Ministers have announced extra funding for mental health services and suicide prevention amid concerns over a surge in cases among young people during COVID-19. New research by Thierry Gagné, Alita Nandi and Ingrid Schoon looks more closely at the issue and finds strong differences in mental health responses to the pandemic with deprivation. Resources need to be targeted now at improving housing and employment opportunities in order to prevent long-term mental health effects from the pandemic, they say.
For many years we have seen rising levels of mental illness among the young – and we know this is not evenly distributed. In 2017, research from the ESRC International Centre for Lifecourse Studies at UCL highlighted a polarising trend over time, with an increase in both very poor and very good mental health among young women.
That research did not make a direct link with growing social inequality. However, we do know that mental health is strongly affected by social factors such as difficulties in families and in communities. Until now, though, we did not know the extent to which disadvantage has impacted on young people’s mental health during COVID-19.
Since the start of the pandemic we have seen a massive increase in psychological distress among young adults, particularly women. This exacerbated a crisis which already disproportionately affected this age group, with one in 10 men and one in four women aged 16-24 reporting symptoms of a common mental disorder before 2020. So it was important to know more about the different factors which have driven this latest surge, and who has suffered its most severe effects.
Underlying social factors
We wanted to know how trends in psychological distress among young adults were affected by wider factors such as their family circumstances, where they live, their working lives, social class, ethnicity, age and gender.
Using data from the UK Household Longitudinal Study (UKHLS), we were able to follow samples of young people aged 16-24 in England from 2009-10 onwards. This allowed us to look at trends before and during the pandemic: six sets of questionnaires were completed by UKHLS participants in a COVID-19 survey between April and November 2020.
Using scores from the General Health Questionnaire, which measures levels of distress by asking about respondents’ feelings over the past few weeks as well as their ability to carry out everyday activities, we could see that the average level of psychological distress had increased between 2009-10 and 2019.
In 2009-10, levels of distress were greater among women, the unemployed and those of mixed ethnicity. Heightened levels of distress were still linked to gender and economic activity in 2018-19, though patterns of ethnicity changed: while there were no such differences in 2009-10, White groups reported higher levels of distress and Black groups lower levels in 2018-19. Age was also an important factor in trends, with distress levels increasing more for those aged 16-18 over the ten year period of our study.
When we looked at what happened during the early stages of the pandemic, new patterns emerged. Both sex and work status continued to be important, and again levels of distress rose among those of mixed ethnicity.
We also saw new trends relating to where people lived, with those living in the most deprived areas reporting higher distress levels.
A key factor
Between April and November 2020, just over half of the young people surveyed reported that they had remained in work with similar hours, while around 40% had lost their jobs or had had their hours cut at least by half compared with before the pandemic.
In keeping with differences observed over the last decade, we found that those who lost their jobs or had their hours cut during the pandemic had measurably higher psychological distress scores. The small proportion who started a job during the pandemic also had significantly better mental health scores.
Our findings suggest employment plays a major part in shaping the mental health of the young: with employment for this group becoming more unstable and with incomes stagnating, this should not be ignored by those tackling their growing mental health crisis.
While the Coronavirus furlough scheme was meant to protect wages, preliminary studies suggest these may have had a limited role in mitigating the effects of reduced hours on mental distress, at least in the short term.
We should remember, too, that those living and working in the most deprived areas have been hit harder by COVID-19: other studies have highlighted links between COVID-19 deaths and occupational exposure, overcrowding, public transport use and underlying health conditions. These increased risks may also help to explain the unequal increases in psychological distress we saw.
Other factors will have been amplified by the pandemic: lockdown measures prevented young adults from leaving their residential areas, and so those in poorer districts will have spent all of their time in less than ideal surroundings.
We believe the pandemic may have impacted on the health of those in poorer areas through mechanisms which we weren’t able to study, such as increased fear of infection, social isolation and increased hours spent in inadequate housing. These may subside when infection levels drop, but their consequences are likely to persist for years to come.
Putting all these findings together, we need interventions to reduce the pressures on young people: promoting better employment and housing opportunities, investments in deprived areas and policy approaches which work at individual, family and community levels to improve the structures which can underpin young people’s mental health.
Lessons need to be learned now from earlier economic crises: if extra support is not targeted at the most deprived areas in the short term, the detrimental mental health effects of Covid could be seen in scarring effects for many years to come.
Time trend analysis of social inequalities in psychological distress among young adults before and during the pandemic: evidence from the UK Household Longitudinal Study COVID-19 waves is research published in the Journal of Epidemiology and Community Health, by Dr Thierry Gagné, from the Department of Epidemiology and Public Health at University College London, Alita Nandi from the Institute for Social and Economic Research at the University of Essex and Ingrid Schoon from the Social Research Institute, University College London.