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

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. COVID-19 and SES
Public Health England, 2020

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. 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. 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. 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. 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. Sources of stress during the pandemic
Covid Social Study, weighted data
Fancourt, Bu, Mak, Paul, & Steptoe, 2021

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. Wright, Steptoe, & Fancourt, 2020a
J Epidemiol Community Health

11. Financial stress during the pandemic
Covid Social Study, weighted data
Fancourt, Bu, Mak, Paul, & Steptoe, 2021

12. • Hospital admissions and procedures
• Primary care records

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. % of population consulting for each condition
Mansfield et al, 2021
Primary care consultations

16. Advantages
• Rapid mobilisation
• Inexpensive
• Repeat assessments
• Trajectory analysis
Mental health studies:
New ad hoc studies

17. Depressive and anxiety symptoms
Fancourt, Steptoe, & Bu
Lancet Psychiatry, 2021

18. 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

19. Depressive and anxiety symptoms
CSS, growth curve trajectories
Bu, Steptoe & Fancourt, unpublished

20. Abuse, self-harm and suicidal ideation
N= 44,774; April 2020; weighted data
Iob, Steptoe, Fancourt, 2020, Br J Psychiatry

21. 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

22. 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

23. Mental health in young adults
ALSPAC cohort, assessed in April-May 2020
Kwong et al, 2021, Brit J Psychiatry

24. Data from the UK Household Longitudinal Study
World Happiness Report, 2021
Banks, Fancourt & Xu

25. 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

26. Psychological wellbeing during the pandemic
ELSA data collected in 2018/19, June/July 2020, and Nov/Dec 2020
Iob, Steptoe, & Zaninotto, 2021

27. Covid-19, depression and wealth
ELSA data collected in 2018/19, June/July 2020, and Nov/Dec 2020
Iob, Steptoe, & Zaninotto, 2021

28. Covid-19, quality of life and loneliness
ELSA data collected in 2018/19, June/July 2020, and Nov/Dec 2020
Iob, Steptoe, & Zaninotto, 2021

29. 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

30. Impact of COVID-19 pandemic
• Mental health
• Social contact
Frequency of contact with family and friends
 Real-time (phone, videocall)
 Written (letters, emails)

31. 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

32. Impact of COVID-19 pandemic
• What about the impact of COVID-19 infection
itself?

33. 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

34. 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

35. 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