Socioeconomic position and mental health during the COVID-19 pandemic: a cross-sectional analysis of the CovidLife study

Miranda Pierre,Drew Altschul,Robin Flaig,David J Porteous,Chloe Fawns-Ritchie,Clifford Nangle,Louise Hartley,Archie Campbell,Markéta Keller,Rachel Edwards,Rebecca Dawson

doi:10.12688/wellcomeopenres.16820.1

Miranda Pierre, Drew Altschul + Show 9 more

Open Access

https://doi.org/10.12688/wellcomeopenres.16820.1

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Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has been linked to an increase in mental health problems. This study examined their association with socioeconomic position (SEP), as well as potential confounding and mediating factors. Methods: We analysed data from the CovidLife study (N=14,387; 66.4% female; mean [SD] age, 57.4 [13.9] years). Data were collected in an online survey of UK adults (aged 18 years or over) between 17 April and 7 June 2020. SEP measures included area deprivation (the Scottish Index of Multiple Deprivation [SIMD]), education level, household income, and employment status. Mental health was measured using the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7) scale. Worry indices were derived using principal component analysis. Logistic regression was used to estimate the associations between SEP and mental health. Results: Low SEP was associated with increased odds of depression and anxiety (odds ratio [OR] range 1.18-2.69). These associations remained significant after adjusting for age, sex, relationship status, and psychiatric history. Multivariable adjustment for medical worry and isolation during the pandemic had the largest attenuating effects (ranges 18-60% and 4-46%, respectively) on mental health outcomes. When adding further adjustment for the remaining SEP markers and all potential confounding and mediating factors, depression was associated with high area deprivation and low education level and income, whilst anxiety was only associated with low education level. No dose-response relationship was observed. Conclusions: SEP was inversely associated with mental health, which was mostly explained by medical worry and isolation during the COVID-19 pandemic. Mental health interventions might target these factors to prevent widening inequalities in mental health. Future studies should use longitudinal data to investigate the association.

Highlights

The coronavirus disease 2019 (COVID-19) pandemic has been associated with an increase in mental health problems (Niedzwiedz et al, 2021)
Low socioeconomic position (SEP) was associated with increased odds of depression and anxiety
When adding further adjustment for the remaining SEP markers and all potential confounding and mediating factors, depression was associated with high area deprivation and low education level and income, whilst anxiety was only associated with low education level

Summary

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has been associated with an increase in mental health problems (Niedzwiedz et al, 2021). In the University College London (UCL) COVID-19 Social Study, the odds of severe depressive symptoms were more than five times greater among those with low SEP (Iob et al, 2020a). It is unclear which factors may account for this association. The coronavirus disease 2019 (COVID-19) pandemic has been linked to an increase in mental health problems This study examined their association with socioeconomic position (SEP), as well as potential confounding and mediating factors. Reviewer Status AWAITING PEER REVIEW Any reports and responses or comments on the article can be found at the end of the article

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