Coronavirus (COVID-19): mental health tracker study - wave 2 report

Executive Summary

This report presents findings of Wave 2 of the Scottish COVID-19 (SCOVID) Mental Health Tracker Study. These findings are based on questionnaire data collected from adults aged 18 years and older between 17^th July and 17^th August 2020, a period that coincided with the Phase 3 easing of lockdown measures in Scotland. Phase 3 included an increase in the number of households that could meet indoors and outdoors, and the opening of indoor hospitality. The report focuses on the changes in mental health and wellbeing outcomes from the Wave 1 survey, completed from 28^th May to 21^st June 2020, during the Phase 1 easing of lockdown. This report also investigates which groups are most impacted and explores other lifestyle factors which describe the circumstances and experiences of these respondents at the time of the questionnaire.

In brief, Wave 1 of the SCOVID Mental Health Tracker Study indicated that over a third of the sample reported high levels of psychological distress (GHQ-12: General Health Questionnaire), a quarter reported levels of depressive symptoms (moderate to severe) indicating a possible need for treatment, and nearly a fifth reported anxiety symptoms of a similar level. Approximately one tenth of the sample reported having suicidal thoughts in the past week, with one fifth of young adults reporting suicidal thoughts. Additionally, the Wave 1 report suggested that particular subgroups within the population were at elevated risk across these mental health and wellbeing indicators, specifically women, young adults, people with a pre-existing mental health condition, and individuals from a lower socio-economic grouping.

A total of 65.4% of respondents from Wave 1 (n=2604) took part in the Wave 2 survey (n=1703). This loss to follow-up was higher than anticipated, and meant that a number of demographic groups are under-represented at Wave 2. As such, it was not possible to repeat some of the subgroup analyses from the Wave 1 Report. It should be noted that the follow-up rate for young men was low, so findings for this group should be interpreted with caution. As with the Wave 1 analysis, weights were applied to adjust the sample to reflect quotas based upon the Scottish population, and all analysis included only those who completed both Wave 1 and Wave 2^[1]. Trends remained the same for analysis findings with and without weights applied (figures included in the annex). In addition, this report uses particular terms to describe the rates of particular mental health outcomes reported by subgroups within the overall sample, and the degree to which an outcome is being experienced. The term 'rates' refers to the proportion of respondents within a named subgroup who have reported a particular outcome; it does not describe the degree of a particular outcome. For example, an increased rate of men reporting moderate to severe depressive symptoms means that a higher proportion of men have reported these symptoms; it does not mean that men as a subgroup are experiencing more severe depressive symptoms overall. The term 'level' refers to the degree to which a particular mental health or wellbeing measure is being experienced. For example, stating that older adults reported higher levels of mental wellbeing than younger age groups means that the average mental wellbeing score for older adults was higher than the average score for younger groups.

Wave 2 of the Scottish COVID-19 Mental Health Tracker Study found that nearly a quarter of respondents reported levels of depressive symptoms indicating a possible need for treatment (24.1%) and a sixth (16.9%) reported anxiety symptoms of a similar level. Rates of depressive and anxiety symptoms did not significantly change from Wave 1 to Wave 2. However, rates of suicidal ideation in the week prior to completing the survey increased from Wave 1 (9.6%) to Wave 2 (13.3%). Although the exact reason for this increase cannot be known, it could reflect a lagged effect, or that the items assessing mental health measures such as depression focus on the past, whereas the suicidal question is tapping uncertainty or concerns about the future (i.e., thinking about suicide is an option for the future, which remains uncertain despite easing of lockdown). Despite this, most other indicators of mental health and wellbeing improved for the overall sample. Specifically, rates of high GHQ-12 scores (indicating distress and possible psychiatric disorder) decreased from Wave 1 (32.6%) to Wave 2 (28.8%). Similarly, levels of loneliness and distress reduced from Wave 1 to Wave 2, and mental wellbeing increased over this time. Overall, these findings are consistent with the UK COVID-MH study findings reporting Waves 1-3 (covering a time period of 31^st March to 11^th May 2020; O'Connor et al., 2020), which found an increase in suicidal thoughts over waves, and an improvement in anxiety, defeat, entrapment, and mental wellbeing.

Findings also suggest that several subgroups within the sample reported a change to indicators of mental health and wellbeing from Wave 1 to Wave 2. For example, between from Wave 1 to Wave 2 more men reported moderate to severe depressive symptoms and suicidal ideation, whereas a lower proportion of women reported depressive symptoms and high GHQ-12 scores. For young adults (18-29 years) rates of moderate to severe anxiety increased from Wave 1 to Wave 2, and for young men in particular, rates of suicidal ideation increased. It should be noted that young men experienced a notable dip in response rate in Wave 2 and as such, this finding should be interpreted with caution. A higher proportion of respondents with a pre-existing mental health condition reported anxiety and suicidal thoughts from Wave 1 to Wave 2. However, a lower proportion of respondents from this group reported mental distress (GHQ-12), there was an increase in mental wellbeing over this timeframe.

Consistent with Wave 1, in Wave 2 a number of the same subgroups reported elevated rates of mental health and wellbeing indicators compared to their subgroup counterpoints. These included; young adults (18-29 years), individuals with a pre-existing mental health condition, individuals in the lower socio-economic group (SEG)^[2], and respondents with a pre-existing physical health condition. Due to differences between the Wave 1 and Wave 2 samples, it is difficult to comment on broad mental health trends between the waves, beyond specific indicators.

Key Findings

Suicidal thoughts

• For the overall sample, there was a significant increase in rates of reported suicidal thoughts between Wave 1 (9.6%) and Wave 2 (13.3%).
• Notable increases in suicidal thoughts from Wave 1 to Wave 2 were also found for several subgroups:
  • Men: A higher proportion of men reported suicidal thoughts in Wave 2 (16.3%) than in Wave 1 (10.2%). This is an increase greater than among women, who reported 9.6% in Wave 1 to 10.5% in Wave 2. It should be noted that despite men's significant increase at Wave 2, higher rates of suicidal thoughts were reported among women than men.
  • Young men (18-29 years): A higher proportion of young men reported suicidal thoughts in Wave 2 (34.4%) than Wave 1 (21.5%), though this should be regarded with caution due to the pronounced drop in sample size between Waves 1 and 2.
  • Those with a pre-existing mental health condition: a higher proportion of respondents in this subgroup reported suicidal thoughts in Wave 2 (36.7%) than Wave 1 (25.2%).
• Similar to the Wave 1 report, at Wave 2 several subgroups reported higher rates of suicidal thoughts than their subgroup counterpart including; young adults (age 18-29 years), those with pre-existing mental health or physical health condition, and people from a lower SEG.

Depressive symptoms^[3]

• For the overall sample, rates of reported moderate to severe depressive symptoms indicating a need for treatment did not change significantly from Wave 1 (23.6%) to Wave 2 (24.1%).
• Rates of depressive symptoms among men increased from Wave 1 (20.0%) to Wave 2 (23.7%), whereas rates of depressive symptoms among women decreased from Wave 1 (27.0%) to Wave 2 (24.5%).
• Consistent with Wave 1 findings, at Wave 2 a higher proportion of young adults (18-29 years) reported depressive symptoms compared to older age groups, as did those with a pre-existing mental health condition, from a lower SEG^[4], or a pre-existing physical health condition.

Anxiety Symptoms^[5]

• For the overall sample, there were no statistically significant changes in the rate of respondents reporting moderate to severe anxiety symptoms indicating a need for treatment from Wave 1 (16.3%) to Wave 2 (16.9%).
• Increased rates of anxiety from Wave 1 to Wave 2 were found for several subgroups:
  • Young adults (18-29 years): A higher rate of young adults reported anxiety symptoms in Wave 2 (32.4%) than Wave 1 (26.0%).
  • Young men: A higher rate of young men reported anxiety symptoms in Wave 2 (34.1%) than Wave 1 (22.8%), although this should be interpreted with caution due to the small sample size at Wave 2.
• Decreased rates of anxiety from Wave 1 to Wave 2 were found for one subgroup:
  • A lower proportion of respondents with a pre-existing mental health condition reported anxiety symptoms in Wave 2 (41.7%) than Wave 1 (49.5%), however this subgroup still reported higher rates than those without a pre-existing condition in both waves.
• Some subgroup differences were found at Wave 2: respondents who had a physical health condition and those from the lower SEG reported higher rates of anxiety at Wave 2 compared to their subgroup counterparts.

Mental Distress and mental ill-health^[6]

• For the overall sample, the rate of high GHQ-12 scores (an indication of mental distress and a possible psychiatric disorder) decreased from Wave 1 (32.6%) to Wave 2 (28.8%).
• The more marked decreases in rates of high GHQ-12 were seen in the following groups:
  • Women: There was a reduction in the proportion of women of all ages reporting a high GHQ-12 from Wave 1 (38.6%) to Wave 2 (31.9%), however despite this, they still reported higher rates of high GHQ-12 than men.
  • Those with a pre-existing mental health condition: a lower proportion of respondents from this subgroup reported high GHQ-12 scores at Wave 2 (51.3%) than Wave 1 (62.5%).
• Consistent with Wave 1, in Wave 2 specific subgroups had higher rates of high GHQ-12, including young adults (age 18-29 years), women, those with a pre-existing mental health condition, and respondents from the lower SEG.

Mental wellbeing^[7]

• Looking at the overall sample, respondents' mental wellbeing significantly increased from Wave 1 (Mean score = 21.52) to Wave 2 (Mean score = 21.81).
• Increases in mental wellbeing mean scores were found in several subgroups:
  • Those with a pre-existing mental health condition reported an increase mental wellbeing from Wave 1 (Mean score = 16.20) to Wave 2 (Mean score = 17.29).
  • Respondents from the lower SEG reported an increase in mental wellbeing from Wave 1 (Mean score = 20.49) to Wave 2 (Mean score = 21.00).
  • Those who lived alone reported higher mental wellbeing at Wave 2 (Mean score = 22.05) compared to Wave 1 (Mean score = 21.29).
• As with the Wave 1 report, the Wave 2 findings highlight a number of the same subgroups that reported higher levels of mental wellbeing, including; older adults, people with no pre-existing mental health conditions, and those from the higher SEG.

Loneliness and social support^[8]

• For the whole sample, feelings of loneliness decreased from Wave 1 (Mean score = 5.06) to Wave 2 (Mean score = 4.67).
• Decreases in mean loneliness score were found in several subgroups:
  • Respondents who had no pre-existing physical health condition reported that their loneliness decreased from Wave 1 (Mean score = 5.03) to Wave 2 (Mean score = 4.53), whereas for those with a physical health condition, loneliness did not change significantly from Wave 1 (Mean score = 5.33) to Wave 2 (Mean score = 5.17)
  • People whose working status had changed during the COVID-19 lockdown (i.e., lost job, furloughed) reported that their loneliness had reduced from Wave 1 (Mean score = 5.29) to Wave 2 (Mean score = 4.80)
  • Respondents living in urban areas reported that their loneliness decreased from Wave 1 (Mean score = 5.08) to Wave 2 (Mean score = 4.66)
• For the whole sample, levels of social support did not change significantly from Wave 1 (Mean score = 14.54) to Wave 2 (Mean score = 14.51).
• Changes in levels of social support from Wave 1 to Wave 2 were found for a number of the subgroups:
  • Women reported that their levels of social support decreased from Wave 1 (Mean score = 14.66) to Wave 2 (Mean score = 14.40), and men's increased from Wave 1 (Mean score = 14.33) to Wave 2 (Mean score = 14.49).
  • Young adults (18-29 years old) reported that their social support levels had increased from Wave 1 (Mean score = 14.25) to Wave 2 (Mean score = 14.52), while those aged 30-59 years found that their levels of social support had decreased from Wave 1 (Mean score = 14.17) to Wave 2 (Mean score = 13.85).
  • Respondents with a pre-existing mental health condition reported that their levels of social support decreased from Wave 1 (Mean score = 12.79) to Wave 2 (Mean score = 12.31).

Distress and life satisfaction^[9]

• For the whole sample, the average level of distress reduced from Wave 1 (Mean score = 2.61) to Wave 2 (Mean score = 2.41).
• A number of subgroups reported a decrease in levels of distress from Wave 1 to Wave 2:
  • Women reported that their levels of distress had decreased from Wave 1 (Mean score = 3.07) to Wave 2 (Mean score = 2.74), whereas men's did not change significantly from Wave 1 (Mean score = 2.29) to Wave 2 (Mean score = 2.17). It should be noted that despite women's reduction in level of distress at Wave 2, it remained higher than men's.
  • Young adults (18-29 years) reported that their distress had decreased from Wave 1 (Mean score = 3.76) to Wave 2 (Mean score = 3.38).
  • Those aged 30-59 years also reported reduced levels of distress had decreased from Wave 1 (Mean score = 3.00) to Wave 2 (Mean score = 2.67).
• Older adults (60+ years) did not report a significant change from Wave 1 (Mean score = 1.45) to Wave 2 (Mean score = 1.50), and retained the lowest level of distress at Wave 2 across the age groups
• The overall sample did not report changes in life satisfaction from Wave 1 (Mean score = 6.39) to Wave 2 (Mean score = 6.40).
• A number of subgroups reported a change in their life satisfaction from Wave 1 to Wave 2:
  • Older adults (60+ years) reported a decrease in life satisfaction from Wave 1 (Mean score = 7.19) to Wave 2 (Mean score = 7.04), though at Wave 2 60+ year olds still reported higher life satisfaction than both 18-29 year olds (Mean score = 6.04) and 30-59 year olds (Mean score = 6.07) at Wave 2.
  • Respondents with a mental health condition reported that their life satisfaction had increased from Wave 1 (Mean score = 4.13) to Wave 2 (Mean score = 4.37), although at Wave 2 this remained significantly lower than those with no mental health condition (Mean score = 6.64).