How are adversities during COVID-19 affecting mental health? Differential associations for worries and experiences and implications for policy

ImportanceMultiple data sources suggest that COVID-19 is having adverse effects on mental health. But it is vital to understand what is causing this: worries over potential adversities due to the pandemic, or the toll of experiencing adverse events. ObjectiveTo explore the time-varying longitudinal relationship between (i) worries about adversity, and (ii) experience of adversity, and both anxiety and depression and test the moderating role of socio-economic position. DesignLongitudinal cohort study SettingCommunity study ParticipantsA well-stratified sample of UK adults recruited into the UCL COVID -19 Social Study (a panel study collecting data weekly during the Covid-19 pandemic) via a combination of convenience and targeted recruitment. The sample was weighted to population proportions of gender, age, ethnicity, education and geographical location. ExposuresWorries or experiences of adversities during the COVID-19 pandemic OutcomesAnxiety (GAD-7) and depression (PHQ-9) ResultsData were analysed from 41,909 UK adults (weighted data: 51% female, aged 18-99) followed up across 6 weeks (178,430 observations). Using fixed effects regression was used to explore within-person variation over time, cumulative number of worries and experience of adversities were both related to higher levels of anxiety and depression. Number of worries were associated more with anxiety than depression, but number of experiences were equally related to anxiety and depression. Individuals of lower socio-economic position were more negatively affected psychologically by adverse experiences. Conclusions & relevanceMeasures over the first few weeks of lockdown in the UK appear to have been insufficient at reassuring people given we are still seeing clear associations with poor mental health both for cumulative worries and also for a range of specific worries relating to finance, access to essentials, personal safety and COVID-19. Interventions are required that both seek to prevent adverse events (e.g. redundancies) and that reassure individuals and support adaptive coping strategies. Key pointsO_ST_ABSQuestionC_ST_ABSHow do worries over potential adversities due to the COVID-19 pandemic, or the toll of experiencing adverse events affect mental health? FindingsCumulative number of worries and experience of adversities were both related to higher levels of anxiety and depression during COVID-19, especially amongst individuals of lower socio-economic position. MeaningDuring a pandemic, interventions are required that both seek to prevent adverse events (e.g. redundancies) and that reassure individuals and support adaptive coping strategies.