Understanding inequalities in mental health by family structure during COVID-19 lockdowns: evidence from the UK household longitudinal study

Green, M. J. , Craig, P. , Demou, E. , Katikireddi, S. V. , Leyland, A. H. and Pearce, A. (2023) Understanding inequalities in mental health by family structure during COVID-19 lockdowns: evidence from the UK household longitudinal study. Annals of General Psychiatry, 22(1), 24. (doi: 10.1186/s12991-023-00454-1) (PMID:37280641) (PMCID:PMC10242239)

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Purpose: The COVID-19 pandemic increased psychiatric distress and impacts differed by family structure. We aimed to identify mechanisms contributing to these inequalities. Methods: Survey data were from the UK Household Longitudinal Study. Psychiatric distress (GHQ-12) was measured in April 2020 (first UK lockdown; n = 10,516), and January 2021 (lockdown re-introduced following eased restrictions; n = 6,893). Pre-lockdown family structure comprised partner status and presence of children (< 16 years). Mediating mechanisms included: active employment, financial strain, childcare/home-schooling, caring, and loneliness. Monte Carlo g-computation simulations were used to adjust for confounding and estimate total effects and decompositions into: controlled direct effects (effects if the mediator was absent), and portions eliminated (PE; representing differential exposure and vulnerability to the mediator). Results: In January 2021, after adjustment, we estimated increased risk of distress among couples with children compared to couples with no children (RR: 1.48; 95% CI 1.15–1.82), largely because of childcare/home-schooling (PE RR: 1.32; 95% CI 1.00–1.64). Single respondents without children also had increased risk of distress compared to couples with no children (RR: 1.55; 95% CI 1.27–1.83), and the largest PE was for loneliness (RR: 1.16; 95% CI 1.05–1.27), though financial strain contributed (RR: 1.05; 95% CI 0.99–1.12). Single parents demonstrated the highest levels of distress, but confounder adjustment suggested uncertain effects with wide confidence intervals. Findings were similar in April 2020 and when stratified by sex. Conclusion: Access to childcare/schooling, financial security and social connection are important mechanisms that need addressing to avoid widening mental health inequalities during public health crises.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Katikireddi, Professor Vittal and Craig, Professor Peter and Leyland, Professor Alastair and Demou, Dr Evangelia and Green, Dr Michael and Pearce, Dr Anna
Authors: Green, M. J., Craig, P., Demou, E., Katikireddi, S. V., Leyland, A. H., and Pearce, A.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:Annals of General Psychiatry
Publisher:BioMed Central
ISSN (Online):1744-859X
Published Online:06 June 2023
Copyright Holders:Copyright © The Author(s) 2023
First Published:First published in Annals of General Psychiatry 22(1):24
Publisher Policy:Reproduced under a Creative Commons license

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
3048231Inequalities in healthAlastair LeylandMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit
3048231Inequalities in healthAlastair LeylandOffice of the Chief Scientific Adviser (CSO)SPHSU17HW - MRC/CSO Social and Public Health Sciences Unit
172690Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiOffice of the Chief Scientific Adviser (CSO)SCAF/15/02HW - Public Health
174091Improving life chances & reducing child health inequalities: harnessing the untapped potential of existing dataAnna PearceWellcome Trust (WELLCOTR)205412/Z/16/ZHW - MRC/CSO Social and Public Health Sciences Unit