, Depression, Traumatic Stress, and COVID-19 Related Anxiety in the UK General Population During the COVID-19 Pandemic. 2020 May 18 (viewed on 27 August 2020).

5. Jia R, Ayling K, Chalder T, Massey A, Broadbent E, Coupland C, and other. Mental health in the UK during the COVID-19 pandemic: early observations. medRxiv. 2020 May 19;2020.05.14.20102012.

6. Shevlin M, McBride O, Murphy J, Hartman TK, Butter S, Bennett KM, et al. STUDY: Modelling changes in clinically relevant anxiety, depression, COVID-19 related traumatic stress and COVID-19 anxiety across three timepoints during the first five months of the COVID-19 pandemic in the UK. 2020 Aug 10 (viewed 27 August 2020)

7. Fancourt D, Steptoe A, Bu F. Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study. Lancet Psychiatry. 2021 Feb;8(2):141–9.

8. Fancourt DD, Bu DF, Mak DHW, Paul DE, Steptoe A. Covid-19 Social Study: Results Release 34 [Internet]. p. 72.

9. ONS. Coronavirus and depression in adults, Great Britain - Office for National Statistics [Internet]. [cited 2020 Aug 27].

10. Zaninotto P, Iob E, Demakakos P, Steptoe A. The immediate and longer-term impact of the COVID-19 pandemic on the mental health and wellbeing of older adults in England. medRxiv. 2021 May 3;2021.04.30.21256385.

11. Paul E, Fancourt D. Factors influencing self-harm thoughts and self-harm behaviours over the first year of the COVID-19 pandemic in the UK: a longitudinal analysis of 49,324 adults. medRxiv. 2021 Jun 3;2021.02.19.21252050.

12. Iob E, Steptoe A, Fancourt D. Abuse, self-harm and suicidal ideation in the UK during the COVID-19 pandemic. Br J Psychiatry. 2020 Jul 13;1–4.

13. Fancourt D, Steptoe A, Bu F. Trajectories of depression and anxiety during enforced isolation due to COVID-19: longitudinal analyses of 59,318 adults in the UK with and without diagnosed mental illness. medRxiv. 2020 Jun 4;2020.06.03.20120923.

14. Davillas A, Jones AM. The first wave of the COVID-19 pandemic and its impact on socioeconomic inequality in psychological distress in the UK. Department of Economics, University of York [Internet] (PDF, 1.13MB)

15. Daly M, Sutin A, Robinson E. Longitudinal changes in mental health and the COVID-19 pandemic: Evidence from the UK Household Longitudinal Study. PsyArXiv; 2020 Jun (viewed on 27 August 2020).

16. Shevlin M, Butter S, McBride O, Murphy J, Miller JG, Hartman TK, et al. Psychological responses to the COVID-19 pandemic are heterogeneous but have stabilised over time: One year longitudinal follow-up of the COVID-19 Psychological Research Consortium (C19PRC) Study [Internet]. PsyArXiv; 2021 Sep [cited 2021 Sep 17].

17. Ellwardt L, Präg P. Heterogeneous Mental Health Development During the COVID-19 Pandemic in the United Kingdom. medRxiv. 2021 Feb 26;2021.02.24.21251565.

18. Chandola T, Kumari M, Booker CL, Benzeval MJ. The mental health impact of COVID-19 and pandemic related stressors among adults in the UK. medRxiv. 2020 Jul 7;2020.07.05.20146738.

19. Xue B, McMunn A. Gender differences in the impact of the Covid-19 lockdown on unpaid care work and psychological distress in the UK. SocArXiv; 2020 Aug (viewed on 18 September 2020).

20. Etheridge B, Spantig L. The Gender Gap in Mental Well-Being During the Covid-19 Outbreak: Evidence from the UK. . :26.

21. Hu Y, Gutman LM. The trajectory of loneliness in UK young adults during the summer to winter months of COVID-19. Psychiatry Research. 2021 Sep;303:114064.

22. Stroud I, Gutman LM. Longitudinal changes in the mental health of UK young male and female adults during the COVID-19 pandemic. Psychiatry Research. 2021 Sep;303:114074.

23. Steptoe A, Di Gessa G. Mental health and social interactions of older people with physical disabilities in England during the COVID-19 pandemic: a longitudinal cohort study. Lancet Public Health. 2021 Jun;6(6):e365–73.

24. Rutland-Lawes J, Wallinheimo A-S, Evans SL. Risk factors for depression during the COVID-19 pandemic: a longitudinal study in middle-aged and older adults. 2021

25. Chatzi G. Differences in Subjective and Objective Social Isolation and Subjective Loneliness before and during the COVID-19 pandemic [Internet]. 2021. (PDF, 341KB)

26. Andrew Steptoe. The experience of older people instructed to shield or self-isolate during the COVID-19 pandemic [Internet]. ELSA; 2020. (PDF, 297KB)

27. Zaninotto DP. The experience of older people with multimorbidity during the COVID-19 pandemic. :10.

28. Frontiers. COVID-19, Inter-household Contact and Mental Well-Being Among Older Adults in the US and the UK. Sociology [Internet]. [cited 2021 Sep 17].

29. McKinlay AR, Fancourt D, Burton A. A qualitative study about the mental health and wellbeing of older adults in the UK during the COVID-19 pandemic. BMC Geriatr. 2021 Dec;21(1):439.

30. Pierce M, McManus S, Hope H, Hotopf M, Ford T, Hatch S, et al. Different Mental Health Responses to the COVID-19 Pandemic: Latent Class Trajectory Analysis Using Longitudinal UK Data [Internet]. Rochester, NY: Social Science Research Network; 2021 Feb [cited 2021 Jun 21]. Report No.: ID 3784647.

31. University Of Essex IFS. ETHNIC DIFFERENCES IN EFFECTS OF COVID-19: household and local context [Internet]. UK Data Service; 2020 [cited 2020 Aug 27]. (PDF, 5.1MB)

32. Proto E, Quintana-Domeque C. COVID-19 and Mental Health Deterioration among BAME Groups in the UK. 2020;56.

33. Dickerson J, Kelly B, Lockyer B, Bridges S, Cartwright C, Willan K, et al. “When will this end? Will it end?” The impact of the March-June 2020 UK Covid-19 lockdown response on mental health: a longitudinal survey of mothers in the Born in Bradford study [Internet]. Public and Global Health; 2020 Nov [cited 2021 Jan 14].

34. Dickerson J, Kelly B, Lockyer B, Bridges S, Cartwright C, Willan K, et al. Experiences of lockdown during the Covid-19 pandemic: descriptive findings from a survey of families in the Born in Bradford study. Wellcome Open Res. 2020 Oct 2;5:228.

35. Yang H, Chen W, Hu Y, Chen Y, Zeng Y, Sun Y, and others. Pre-pandemic psychiatric disorders and risk of COVID-19: a cohort analysis in the UK Biobank. medRxiv. 2020 Aug 7;2020.08.07.20169847.

36. Stewart R, Jewell A, Broadbent M, Bakolis I, Das-Munshi J. Causes of death in mental health service users during the first wave of the COVID-19 pandemic: South London and Maudsley data from March to June 2020, compared with 2015-2019. medRxiv. 2020 Oct 27;2020.10.25.20219071.

37. Chen S, Jones PB, Underwood BR, Moore A, Bullmore ET, Banerjee S, et al. The early impact of COVID-19 on mental health and community physical health services and their patients’ mortality in Cambridgeshire and Peterborough, UK. Journal of Psychiatric Research. 2020 Dec;131:244–54.

38. Gessa GD, Maddock J, Green MJ, Thompson EJ, McElroy E, Davies HL, et al. Mental health inequalities in healthcare, economic, and housing disruption during COVID-19: an investigation in 12 longitudinal studies. medRxiv. 2021 Apr 7;2021.04.01.21254765.

39. Stewart R, Martin E, Broadbent M. Mental health service activity during COVID-19 lockdown: South London and Maudsley data on working age community and home treatment team services and mortality from February to mid-May 2020. medRxiv. 2020 Jun 16;2020.06.13.20130419.

40. Burton A, McKinlay A, Aughterson H, Fancourt D. Impact of the COVID-19 pandemic on the mental health and well-being of adults with mental health conditions in the UK: a qualitative interview study. null. 2021 Jul 29;1–8.

41. Frank P, Iob E, Steptoe A, Fancourt D. Trajectories of depressive symptoms among vulnerable groups in the UK during the COVID-19 pandemic. medRxiv. 2020 Jun 11;2020.06.09.20126300.

42. Bu F, Steptoe A, Fancourt D. Loneliness during lockdown: trajectories and predictors during the COVID-19 pandemic in 35,712 adults in the UK. medRxiv. 2020 May 29;2020.05.29.20116657.

43. Bu F, Steptoe A, Fancourt D. Who is lonely in lockdown? Cross-cohort analyses of predictors of loneliness before and during the COVID-19 pandemic. medRxiv. 2020 Jul 16;2020.05.14.20101360.

44. Burchell B, Wang S. CUT HOURS, NOT PEOPLE: NO WORK, FURLOUGH, SHORT HOURS AND MENTAL HEALTH DURING THE COVID-19 PANDEMIC IN THE UK. :23.

45. NATCEN. Exploring the relationship between economic security, furlough and mental distress [Internet]. NATCEN Social Research. [cited 2021 Jun 21].

46. NATCEN. Finances and mental health during the COVID-19 pandemic [Internet]. NATCEN Social Research. [cited 2021 Jun 21].

47. Warren T, Lyonette C. Carrying the work burden of the COVID-19 pandemic: working class women in the UK. :12. (PDF, 933KB)

48. Bonomi Bezzo F, Silva L, van Ham M. The combined effect of Covid-19 and neighbourhood deprivation on two dimensions of subjective well-being: Empirical evidence from England. Yang XY, editor. PLoS ONE. 2021 Jul 23;16(7):e0255156.

49. Teo C, Kim C, Nielsen A, Young T, O’Campo P, Chum A. Did the UK COVID-19 Lockdown Modify the Influence of Neighbourhood Disorder on Psychological Distress? Evidence From a Prospective Cohort Study. Frontiers in Psychiatry. 2021;12:970.

50. Paul E, Mak HW, Fancourt D, Bu F. Comparing mental health trajectories of four different types of key workers with non-key workers: A 12-month follow-up observational study of 21,874 adults in England during the COVID-19 pandemic. medRxiv. 2021 Apr 23;2021.04.20.21255817.

51. May T, Aughterson H, Fancourt D, Burton A. ‘Stressed, uncomfortable, vulnerable, neglected’: a qualitative study of the psychological and social impact of the COVID-19 pandemic on UK frontline keyworkers. [Internet]. SocArXiv; 2021 Feb [cited 2021 Jun 21].

52. Pearcey S, Creswell C. Report 09: Update on children’s & parents/carers’ mental health; Changes in parents/carers’ ability to balance childcare and work: March 2020 to February 202. :22. (PDF, 2.1MB)

53. Gibson LY, Lockyer B, Dickerson J, Endacott C, Bridges S, McEachan RRC, et al. Comparison of Experiences in Two Birth Cohorts Comprising Young Families with Children under Four Years during the Initial COVID-19 Lockdown in Australia and the UK: A Qualitative Study. International Journal of Environmental Research and Public Health. 2021 Jan;18(17):9119.

54. Dawes J, May T, McKinlay A, Fancourt D, Burton A. Impact of the COVID-19 pandemic on the mental health and wellbeing of parents with young children: a qualitative interview study. medRxiv. 2021 May 14;2021.05.13.21256805.

55. Whitley E, Reeve K, Benzeval M. Tracking the mental health of home-carers during the first COVID-19 national lockdown: evidence from a nationally representative UK survey. medRxiv. 2021 Jan 25;2021.01.25.21250437.

56. Gallagher S, Wetherell MA. Risk of depression in family caregivers: unintended consequence of COVID-19. BJPsych open. 2020 Nov;6(6):e119.

57. Mak HW, Bu F, Fancourt D. Mental health and wellbeing amongst people with informal caring responsibilities across different time points during the COVID-19 pandemic: A population-based propensity score matching analysis. medRxiv. 2021 Jan 25;2021.01.21.21250045.

58. Higbee DH, Nava G, Kwong ASF, Dodd JW, Granell R. The impact of asthma on mental health & wellbeing during COVID-19 lockdown. medRxiv. 2020 Sep 11;2020.09.10.20190793.

59. Gallagher S, Bennett KM, Roper L. Loneliness and depression in patients with cancer during COVID-19. Journal of Psychosocial Oncology. 2020 Dec 4;1–7.

60. Fisher A, Roberts A, McKinlay AR, Fancourt D, Burton A. The impact of the COVID-19 pandemic on mental health and well-being of people living with a long-term physical health condition: a qualitative study [Internet]. Public and Global Health; 2020 Dec [cited 2021 Jan 14].

61. Totsika V, Emerson E, Hastings RP, Hatton C. The impact of the COVID-19 pandemic on the health of adults with intellectual impairment: evidence from two longitudinal UK surveys. Journal of Intellectual Disability Research. 2021 Oct 1;65(10):890–7.

62. Kavanagh A, Hatton C, Stancliffe RJ, Aitken Z, King T, Hastings R, et al. Health and healthcare for people with disabilities in the UK during the COVID-19 pandemic. Disability and Health Journal. 2021 Jul 17;101171.

63. Li LZ, Wang S. Prevalence and predictors of general psychiatric disorders and loneliness during COVID-19 in the United Kingdom. Psychiatry Research. 2020 Sep;291:113267.

64. Niedzwiedz CL, Benzeval M, Hainey K, Leyland AH, Katikireddi SV. Psychological distress among people with probable COVID-19 infection: analysis of the UK Household Longitudinal Study [Internet]. Public and Global Health; 2020 Nov [cited 2021 Jan 14].

65. Bu F, Mak HW, Fancourt D. Rates and predictors of uptake of formal and informal mental health support during the COVID-19 pandemic: an analysis of 26,740 adults in the UK in lockdown. medRxiv. 2021 Jan 13

66. Sommerlad A, Marston L, Huntley J, Livingston G, Lewis G, Steptoe A, et al. Social relationships and depression during the COVID-19 lockdown: longitudinal analysis of the COVID-19 Social Study. Psychol Med. 2021 Jan 13;1–10

67. Wallinheimo A-S, Evans SL. More Frequent Internet Use during the COVID-19 Pandemic Associates with Enhanced Quality of Life and Lower Depression Scores in Middle-Aged and Older Adults. Healthcare. 2021 Apr;9(4):393.

68. Paul E, Fancourt D. Did social factors buffer against the effect of adversities on self-harm during the COVID-19 pandemic? A longitudinal analysis of 49,227 UK adults [Internet]. 2021 Jun [cited 2021 Sep 17] p. 2021.06.19.21259173.

69. Wright L, Fluharty M, Steptoe A, Fancourt D. How did people cope during the COVID-19 pandemic? A Structural Topic Modelling Analysis of Free-Text Data from 11,000 UK Adults [Internet]. 2021 Aug [cited 2021 Sep 17] p. 2021.08.13.21262002.

70. Herle M, Smith A, Bu F, Steptoe A, Fancourt D. Trajectories of eating behavior during COVID-19 lockdown: Longitudinal analyses of 22,374 adults in the UK [Internet]. PsyArXiv; 2020 Nov [cited 2021 Jan 11].

71. Warne N, Heron J, Mars B, Kwong ASF, Solmi F, Pearson R, et al. Disordered eating and self-harm as risk factors for poorer mental health during the COVID-19 pandemic: A population-based cohort study. medRxiv. 2021 May 4;2021.04.30.21256377.

72. McBride O, Bunting E, Harkin O, Butter S, Shevlin M, Murphy J, et al. Testing both affordability-availability and psychological-coping mechanisms underlying changes in alcohol use during the COVID-19 pandemic [Internet]. PsyArXiv; 2021 May [cited 2021 Jul 8].

73. Villadsen A, Patalay P, Bann D. Mental health in relation to changes in sleep, exercise, alcohol and diet during the COVID-19 pandemic: examination of four UK cohort studies. medRxiv. 2021 Apr 12;2021.03.26.21254424.

74. Wright L, Steptoe A, Fancourt D. Are adversities and worries during the COVID-19 pandemic related to sleep quality? Longitudinal analyses of 46,000 UK adults. PLOS ONE. 2021 Mar 25;16(3):e0248919.

75. Batty GD, Deary IJ, Altschul D. Pre-pandemic mental and physical health as predictors of COVID-19 vaccine hesitancy: evidence from a UK-wide cohort study. medRxiv. 2021 Apr 30;2021.04.27.21256185.

76. Daly M, Robinson E. Psychological distress associated with the second COVID-19 wave: prospective evidence from the UK Household Longitudinal Study.

77. Fancourt DD, Bu DF, Mak DHW, Paul DE, Steptoe A. Covid-19 Social Study: Results Release 42 [Internet]. p. 27 (PDF, 2.7MB)

78. Zhou M, Kan MY. The varying impacts of COVID-19 and its related measures in the UK: A year in review. PloS one. 2021 Sep 29;16(9):e0257286

79. Gao X, Davillas A, Jones AM. The Covid-19 pandemic and its impact on socioeconomic inequality in psychological distress in the UK: an update

80. Hu Y, Gutman LM. The trajectory of loneliness in UK young adults during the summer to winter months of COVID-19. Psychiatry Research. 2021 Sep 1;303:114064

81. https://www.medrxiv.org/content/10.1101/2021.12.16.21267914v1

82. Moulton V, Sullivan A, Patalay P, Fitzsimons E, Henderson M, Bann D, Ploubidis GB. Association between psychological distress trajectories from adolescence to midlife and mental health during the pandemic: Evidence from two British birth cohorts. medRxiv. 2021 Jan 1

83. Fancourt DD, Bu DF, Mak DHW, Paul DE, Steptoe A. Covid-19 Social Study: Results Release 40 [Internet]. p. 68 (PDF, 18.6MB)

84. Wels J, Booth C, Wielgoszewska B, Green MJ, Di Gessa G, Huggins CF, Griffith GJ, Kwong AS, Bowyer RC, Maddock J, Patalay P. Association of COVID-19 employment disruption with mental and social wellbeing: evidence from nine UK longitudinal studies. medRxiv. 2021 Jan 1

85. Kromydas T, Green MJ, Craig P, Katikireddi SV, Leyland AH, Niedzwiedz CL, Pearce A, Thomson RM, Demou EL. Population-level changes in the mental health of UK workers during the COVID-19 pandemic: A longitudinal study using Understanding Society. medRxiv. 2021 Jan 1

86. Fancourt DD, Bu DF, Mak DHW, Paul DE, Steptoe A. Covid-19 Social Study: Results Release 38 [Internet]. p.66

87. Proto E, Zhang A. COVID-19 and mental health of individuals with different personalities. Proceedings of the National Academy of Sciences. 2021 Sep 14;118(37)

88. Baz S, Fang C, Carpentieri JD, Sheard L. Understanding the lived experience of Long Covid: A rapid literature review

89. Bagues M, Dimitrova V. The psychological gains from COVID-19 vaccination: who benefits the most?. Available from: https://cepr.org/active/publications/discussion_papers/dp.php?dpno=16694

90. Fancourt DD, Bu DF, Mak DHW, Paul DE, Steptoe A. Covid-19 Social Study: Results Release 39 [Internet]. p. 64 (PDF, 14.3MB)

1. Referenced paper describes ‘Intellectual impairment’ as being present in about 15% of the UK population. About 13% have cognitive limitations, sometimes defined by a low IQ (70 to 85), and 2% to 2.5% have intellectual disability defined as IQ <70 and significant limitations in adaptive skills (summarised from paper). ↩