COVID-19, economic downturn, and long-term trajectories of population mental health:Evidence from two nationally representative British birth cohorts at the intersection of gender and socioeconomic position

BackgroundWe examined long-term trajectories of mental (ill-)health in two British generations (‘Baby Boomers’ and ‘Generation X’) across the life-course, including the COVID-19 lockdowns and the following cost-of-living increases. We analysed inequalities by generation, gender, socioeconomic position (SEP), and their intersections, and explored the relationship between inflation and mental (ill-)health post-lockdown.Methods and findingsWe used data from the National Child Development Study (NCDS/1958, n = 8215) and the 1970 British Cohort Study (BCS/1970, n = 7789), with repeated measures of psychological distress (Malaise Inventory) between ages 23–64.5 (NCDS/58) and 26–52.5 (BCS/70). We used multilevel growth curve models to study long-term trajectories, and negative binomial regression models to analyse associations with inflation/cost-of-living in the 2021–2023 period. Distress increased during the pandemic but declined post-lockdown (second quadratic spline: BNCDS/58 = −0.12 [-0.17, −0.08], p < 0.001; BBCS/70 = −0.16 [-0.21, −0.11], p < 0.001). Women and individuals from disadvantaged childhood SEPs started their trajectories with significantly (p < 0.001) higher distress levels in both cohorts (women: BNCDS/58 = 0.72 [0.62, 0.82], BBCS/70 = 0.73 [0.62, 0.83]; manual-class background: BNCDS/58 = 0.24 [0.14, 0.35], BBCS/70 = 0.23 [0.12, 0.35]; rented housing: BNCDS/58 = 0.34 [0.22, 0.46], BBCS/70 = 0.30 [0.15, 0.45]). Inequalities were larger for women from disadvantaged SEPs born in 1958, indicating intersectional effects. None of these inequalities significantly reduced in the long term. Inflation/cost-of-living was significantly associated with distress, but effects did not vary by gender, concurrent SEP, or their intersection.ConclusionsDespite post-pandemic improvements, persistent inequalities by gender and childhood SEP remain. Considering the high levels of socioeconomic adversity in the UK, action is needed to reduce these inequalities and prevent their transmission across generations

Ethnic minority inequalities in access to treatments for schizophrenia and schizoaffective disorders:Findings from a nationally representative cross-sectional study

BackgroundEthnic minority service users with schizophrenia and schizoaffective disorders may experience inequalities in care. There have been no recent studies assessing access to evidence-based treatments for psychosis amongst the main ethnic minority groups in the UK.MethodsData from nationally representative surveys from England and Wales, of 10512 people with a clinical diagnosis of schizophrenia or schizoaffective disorders, were used for analyses. Multi-level multivariable logistic regression analyses were used to assess ethnic minority inequalities in access to pharmacological treatments, psychological interventions, shared decision making and care planning, taking into account a range of potential confounders. ResultsCompared with White service users, Black service users were more likely prescribed depot/ injectable antipsychotics (odds ratio:1.56 (95% confidence interval:1.33-1.84). Black service users with treatment-resistance were less likely to be prescribed clozapine (odds ratio: 0.56 (95% confidence interval: 0.39-0.79)). All ethnic minority service users, except those of mixed ethnicity, were less likely to be offered cognitive behavioural therapy, compared to White service users. Black service users were less likely to have been offered family therapy and Asian service users were less likely to have received copies of care plans (odds ratio:0.50 (95% confidence interval:0.33-0.76)), compared to White service users. There were no clinician-reported differences in shared decision making, across each of the ethnic minority groups.ConclusionsRelative to White service users, ethnic minority service users with psychosis were generally less likely to be offered a range of evidence-based treatments for psychosis, which included pharmacological and psychological interventions as well as involvement in care-planning.<br/

Regional differences in mental health stigma—Analysis of nationally representative data from the Health Survey for England, 2014

BackgroundMental health stigma persists despite coordinated and widely-evaluated interventions. Socioeconomic, structural, and regional context may be important in shaping attitudes to mental illness, and response to stigma interventions. Regional differences in attitudes towards mental illness could be relevant for intervention, but have not been systematically explored. We evaluated regional variation in mental health stigma using nationally representative data from England, the Health Survey for England (HSE), from 2014.MethodsA previously derived scale for mental health-related attitudes with 2 factors (i. tolerance and support, ii. prejudice and exclusion), and overall attitudes, were outcomes. Weighted linear regressions estimated contribution of individual characteristics and region of residence to inter-individual variability in mental health-related attitudes.ResultsLondon and southern regions tended to have more negative mental health-related attitudes. These differences were not fully or consistently explained by individual sociodemographic characteristics, or personal familiarity with mental illness.ConclusionsStigma policies could require refinements based on geographic setting. Regions may be in particular need of stigma interventions, or be more resistant to them. Regional differences might be related to media coverage of mental illness, funding differences, service availability, or accessibility of educational opportunities. Greater geographic detail is necessary to examine reasons for regional variation in stigmatizing attitudes towards people with mental illness, for example through multilevel analysis

Unequal effects of climate change and pre-existing inequalities on the mental health of global populations

Climate change is already having unequal effects on the mental health of individuals and communities and will increasingly compound pre-existing mental health inequalities globally. Psychiatrists have a vital part to play in improving both awareness and scientific understanding of structural mechanisms that perpetuate these inequalities, and in responding to global calls for action to promote climate justice and resilience, which are central foundations for good mental and physical health

The association between childhood seizures and later childhood emotional/ behavioral problems:findings from a nationally representative birth cohort

Objectives: Emotional/behavioral disorders are often comorbid with childhood epilepsy, but both may be predicted by social disadvantage and fetal risk indicators (FRIs). We used data from a British birth cohort, to assess the association of epilepsy, single unprovoked seizures, and febrile seizures with the later development of emotional/behavioral problems.Methods: A total of 17,416 children in the 1958 British birth cohort were followed up until age 16 years. Logistic and modified Poisson regression models were used to determine a) the association of social disadvantage at birth and FRI with epilepsy, single unprovoked seizures, and febrile seizures at 7 years, and emotional/behavioral disorders in later childhood, and (ii) the association of childhood seizures by age 7 years with emotional/behavioral disorders in later childhood, after accounting for social disadvantage and FRI.Results: Higher scores on FRI and social disadvantage were associated with emotional/behavioral problems at 7, 11, and 16 years, but not with seizure disorders at age 7 years. Epilepsy was associated with emotional/behavioral problems at 7 years (odds ratio [OR] = 2.50, 95% confidence interval [CI] = 1.29-4.84), 11 years (OR = 2.00, 95% CI = 1.04-3.81), and 16 years (OR = 5.47, 95% CI = 1.65-18.08), whereas single unprovoked seizures were associated with emotional/behavioral problems at 16 years (OR = 1.44, 95% CI = 1.02-2.01), after adjustment for FRI and social disadvantage. Febrile convulsions were not associated with increased risk for emotional/behavioral problems.Conclusions: Emotional/behavioral problems in children are related to an earlier diagnosis of epilepsy and single unprovoked seizures after accounting for social disadvantage and FRI, whereas febrile convulsions are not associated with emotional/behavioral problems

Predicting type 2 diabetes prevalence for people with severe mental illness in a multi-ethnic East London population

Background and aimsPrevalence of type two diabetes mellitus (T2DM) in people with severe mental illness (SMI) is 2–3 times higher than in general population. Predictive modelling has advanced greatly in the past decade, and it is important to apply cutting-edge methods to vulnerable groups. However, few T2DM prediction models account for the presence of mental illness, and none seemed to have been developed specifically for people with SMI. Therefore, we aimed to develop and internally validate a T2DM prevalence model for people with SMI.MethodsWe utilised a large cross-sectional sample representative of a multi-ethnic population from London (674,000 adults); 10,159 people with SMI formed our analytical sample (1,513 T2DM cases). We fitted a linear logistic regression and XGBoost as stand-alone models and as a stacked ensemble. Age, sex, body mass index, ethnicity, area-based deprivation, past hypertension, cardiovascular diseases, prescribed antipsychotics, and SMI illness were the predictors.ResultsLogistic regression performed well while detecting T2DM presence for people with SMI: area under the receiver operator curve (ROC-AUC) was 0.83 (95 % CI 0.79–0.87). XGBoost and LR-XGBoost ensemble performed equally well, ROC-AUC 0.83 (95 % CI 0.79–0.87), indicating a negligible contribution of non-linear terms to predictive power. Ethnicity was the most important predictor after age. We demonstrated how the derived models can be utilised and estimated a 2.14 % (95 %CI 2.03 %-2.24 %) increase in T2DM prevalence in East London SMI population in 20 years’ time, driven by the projected demographic changes.ConclusionsPrimary care data, the setting where prediction models could be most fruitfully used, provide enough information for well-performing T2DM prevalence models for people with SMI. We demonstrated how thorough internal cross-validation of an ensemble of a linear and machine-learning model can quantify the predictive value of non-linearity in the data

A quantitative approach to the intersectional study of mental health inequalities during the COVID-19 pandemic in UK young adults

PurposeMental health inequalities across social identities/positions during the COVID-19 pandemic have been mostly reported independently from each other or in a limited way (e.g., at the intersection between age and sex or gender). We aim to provide an inclusive socio-demographic mapping of different mental health measures in the population using quantitative methods that are consistent with an intersectional perspective.MethodsData included 8,588 participants from two British cohorts (born in 1990 and 2000–2002, respectively), collected in February/March 2021 (during the third UK nationwide lockdown). Measures of anxiety and depressive symptomatology, loneliness, and life satisfaction were analysed using Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) models.ResultsWe found evidence of large mental health inequalities across intersectional strata. Large proportions of those inequalities were accounted for by the additive effects of the variables used to define the intersections, with some of the largest gaps associated with sexual orientation (with sexual minority groups showing substantially worse outcomes). Additional inequalities were found by cohort/generation, birth sex, racial/ethnic groups, and socioeconomic position. Intersectional effects were observed mostly in intersections defined by combinations of privileged and marginalised social identities/positions (e.g., lower-than-expected life satisfaction in South Asian men in their thirties from a sexual minority and a disadvantaged childhood social class).ConclusionWe found substantial inequalities largely cutting across intersectional strata defined by multiple co-constituting social identities/positions. The large gaps found by sexual orientation extend the existing evidence that sexual minority groups were disproportionately affected by the pandemic. Study implications and limitations are discussed

The association of physical and sexual assault with mortality in two British birth cohorts.

Aims The association of assault in adulthood with all-cause mortality, and the relevance of intermediate psychological distress, alcohol use and cigarette smoking, is poorly understood. We used data from British birth cohorts (the 1958 National Child Development Study referred to as the 1958 birth cohort and the 1970 British Birth Cohort Study) to investigate association between assault and mortality, employing a formal approach for the identification of psychological distress, alcohol use and cigarette smoking as mediators.Methods Associations (HRs), between assault and mortality were estimated with Cox regressions, adjusting for potential confounders. Mediation via intermediate psychological distress, alcohol use and cigarette smoking was explored using the gformula approach. The birth cohorts were analysed separately, and together estimating interaction between exposure and cohort year.Results Results were based on 353 deaths in 19 725 individuals. Based on multiply imputed data, the fully adjusted estimate for assault on mortality was 1.72 (95% CI 1.22 to 2.42) in the combined cohorts, 1.53 (95% CI 0.97 to 2.40) in the 1958 birth cohort and 2.05 (95% CI 1.20 to 1.50) in the 1970 birth cohort. The fully adjusted estimate for the association of sexual assault with mortality was 3.17 (95% CI 1.17 to 8.60) in the combined cohorts, 1.36 (95% CI 0.19 to 9.81) in the 1958 birth cohort and 6.02 (95% CI 1.84 to 19.69) in the 1970 birth cohort. The fully adjusted mortality HR for one additional assault was 1.46 (95% CI 1.23 to 1.73) in the combined cohorts, 1.34 (95% CI 0.99 to 1.82) in the 1958 birth cohort and 1.53 (95% CI 1.25 to 1.87) in the 1970 birth cohort. Greater need for medical treatment for assault was associated with a fully adjusted mortality HR of 1.56 (95% CI 1.19 to 2.05) in the combined cohorts, 1.43 (95% CI 1.00 to 2.05) in the 1958 birth cohort and 1.79 (95% CI 1.18 to 2.74) in the 1970 birth cohort.Conclusions There was statistical evidence on combining the two birth cohorts, and on analysing the 1970 birth cohort, that assault in adulthood is associated with mortality. Understanding mechanisms underlying this relationship could benefit violence reduction strategies for public health