1. This population-based cohort study using eleven United Kingdom studies demonstrated that psychological distress increased during the first year of the COVID-19 pandemic, which persisted despite the easing of lockdown measures.

2. Women, individuals with degree-level education, and young adults (aged 24-34) demonstrated greater mental health deterioration than their counterparts (men, individuals with below-degree level education, and adults aged 35-44 years).

Evidence Rating Level: 2 (Good)

Study Rundown: The COVID-19 pandemic and the impact of measures to limit its spread is widely believed to have increased mental health issues worldwide. However, how mental health has evolved throughout different pandemic stages and whether certain groups of people were more affected than others has yet to be fully elucidated. This population-based cohort using United Kingdom longitudinal studies investigated the changes in mental health outcomes from before the COVID-19 pandemic through the first year of the pandemic and whether inequalities existed by these impacts. Data were collected from the eleven studies, which consisted of pre-pandemic surveys and mid-COVID-19 pandemic surveys using various validated, continuous scales that measured symptoms of mental health disorders. The pandemic time period (TP) was separated into three stages: April to June 2020, when the first wave and first lockdown occurred (TP1), July to October 2020, when restrictions were eased (TP2), and November 2020 to March 2021, when the second wave of infection occurred (TP3). The primary outcome was psychological distress changes from pre-pandemic to year one of the COVID-19 pandemic. Across most studies (8/11), the prevalence of high psychological distress worsened in all three pandemic TPs compared to pre-pandemic, but did not appear to worsen much across the three TPs (TP1: standardized mean difference [SMD], 0.15 [95% CI: 0.06-0.25]; TP2: SMD, 0.18 [95% CI: 0.09-0.27]; TP3: SMD, 0.21 [95% CI: 0.10-0.32]). Furthermore, there was a larger change in distress in women more than men (TP3: SMDs, 0.23 [95% CI: 0.11-0.35] vs. 0.16 [95% CI: 0.06-0.26]), in individuals with a degree-level education compared to those with a below-degree level education (TP3: SMDs, 0.26 [95% CI: 0.14-0.38] vs. 0.18 [95% CI: 0.06-0.30]), and in individuals aged 24-34 years of age compared to those aged 35-44 years (TP3: SMDs, 0.49 [95% CI: 0.14-0.84] vs. 0.35 [95% CI: 0.10-0.60]). Overall, this cohort study demonstrated that mental health has deteriorated during the COVID-19 pandemic with sustained worsening even during the easing of lockdown measures. Additionally, certain groups, such as women, those with a degree-level education, and young adults, appeared to be affected most. Given the considerable heterogeneity in effect sizes estimated, more studies are needed to validate these findings; however, the impact of this pandemic will likely require a greater investment in supporting mental health.

Click to read the study in JAMA Network Open

Relevant Reading: Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population

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