1. Place Spotlight
Updated 18 November 2021
Applies to England
© Crown copyright 2021
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Introduction
This Spotlight is part of a series within the COVID-19: mental health and wellbeing surveillance report.
The series describes variation and inequality in the population. Spotlights have also been published for:
- age
- gender
- ethnicity
- experience of people with pre-existing mental health conditions
- employment and income
- parents and carers
This spotlight is composed of analysis from a range of ongoing academic research projects made publicly available by week 36 of 2021 (6 September) or added by special request to highlight key findings to date on place-related mental health during the pandemic.
Note: Any deterioration of mental health captured in studies and weekly reporting should not be automatically interpreted as an increase in mental illness or need for mental health services. This continues to be a difficult and stressful time for many.
Note: To enable this Spotlight to be as up to date as possible, some pre-print (and therefore not yet peer reviewed) academic research is presented. Even with this approach there is still a time delay between data being gathered and findings reported.
Main findings
Understanding people’s different experience of the COVID-19 pandemic by ‘place’, or location, is an important component of public health surveillance. This spotlight presents the information available (to date) about how the mental health and wellbeing impacts of the COVID-19 pandemic has varied by location in England. It looks at differences associated with housing, community deprivation, region of England, and living in urban or rural communities. Coastal communities, whose needs were highlighted in the Chief Medical Officer’s 2021 Annual Report, were also considered, although no analysis of the mental health and wellbeing impact specific to these areas was identified.
Home
Housing is a known determinant of mental health. Pandemic control measures have led to people spending more time in their home and local environments. Key aspects of housing that have impacted on mental health during the pandemic include poor quality of housing, changing family dynamics, working from home and increases in domestic abuse.
Recent reports have outlined the risks of unsafe housing during the pandemic, highlighting 2 issues in particular. First, in 2019 17% of homes failed to meet the decent homes standard (a measure of thermal comfort, state of repair, nature of facilities and presence of hazards), and living in persistent poor quality housing is associated with worse mental health and it is likely that increased time at home exacerbates these effects. Second, incidents of domestic violence have increased (PDF, 686KB) since the start of the pandemic.
Data collected during the pandemic from a pre-existing longitudinal study in Bradford suggests that many families in this area live in poor quality (28%) or overcrowded (19%) housing. Many respondents also reported vermin problems, needing household repairs doing and housing insecurity. The study has reported that housing insecurity was associated with increases in depression or anxiety during the pandemic.
A study using data from a pre-existing national longitudinal cohort, The UK Household Longitudinal Study (UKHLS) compared measures of socioeconomic inequality (including housing conditions) in psychological distress both pre-pandemic and at points during the first wave. It identified that the contribution that housing conditions made to psychological distress fluctuated in the months following the start of the pandemic. It reduced in April 2020 compared to pre-pandemic levels, when age and gender increased in importance. However, by May 2020 housing conditions contributed a greater share than it did pre-pandemic, but by June 2020 the association had returned to levels seen before the pandemic.
Another study reported that adults in overcrowded accommodation were more likely to report moderate and relatively constant levels of anxiety during the first months of the pandemic than to report stable and good mental health. They were also more likely to report moderate and worsening depressive symptoms. It is also worth noting that living alone was found to be a risk factor for anxiety.
The pandemic has also brought many households back together, most commonly with young adults moving back in with their parents. Data from the first national lockdown suggested that changing living arrangements during the pandemic were associated with increased stress and adults in the study cohorts over the age of 50 were more likely to experience this. Further analysis of younger cohorts (age 19) suggested that any increased stress was largely due to increased interpersonal conflict, whereas for the older cohorts a key reason for increased stress was stopping work or being furloughed.
Another change in household dynamics during the pandemic has been an increase in working from home. Analysis of data from before the pandemic and April 2020 suggested that those who experienced a shift from working at the employer’s premises to working from home became more concerned about their future financial situation, however those who did not switch to working from home were even more concerned. Working from home full time was associated with a deterioration in mental wellbeing. No difference in the mental wellbeing before or during the pandemic was observed among those who worked from home on occasion. The study does not report on the association between working from home and wellbeing as the pandemic progressed.
An analysis of associations between pre-pandemic mental health and disruptions to healthcare, economic, and housing outcomes during the pandemic was carried out to identify potential increasing inequality for those with pre-existing mental health problems. The study found that those with higher psychological distress before the pandemic were not more likely to experience housing disruptions during the pandemic than those without psychological distress.
One study from a large research project found that, between April and August 2021, the largest specific adversity contributing to increases in self-harm thoughts and behaviours was having experienced physical or psychological abuse. Early on in the pandemic another study from the same project reported that fewer than half of adults affected by abuse, self-harm and thoughts of suicide/self-harm accessed formal or informal support (PDF, 384KB) during April 2020.
Community/neighbourhood
One study suggested that those who had negative perceptions of their neighbourhood’s medical and leisure facilities were more likely to experience psychological distress during the first 3 months of the pandemic. Analysis of data from the same project reported that overall psychological distress increased and life satisfaction decreased between April and July 2020 as a result of the pandemic and lockdown. The impact on psychological distress was more pronounced among adults living in more deprived areas, but no deprivation related differences in life satisfaction were observed. A similar study looking at a longer time period suggested that, between April and October 2020, adults with steadily deteriorating or very poor mental health were more likely to be living in more deprived neighbourhoods than less deprived neighbourhoods.
Based on data collected between 2017 and June 2020, the effect of neighbourhood social stressors such as graffiti, presence of trash, loitering, vandalism, and public intoxication and homelessness on psychological distress increased during the first national lockdown. Compared to the pre-COVID period, the effect of being in neighbourhoods with the highest social stressors (compared to the lowest) on psychological distress increased by 20% during this period. However, the effect of neighbourhood property crime on mental health did not change during the first national lockdown.
Urban or rural communities
A small number of studies have reported on differences in the pandemic’s impact on mental health and wellbeing by whether an individual lives in an urban or a rural area. Findings are inconsistent, however, there is some suggestion of differences overall and for particular groups within the population.
One study found that adults living in urban areas have a marginally higher risk of being lonely than adults living in rural areas. This was observed before the pandemic, and was maintained throughout the pandemic. Another study of the same dataset found no association between area of living (urban/rural) and use of mental health support.
Data from the UKHLS show similar trends in psychological distress seen for those living in urban and rural areas, however, larger proportions of people living in urban areas reported high levels of psychological distress during first and second national lockdowns. It is not clear if this represented a real difference. A smaller study (but with a randomly collected sample) looking at data from March to June 2020 reported that adults who live in urban areas were more likely to experience a change in or persistently increased symptoms of post-traumatic stress during the pandemic. A study looking at depressive symptoms in adults aged over 50 reported significant increases during the pandemic and that living in an urban area was a risk factor for women but not men.
Region
Evidence is inconsistent and it is not clear if measured differences describe real differences in mental health trajectories between regions. It should also be noted that variance between regions may be influenced by population characteristics such as age, deprivation and ethnicity, as well as regional COVID-19 control and support measures. However, there is some evidence of variation in psychological distress across regions, including there being greater variation during the second pandemic wave.
Analysis of UKHLS data shows that between April and June 2020 the proportion of adults reporting high levels of distress was similar across the regions. However, by the end of 2020 and early 2021 greater variation was seen across regions, and proportions reporting high levels of distress were larger in London. One study, reporting regional level data, considered differences in mental health and wellbeing (PDF, 18.7MB) between adults in the north of England and the rest of the country. Although it found that adults living in London reported the largest drop in mental wellbeing, the North East and Yorkshire and the Humber regions also reported large drops between pre-pandemic and April 2020. Among employed adults, those living in the North were more likely to reduce hours worked and to have made new Universal Credit claims. There was no difference in furlough participation, but the authors highlighted the higher pre-existing unemployment rates in the North. Although highest rates of loneliness were reported in London, rates were also high in the North East, North West and Yorkshire and the Humber.
Data from the UCL COVID-19 Social Study is shown broken down by region in the Wider Impacts of COVID-19 on Health (WICH) tool. Trends are difficult to interpret but there is some suggestion that the South West and East of England have better mental health and wellbeing over the course of the pandemic (so far) compared to the England average. It should be noted that the study sample is self-selected and data presented does not take into account other factors that may contribute to population differences such as age and deprivation. It should also be noted that the change in methodology in September 2020 led to greater weekly variation in the results.
Coastal communities
The Chief Medical Officer’s (CMO’s) Annual Report 2021 highlights a high burden of mental ill-health in coastal communities which can often go unnoticed in public health surveillance. This is because analysis is generally presented at local authority or clinical commissioning group (CCG) level that covers a wider geographical patch and larger population. Areas of relative affluence that are just inland (but within the same local authority or CCG) can mask the outcomes experienced by people living on the coast. For example, Clacton, on the Essex coast reports the second highest mental health need in the country whereas the county of Essex (which Clacton is within) has comparably low rates of mental illness. The rates of self-harm among 10 to 24 year olds are higher in coastal compared to non-coastal communities.
No information on the mental health and wellbeing impacts of the pandemic in coastal communities was identified. However, given what is known about existing inequality in mental health and wellbeing being exacerbated during the pandemic this is likely to represent a gap in current surveillance.