Refuting the myth of a 'tsunami' of mental ill-health in populations affected by COVID-19: evidence that response to the pandemic is heterogeneous, not homogeneous.

Jilly Gibson-Miller,Liam Mason,Ryan Mckay,Liat Levita,Anton P Martinez,Todd K Hartman,Orla Mcbride,Jamie Murphy,Richard P Bentall,Thomas V A Stocks,Sarah Butter,Mark Shevlin,Kate Bennett,Philip Hyland

doi:10.1017/s0033291721001665

Abstract

The current study argues that population prevalence estimates for mental health disorders, or changes in mean scores over time, may not adequately reflect the heterogeneity in mental health response to the COVID-19 pandemic within the population. The COVID-19 Psychological Research Consortium (C19PRC) Study is a longitudinal, nationally representative, online survey of UK adults. The current study analysed data from its first three waves of data collection: Wave 1 (March 2020, N = 2025), Wave 2 (April 2020, N = 1406) and Wave 3 (July 2020, N = 1166). Anxiety-depression was measured using the Patient Health Questionnaire Anxiety and Depression Scale (a composite measure of the PHQ-9 and GAD-7) and COVID-19-related posttraumatic stress disorder (PTSD) with the International Trauma Questionnaire. Changes in mental health outcomes were modelled across the three waves. Latent class growth analysis was used to identify subgroups of individuals with different trajectories of change in anxiety-depression and COVID-19 PTSD. Latent class membership was regressed on baseline characteristics. Overall prevalence of anxiety-depression remained stable, while COVID-19 PTSD reduced between Waves 2 and 3. Heterogeneity in mental health response was found, and hypothesised classes reflecting (i) stability, (ii) improvement and (iii) deterioration in mental health were identified. Psychological factors were most likely to differentiate the improving, deteriorating and high-stable classes from the low-stable mental health trajectories. A low-stable profile characterised by little-to-no psychological distress ('resilient' class) was the most common trajectory for both anxiety-depression and COVID-19 PTSD. Monitoring these trajectories is necessary moving forward, in particular for the ~30% of individuals with increasing anxiety-depression levels.

Highlights

In response to fears of a ‘tsunami’ of mental ill health caused by the COVID-19 pandemic (e.g. Roxby, 2020), numerous attempts have been made to estimate the impact of the pandemic on populations (Holmes et al, 2020), either through cross-sectional surveys or, in fewer cases, longitudinal studies
The current study attempted to overcome an important limitation present within the majority of COVID-19 mental health literature to date: failure to account for heterogeneity in psychological response to the outbreak, which may undermine the ability to accurately identify groups of individuals most in need of support
The current findings suggest that for the overall sample, the prevalence of anxiety-depression remained stable across the first 4 months of the pandemic, while COVID-19-related posttraumatic stress disorder (PTSD) fell between April and July 2020

Summary

Introduction

In response to fears of a ‘tsunami’ of mental ill health caused by the COVID-19 pandemic (e.g. Roxby, 2020), numerous attempts have been made to estimate the impact of the pandemic on populations (Holmes et al, 2020), either through cross-sectional surveys or, in fewer cases, longitudinal studies. A US study reported the population prevalence estimate of ‘psychological distress’ among adults surveyed in April 2020 at 14% (11–17%), a substantial increase from the 4% (3.6–4.2%) reported in the 2018 National Health Interview Survey (McGinty, Presskreischer, Han, & Barry, 2020b). A low-stable profile characterised by little-to-no psychological distress (‘resilient’ class) was the most common trajectory for both anxiety-depression and COVID-19 PTSD Monitoring these trajectories is necessary moving forward, in particular for the ∼30% of individuals with increasing anxiety-depression levels

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