Longitudinal associations between going outdoors and mental health and wellbeing during a COVID-19 lockdown in the UK

The COVID-19 pandemic led to national lockdowns in countries around the world. Whilst lockdowns were shown to be effective in reducing the spread of disease, they were also associated with adverse effects on people’s mental health and wellbeing. Previous studies have suggested that time spent outside may have played a role in mitigating these negative effects, but research on this topic remains limited. Therefore, this study was designed to explore the longitudinal associations between going outdoors and people’s mental health and wellbeing during the first national lockdown (March–May 2020) in the UK. Data from 35,301 participants from the COVID-19 Social Study were analysed. Fixed effects regression was used to explore the longitudinal association between changes in going outdoors (the number of days spent outside) and changes in depressive symptoms, anxiety symptoms, life satisfaction and loneliness. A range of household and neighbourhood moderators were examined. Results show that an increase in the number of days spent outside was associated with decreases in depressive and anxiety symptoms and an increase in life satisfaction. Associations were more salient amongst people living with others, and those with greater satisfaction with their neighbourhood walkability and green spaces. No longitudinal association was found with loneliness. Overall, our analyses showed a positive association between going outdoors and improved mental health and wellbeing during the first COVID-19 lockdown in the UK. These findings are important for formulating guidance for people to stay well at home during pandemics and for the on-going nature-based social prescribing scheme

Are happier people more compliant? Evidence from lockdowns

What makes people more likely to comply with a lockdown? Christian Krekel (LSE), Sarah Swanke (LSE), Jan-Emmanual De Neve (Oxford University) and Daisy Fancourt (UCL) drew on large-scale surveys and found that happiness predicts compliance, over and beyond a wide range of people’s other observable characteristics. Older and less healthy people seem to be predominantly motivated by risk-avoidance, whereas the motivations of younger ones seem more mixed. People are less likely to follow the rules if they were unhappy

Happiness predicts compliance with preventive health behaviours during Covid-19 lockdowns

To combat the public health crisis of Covid-19, governments and public health officials have been asking individuals to substantially change their behaviours for prolonged periods of time. Are happier people more willing to comply with such measures? Using independent, large-scale surveys covering about 79,000 adult respondents across 29 countries, including longitudinal data from the UK, we find that life satisfaction predicts compliance with preventive health behaviours during Covid-19 lockdowns, especially the number of weekdays stood at home (β=0.02, p0.10, 2 on 0-to-10 scale). We explore risk-avoidance and pro-social motivations for this relationship, and find suggestive evidence that people who are older or have certain medical preconditions seem to be behave in line with risk-avoidance, whereas motivations of people who are less at risk of Covid-19 seem more mixed. While it is difficult to estimate the relationship between life satisfaction and compliance behaviour due to potential confounders and unobserved heterogeneity, our findings cautiously suggest that life satisfaction is important, both for complying with preventive health measures and as a policy end in itself

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Learning to Facilitate Arts-in-health Programmes: A Case Study of Musicians Facilitating Creative Interventions for Mothers With Symptoms of Postnatal Depression

There is growing research documenting the effects of arts-in-health interventions on diverse participant groups. However, the impact of interventions on facilitators remains largely lacking. Drawing on a case study project, this article reports on a qualitative study to understand the practices, challenges, enablers and impacts for musicians of facilitating creative interventions for women with symptoms of postnatal depression. Thematic analysis revealed that the musicians used specific practices to successfully facilitate their activities, relying on a balance of forward-planning with the need to retain flexibility and provide women with autonomy and opportunities for social bonding. Key challenges included coping with the emotional impact of the project as well as facilitating different types of creative activities, while a strong sense of team and the structure of the interventions supported delivery. Finally, the project enabled the development of both generic and context-specific creative facilitation skills, and also contributed to the facilitators’ wellbeing. The logistical, educational and support implications for other practitioners seeking to establish such interventions are considered within the context of arts-in-health and musicians’ education

Going outdoors, neighbourhood satisfaction and mental health and wellbeing during a COVID-19 lockdown: A fixed-effects analysis

The COVID-19 pandemic led to national lockdowns in countries around the world. Whilst lockdowns were shown to be effective in reducing the spread of disease, they were also associated with adverse effects on people’s mental health and wellbeing. Previous studies have suggested that time spent outside may have played a role in mitigating these negative effects, but research on this topic remains limited. Therefore, this study was designed to explore the longitudinal associations between going outdoors and people’s mental health and wellbeing during the first national lockdown (March-May 2020) in the UK. Data from 35,301 participants from the COVID-19 Social Study were analysed. Fixed effects regression was used to explore the longitudinal association between changes in going outdoors (the number of days spent outside) and changes in depressive symptoms, anxiety symptoms, life satisfaction and loneliness. A range of household and neighbourhood moderators were examined. Results show that an increase in the number of days spent outside was associated with decreases in depressive and anxiety symptoms and an increase in life satisfaction. No longitudinal association was found with loneliness. Further analysis revealed some moderating effects of household and neighbourhood factors, including living arrangement, perceived walkability satisfaction, and satisfaction with green space/park within neighbourhood. Overall, our analyses showed a positive association between going outdoors and improved mental health and wellbeing during the first COVID-19 lockdown in the UK. Associations were more salient amongst people living with others, and those with greater satisfaction with their neighbourhood walkability and green spaces. These findings are important for formulating guidance for people to stay well at home during pandemics and for the on-going nature-based social prescribing scheme

COVID-19, smoking and inequalities: a study of 53 002 adults in the UK.

BACKGROUND: This study aimed to examine associations between smoking and COVID-19 relevant outcomes, taking into account the influence of inequalities and adjusting for potential confounding variables. METHODS: Cross-sectional data were used from an online study of adults in the UK (n=53 002). Main outcome measures were confirmed and suspected COVID-19, worry about catching or becoming seriously ill from COVID-19 and adherence to protective behaviours. Covariates included age, sex, ethnicity, education (post-16 qualifications: yes/no), key worker status and comorbid health conditions. RESULTS: Compared with never smokers (0.26% (95% CI 0.21% to 0.33%)), prevalence of confirmed COVID-19 was higher among current (0.56% (0.41% to 0.75%)) but not ex-smokers (0.19% (0.13% to 0.28%)). Associations were similar before (current: OR=2.14 (1.49-3.08); ex-smokers: OR=0.73 (0.47-1.14)) and after (current: OR=1.79 (1.22-2.62); ex-smokers: OR=0.85 (0.54-1.33)) adjustment. For current smokers, this was moderated by socio-economic position, with higher rates only seen in those without post-16 qualifications (OR=3.53 (2.04-6.10)). After including suspected cases, prevalence was higher among current smokers (11.2% (10.6% to 11.9%), OR=1.11 (1.03-1.20)) and ex-smokers (10.9% (10.4% to 11.5%), OR=1.07 (1.01-1.15)) than never smokers (10.2% (9.9% to 10.6%)), but remained higher only among ex-smokers after adjustment (OR=1.21 (1.13-1.29)). Current and ex-smokers had higher odds than never smokers of reporting significant stress about becoming seriously ill from COVID-19 (current: OR=1.34 (1.27-1.43); ex-smokers: OR=1.22 (1.16-1.28)). Adherence to recommendations to prevent spread of COVID-19 was high (96.3% (96.1% to 96.4%)), but lower among current than never smokers (OR=0.70 (0.62-0.78)). CONCLUSIONS: In a population sample, current smoking was independently associated with self-reported confirmed COVID-19 infection. There were socio-economic disparities, with the association only apparent among those without post-16 qualifications. Smokers reported lower adherence to guidelines despite being more worried than non-smokers about catching or becoming seriously ill from COVID-19

Factors associated with drinking behaviour during COVID-19 social distancing and lockdown among adults in the UK.

Background: To assess what factors were associated with reported changes to usual alcohol drinking behaviour during the start of lockdown in the United Kingdom (UK). Methods: Online cross-sectional survey of 30,375 adults in the UK from 21st March to 4th April 2020 (sample weighted). Logistic regression models were used to examine sociodemographic, drinking and COVID-19 factors associated with i) drinking less and ii) drinking more (versus same as usual). Results: Of 22,113 drinkers, 48.1 % reported drinking about the same, 25.7 % reported drinking less, and 26.2 % reported drinking more than usual over the past week. Drinking less was independently associated with being younger (OR = 0.88, p < .001), male (OR = 0.76, p < .001), BAME (OR = 0.76, p = .028), low income (OR = 0.74, p < .001), having COVID-19 (OR = 2.04, p < .001), adhering to COVID-19 protective behaviours (OR = 1.58, p = .020), stress about becoming ill from COVID-19 (OR = 1.26, p = .004) and not being a key worker (OR = 0.87, p = .030). Drinking more was independently associated with being younger (OR = 0.73, p < .001), female (OR = 1.36, p < .001), post-16 qualifications (OR = 1.21, p = .012), high income (OR = 1.43, p < .001), stress about catching (OR = 1.22, p = .020) or becoming ill from COVID-19 (OR = 1.28, p < .001), stress about finances (OR = 1.43, p < .001), and having an anxiety disorder (OR = 1.24, p = .011). Conclusions: In a large, population sample of adults in the UK, around a quarter of drinkers reported drinking more alcohol and a quarter drinking less than usual during the COVID-19 related lockdown. Certain groups, such as those who are younger, female, of high socioeconomic position, have an anxiety disorder, and are stressed about finances or COVID-19 may need targeted alcohol reduction support during lockdown