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Socioeconomic inequalities in mental
health during the COVID-19 Pandemic
Andrew Steptoe
Department of Behavioural Science ...
COVID-19 and SES
Public Health England, 2020
COVID-19 and SES
• Association between lower socioeconomic status and
mortality from COVID-19 infection
• Total estimated ...
COVID-19 and Mental Health
• Factors contributing to mental heath
problems during the pandemic
• Study designs
• Trajector...
Infection risk
• Fear of serious illness and
death
• Fear for health of family and
friends
• Death of family and friends
•...
Infection risk
• Fear of serious illness and
death
• Fear for health of family and
friends
• Death of family and friends
•...
Impact of COVID-19
COVID-19 Social Study
• On-line study started in March 2020
• Weekly then monthly assessments
• Mental ...
Sources of stress during the pandemic
Covid Social Study, weighted data
Fancourt, Bu, Mak, Paul, & Steptoe, 2021
Impact of COVID-19
COVID-19 Social Study
• On-line study started in March 2020
• Weekly then monthly assessments
• ≥70,000...
Wright, Steptoe, & Fancourt, 2020a
J Epidemiol Community Health
Financial stress during the pandemic
Covid Social Study, weighted data
Fancourt, Bu, Mak, Paul, & Steptoe, 2021
• Hospital admissions and procedures
• Primary care records
• Large primary care EHR database (13% UK population)
• Primary care contacts for April – July 2020
• Compared with 2017 –...
% of population consulting for each condition
Mansfield et al, 2021
Primary care consultations
Advantages
• Rapid mobilisation
• Inexpensive
• Repeat assessments
• Trajectory analysis
Mental health studies:
New ad hoc...
Depressive and anxiety symptoms
Fancourt, Steptoe, & Bu
Lancet Psychiatry, 2021
0
10
20
30
40
50
60
3-10-20 4-9-20 5-9-20 6-8-20 7-8-20 8-7-20 9-6-20 10-6-20 11-5-20 12-5-20 1-4-21
PHQ-4 Mild to Severe ...
Depressive and anxiety symptoms
CSS, growth curve trajectories
Bu, Steptoe & Fancourt, unpublished
Abuse, self-harm and suicidal ideation
N= 44,774; April 2020; weighted data
Iob, Steptoe, Fancourt, 2020, Br J Psychiatry
Advantages
• Rapid mobilisation
• Inexpensive
• Repeat assessments
• Trajectory analysis
Limitations
• Representativeness ...
Advantages
• Known sampling frame
• Population representative
• Pre-pandemic measures
• Extensive historical information
o...
Mental health in young adults
ALSPAC cohort, assessed in April-May 2020
Kwong et al, 2021, Brit J Psychiatry
Data from the UK Household Longitudinal Study
World Happiness Report, 2021
Banks, Fancourt & Xu
Impact of COVID-19
English Longitudinal Study of Ageing (ELSA)
• Representative sample of men and women aged ≥50
years liv...
Psychological wellbeing during the pandemic
ELSA data collected in 2018/19, June/July 2020, and Nov/Dec 2020
Iob, Steptoe,...
Covid-19, depression and wealth
ELSA data collected in 2018/19, June/July 2020, and Nov/Dec 2020
Iob, Steptoe, & Zaninotto...
Covid-19, quality of life and loneliness
ELSA data collected in 2018/19, June/July 2020, and Nov/Dec 2020
Iob, Steptoe, & ...
COVID-19 and Mental Health
Who is at greater risk?
• Women
• Less affluent
• People with physical disabilities
• People wi...
Impact of COVID-19 pandemic
• Mental health
• Social contact
Frequency of contact with family and friends
 Real-time (ph...
Written contact during COVID-19 pandemic
Written contact (letter, email) less than once per week in June/July 2020 by weal...
Impact of COVID-19 pandemic
• What about the impact of COVID-19 infection
itself?
Impact of COVID-19 infection
• EHR study of TriNetX network (81 million patients)
• Diagnoses up until Dec 2020
• Comparis...
COVID-19 and Mental Health
• Immediate increases in mental ill-health in the
general adult population
• Mental ill-health ...
Acknowledgements
University College London
Feifei Bu
Panos Demakakos
Daisy Fancourt
Giorgio di Gessa
Eleonora Iob
Liam Wri...
Socio-economic Inequalities in Mental Health during the COVID-19 Pandemic, Andrew Steptoe
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Socio-economic Inequalities in Mental Health during the COVID-19 Pandemic, Andrew Steptoe

  1. 1. Socioeconomic inequalities in mental health during the COVID-19 Pandemic Andrew Steptoe Department of Behavioural Science and Health University College London http://www.ucl.ac.uk/psychobiology/
  2. 2. COVID-19 and SES Public Health England, 2020
  3. 3. COVID-19 and SES • Association between lower socioeconomic status and mortality from COVID-19 infection • Total estimated cases  USA 33,591,670 10.1% of the population  UK 4,700,694 6.9%  France 5,826,519 8.9%  Spain 3,777,539 8.1% Johns Hopkins, June 2021
  4. 4. COVID-19 and Mental Health • Factors contributing to mental heath problems during the pandemic • Study designs • Trajectories of mental ill-health over the pandemic period • Socio-economic inequalities
  5. 5. Infection risk • Fear of serious illness and death • Fear for health of family and friends • Death of family and friends • Uncertainty • Long COVID Challenges during the pandemic
  6. 6. Infection risk • Fear of serious illness and death • Fear for health of family and friends • Death of family and friends • Uncertainty • Long COVID Mitigation actions • Social distancing - isolation • Work and employment • Financial insecurity • Access to provisions • Access to healthcare • Schooling / child development • Household stress • Interruption of care • Loneliness Challenges during the pandemic
  7. 7. Impact of COVID-19 COVID-19 Social Study • On-line study started in March 2020 • Weekly then monthly assessments • Mental health, compliance with regulations, confidence in government, health behaviours • ≥70,000 participants • www.covidsocialstudy.org • Daisy Fancourt (PI), Andrew Steptoe (Co-I)
  8. 8. Sources of stress during the pandemic Covid Social Study, weighted data Fancourt, Bu, Mak, Paul, & Steptoe, 2021
  9. 9. Impact of COVID-19 COVID-19 Social Study • On-line study started in March 2020 • Weekly then monthly assessments • ≥70,000 participants • Daisy Fancourt (PI), Andrew Steptoe (Co-I) Analysis of 12,527 participants in first 3 weeks of national lockdown in 2020 Experience of 10 adversities each week Socioeconomic index:  Household income  Highest educational qualification  Employment status  Housing tenure  Household overcrowding
  10. 10. Wright, Steptoe, & Fancourt, 2020a J Epidemiol Community Health
  11. 11. Financial stress during the pandemic Covid Social Study, weighted data Fancourt, Bu, Mak, Paul, & Steptoe, 2021
  12. 12. • Hospital admissions and procedures • Primary care records
  13. 13. • Large primary care EHR database (13% UK population) • Primary care contacts for April – July 2020 • Compared with 2017 – 2019 and early months of 2020 • Mansfield et al, Lancet Digital Health, 2021
  14. 14. % of population consulting for each condition Mansfield et al, 2021 Primary care consultations
  15. 15. Advantages • Rapid mobilisation • Inexpensive • Repeat assessments • Trajectory analysis Mental health studies: New ad hoc studies
  16. 16. Depressive and anxiety symptoms Fancourt, Steptoe, & Bu Lancet Psychiatry, 2021
  17. 17. 0 10 20 30 40 50 60 3-10-20 4-9-20 5-9-20 6-8-20 7-8-20 8-7-20 9-6-20 10-6-20 11-5-20 12-5-20 1-4-21 PHQ-4 Mild to Severe Psychological Distress by Age All ages <=39 65+ Psychological distress USA USC Understanding Coronavirus in America Study
  18. 18. Depressive and anxiety symptoms CSS, growth curve trajectories Bu, Steptoe & Fancourt, unpublished
  19. 19. Abuse, self-harm and suicidal ideation N= 44,774; April 2020; weighted data Iob, Steptoe, Fancourt, 2020, Br J Psychiatry
  20. 20. Advantages • Rapid mobilisation • Inexpensive • Repeat assessments • Trajectory analysis Limitations • Representativeness / selection issues • Response rates • Self-report measures • No pre-pandemic measures Mental health studies: New ad hoc studies
  21. 21. Advantages • Known sampling frame • Population representative • Pre-pandemic measures • Extensive historical information on health, social and economic circumstances Limitations • Difficult to mobilise rapidly • Remote data collection can be problematic Mental health studies: Existing longitudinal studies
  22. 22. Mental health in young adults ALSPAC cohort, assessed in April-May 2020 Kwong et al, 2021, Brit J Psychiatry
  23. 23. Data from the UK Household Longitudinal Study World Happiness Report, 2021 Banks, Fancourt & Xu
  24. 24. Impact of COVID-19 English Longitudinal Study of Ageing (ELSA) • Representative sample of men and women aged ≥50 years living in England • Started in 2002, assessed every 2 years • UCL, Institute for Fiscal Studies, U Manchester, NatCen • Andrew Steptoe (PI), James Banks, James Nazroo (Co-I) • COVID-19 assessments in June/July and Nov/Dec 2020 • On line and telephone assessments • 75% response rate
  25. 25. Psychological wellbeing during the pandemic ELSA data collected in 2018/19, June/July 2020, and Nov/Dec 2020 Iob, Steptoe, & Zaninotto, 2021
  26. 26. Covid-19, depression and wealth ELSA data collected in 2018/19, June/July 2020, and Nov/Dec 2020 Iob, Steptoe, & Zaninotto, 2021
  27. 27. Covid-19, quality of life and loneliness ELSA data collected in 2018/19, June/July 2020, and Nov/Dec 2020 Iob, Steptoe, & Zaninotto, 2021
  28. 28. COVID-19 and Mental Health Who is at greater risk? • Women • Less affluent • People with physical disabilities • People with mental health issues • People with multimorbidities
  29. 29. Impact of COVID-19 pandemic • Mental health • Social contact Frequency of contact with family and friends  Real-time (phone, videocall)  Written (letters, emails)
  30. 30. Written contact during COVID-19 pandemic Written contact (letter, email) less than once per week in June/July 2020 by wealth Weighted analyses adjusted for pre-pandemic social isolation, age, sex, ethnicity, presence of a spouse/partner, and number of people in the household ELSA microdata 0 5 10 15 20 25 30 35 40 45 50 Lowest 2 3 4 Highest Contact less than once/week Wealth quintile Family Friends
  31. 31. Impact of COVID-19 pandemic • What about the impact of COVID-19 infection itself?
  32. 32. Impact of COVID-19 infection • EHR study of TriNetX network (81 million patients) • Diagnoses up until Dec 2020 • Comparison with matched control cohorts (people with influenza or other URTI) • >236,000 COVID-19 cases • Increased hazard ratios for Mood disorders Anxiety disorders Psychotic disorders Sleep disorders Taquet et al, Lancet Psychiatry, 2021
  33. 33. COVID-19 and Mental Health • Immediate increases in mental ill-health in the general adult population • Mental ill-health sustained, particularly among older people • Marked socioeconomic inequalities in depression, loneliness and poorer quality of life • COVID-19 infection itself may have serious effects on mental health
  34. 34. Acknowledgements University College London Feifei Bu Panos Demakakos Daisy Fancourt Giorgio di Gessa Eleonora Iob Liam Wright Paola Zaninotto Institute for Fiscal Studies James Banks Rowena Crawford Heidi Karjalainen NatCen Social Research Funding Economic and Social Research Council National Institute for Health Research National Institute on Aging (NIH) Nuffield Foundation

Webinar Series on COVID-19 and Inequality, 29 June 2021, More information at: https://www.oecd.org/wise/events/covid-and-inequality-webinars.htm

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