Scottish COVID-19 Mental Health Tracker Study: Wave 3 Report

4. Wave 3 COVID-19 Contextual Factors

This section provides a summary of respondents' experiences of, and views on COVID-19 between the 1^st October to 4^th November 2020 during a period of increased restriction measures in the central belt in Scotland. This section assesses people's experiences during this phase of lockdown restrictions in order to provide an understanding of the context in which respondents were living while they responded to the mental health and wellbeing focussed questions in the Wave 3 SCOVID study questionnaire. Comparison to previous waves will not be made in this section, however contextual data for the previous waves can be found in section 4 of the Wave 1 report and Wave 2 report. More detail on contextual factors is reported in Annex 3 through to Annex 7.

4.1 COVID-19 related experiences

Of the Wave 3 sample, including the booster sample, 0.7% of respondents reported that they had been diagnosed with COVID-19, and 5.7% reported that they had not been diagnosed but suspected they had contracted COVID-19. Around three quarters of this group (73.7%) reported self-isolating as a result of their symptoms. 18.4% of respondents reported that they knew someone diagnosed with COVID-19 and 2.7% of respondents reported having lost friends or family members to COVID-19.

4.1.1 Summary of views on COVID-19

Respondents were asked a series of questions about their views and experiences of COVID-19 and the related restrictions. Responses for each question were recorded on a 0 to 10 scale, with 0 indicating 'Not at all' and 10 indicating 'Very much', with no definition ascribed to the points in between. The average scores for the whole Wave 3 sample are reported in this section. See Annex 3, 4, and 5 for more detail.

• Respondents on average indicated the middle of the scale (5.5/10) to designate the impact COVID-19 had on how they felt emotionally (e.g. scared, upset, angry, depressed)
• Respondents on average indicated slightly above middle of the scale for the impact COVID-19 had on their lives more generally (6/10).
• Respondents also scored their current life satisfaction 6/10.
• When asked how concerned they felt about COVID-19, respondents averaged above the middle of the scale 6.6/10.
• When asked about how much control society had over COVID-19, they scored on average at the lower end of the scale (3.6/10).
• Compared to others of the same sex and age, roughly half of respondents (54.3%) felt they had an 'average' chance of contracting COVID-19, under a fifth of the sample felt they had a lower than average (16.0%) chance, while a fifth of respondents felt they had a greater than average chance (20.4%).
• Respondents chose 8.7/10 to indicate how necessary they felt social distancing and lockdown measures to be in helping prevent the spread of COVID-19.
• Over eighty percent (range 80.9- 92.5%) of respondents reported that they had been following the guidelines regarding social distancing and COVID-19 prevention measures in the two weeks prior to their completion of the Wave 3 survey (see Table F in Annex 5) at all times or often. There were no significant differences between subgroups regarding adherence to the government guidelines.

Wave 3 specific items

• Around half of respondents with a pre-existing mental health condition (51.8%), those with dependents under 5 years old (51.0%) and those in the youngest age group (49.0%) reported feeling negatively affected by the fact that others seemed to be living more normally than they were.
• Respondents with a pre-existing physical health condition (62.8%) and women (59.4%) were most likely to report feeling concerned that their risk of catching COVID-19 had increased with the easing of restrictions.
• Around three quarters of respondents with a pre-existing mental (70.4%) or physical (69.6%) health condition, and women (68.3%), reported feeling concerned that the risk of a loved one getting COVID-19 had increased.
• The majority of respondents with pre-existing physical health conditions (89.6%) and the 60+ age group (87.6%) reported feeling concerned about the occurrence of a second wave of COVID-19.
• Just under three quarters of the sample (71.9%) at Wave 3 felt the Scottish Government guidance on Phase 3 COVID-19 restrictions was easy to understand.

Interacting with others

Wave 3 coincided with increased restriction measures in the central belt in Scotland. Specifically, from 1^st October people could no longer meet inside people's homes unless they were part of a bubble, and only two households could meet outdoors. Respondents were asked about their activities in the previous two weeks. Around two thirds of respondents reported having neither visited others (68.1%) nor received visitors (68.2%). Of respondents who had, the majority indicated this had happened once (visiting others 18.5%, receiving visitors 18.3%). The middle age group (30-59 years) were least likely to have received visitors (26.6%), followed by the 60+ age group (30.6%) while the youngest age group (44.1%) were most likely to have received visitors at least once.

Similarly, respondents in the youngest age group were most likely to have visited another's home (49.4%), compared to over a quarter of 30-59 year olds (28.1%) and a quarter of the 60+ age group (24.7%).

At Wave 3, three quarters (76.6%) of respondents indicated feeling concern about other people's willingness to adhere to COVID-19 restrictions. The areas of concerns varied across key groups.

• Respondents in the 60+ age group (80.3%) and those with pre-existing mental (82.0%) or physical (84.9%) health conditions were most likely to feel concerned about others' ability to adhere to guidelines.
• Keyworkers (52.1%) and respondents with dependents aged 5-16 years old (40.4%) were the groups most likely to express concern around catching COVID-19 at work.

Support seeking

• Respondents at Wave 3 reported that they would feel reasonably willing to contact their GP about a non-COVID-19 related health concern (7/10). Respondents in the 60+ age group (7.9/10) and those with pre-existing physical health conditions (7.3/10) were most willing to contact the GP.
• Overall respondents were reasonably likely (6.3/10) to seek professional help for their mental health. Respondents in the 60+ age group (6.6/10) and those from high SEG (6.4/10) were most likely to seek help for their mental health.

4.2 General health and lifestyle factors during COVID-19

This section presents a brief breakdown of physical health, sleep, activity levels, and other lifestyle factors at Wave 3, which help to contextualise the mental health findings. Wave 3 findings suggest that respondents felt that their overall health was reasonably good. Respondents with a pre-existing mental or physical health condition reported worse perceptions of their health compared to those without pre-existing mental or physical health conditions.

4.2.1 Perceptions of overall health

At the time of the Wave 3 survey, around two thirds of respondents (62.4%) reported that their health was 'very good' (16.7%) or 'good' (45.7%). Over a quarter (28.9%) reported their health as 'fair', and fewer than one in ten felt their health was either 'poor' (7.4%) or 'very poor' (0.9%).

Looking at the data more closely, there were some differences in reports on perceived health according to groups categorised by background factors:

• Respondents in the youngest age group (18-29 years) (5.1%) were least likely to report feeling their health was poor or very poor compared to 30-59 year olds (7.9%) and the 60+ years group (11.3%).
• Women were less likely to report their general health as good or very good (60.1%) than men (64.9%).
• Respondents from the lower SEG (13.4%) were more likely to report poorer general health than those from higher SEG (5.3%).
• Over a third of respondents with pre-existing mental (34.9%) and over a quarter of those with physical health conditions (27.3%) reported poor or very poor general health compared to those without a pre-existing mental (4.2%) or physical health (3.7%) conditions.

4.2.2 Sleep

This section presents a brief overview of respondents' sleep quality in the week prior to the Wave 3 survey. Respondents were asked how they felt their sleep quality had been in the week prior to the Wave 3 survey. The data indicated that 40.5% of respondents rated their sleep as 'average'. Around a third (31.4%) of respondents rated their sleep as 'good' (24.5%) or 'very good' (6.9%), while over a quarter (28.2%) felt their sleep had been 'poor' (20.8%) or 'very poor' (7.4%).

A more detailed analysis of the sleep data shows that there were some subgroup differences by background:

• Respondents in the middle age group (30-59 year olds) were more likely to report experiencing poor or very poor (30.1%) sleep compared to respondents in the youngest age group (28.4%) or the 60+ age group (25.0%).
• Women were more likely to report poor or very poor (31.5%) sleep compared to men (24.8%).
• Respondents from the lower SEG were more likely to report poor or very poor (31.5%) sleep compared to the higher SEG (26.3%).
• Sleep quality differed significantly between respondents with or without a pre-existing mental health condition:

• Almost half of respondents with a pre-existing mental health condition reported poor or very poor (46.7%) sleep quality in the past week, compared to a quarter (25.4%) of those with no mental health condition.
• Just over a tenth of those with a pre-existing mental health condition reported good sleep quality (12.2%) compared to over a third (34.3%) of those with no mental health condition.

4.2.3 Lifestyle factors

Lifestyle factors can be important factors in an individual's mental and physical wellbeing. This section presents a brief breakdown of respondents' lifestyle factors at Wave 3.

Respondents were asked to indicate whether, in comparison to their usual behaviours, they felt that they had done various activities 'Less than usual', 'About the same', or 'More than usual' in the week prior to the questionnaire. The lifestyle factors and behaviours included alcohol use, smoking, drug use (other than prescription or over the counter medicines), online gambling, and physical activity. The following section provides a brief overview of these lifestyle factors, noting significant differences by subgroups.

Alcohol

34.3% reported not drinking alcohol in the past week. 39.4% reported no changes in their drinking in the past week. 16.9% reported drinking less than usual while 9.4% of respondents felt they had drunk more than usual.

Smoking

The majority of the sample (80.6%) reported not smoking during the previous week. Under 10% of the sample reported changes in smoking behaviour, with 2.3% of respondents reporting having smoked less than usual, while 4.0% felt they had smoked more than usual.

Drugs

The majority of the sample (88.6%) reported not using drugs, 1.5% of the sample reported increased drug use in the previous week prior compared to their usual usage, while 1.2% reported decreased use.

Gambling

The majority of the sample reported not engaging in online gambling (80.6%) in the week prior. Of respondents who did gamble online, 64.4% reported no change in their gambling in the preceding week, 19.3% reported gambling less than usual, and 16.3% reported gambling more than usual.

Physical Activity

This section reports on how many days in the last week respondents had engaged in moderate or vigorous physical activity for 15 minutes or more. Overall, respondents reported engaging in exercise for an average of just under 3 days per week (Mean was 2.73 days).

• Men reported engaging in more vigorous physical activity compared to women.
• Respondents from the higher SEG reported engaging in significantly more vigorous physical activity compared to those from lower SEG.
• Respondents without a pre-existing mental or physical health condition reported more vigorous activity than those with a pre-existing mental or physical health condition.

4.3 Support network and emotional support

This section presents an overview of respondents' emotional and social support at Wave 3. Given the possibility that people would be isolated from their usual support networks due to the COVID-19 restrictions, Wave 3 asked respondents how connected they felt to friends, family, colleagues, and their community during the COVID-19 lockdown. For the purposes of this report, those who reported being quite a bit, moderately or extremely connected were grouped in the category of 'Connected', and those who reported feeling not or a little bit connected were grouped as being 'Not connected'.

Those that felt the most connected included:

• Young adults (18-29 years) felt more connected to friends and colleagues than the other age groups.
• Women felt more connected to family and colleagues than men.
• Those in the higher SEG felt more connected to friends and colleagues than those in the lower SEG.
• Respondents without a pre-existing mental or physical health condition felt more connected to family, friends, colleagues, and community than those with a pre-existing mental or physical health condition.

4.3.1 Support Network

Family and Friends

Two thirds of the sample (66.4%) felt connected to family, while almost half the sample felt connected to friends (47.8%) and almost a fifth (18.7%) felt connected to their community. Of respondents who worked, 40.5% felt connected to their colleagues.

Differences in feelings of social connectedness to friends or family were found for different groups based on age, sex and background:

• Young adults (18-29 year olds) were more likely to report feeling connected to their friends (56.9%), followed by older adults (46.2%), and then the middle age (30-59 years old) group (44.3%).
• Women were more likely to feel connected to family (68.7%) than men (63.7%).
• Respondents from the lower SEG were less likely to feel connected to friends (39.4%) compared to those from a higher SEG (52.7%).

Living with a health condition was also associated with different reports of connectedness:

• Respondents with a pre-existing mental (47.1%) or physical health (42.0%) condition were more likely to not feel connected to family compared to respondents without a pre-existing mental (30.6%) or physical (30.5%) health condition.
• Respondents with a pre-existing mental (69.2%) or physical (58.8%) health condition more likely to not feel connected to friends compared to those with a pre-existing mental (46.3%) or physical (47.1%) health condition.

Colleagues and Community

Under a fifth (18.7%) of the overall sample reported feeling connected to their community. Around a quarter (26.2%) of respondents responded that the item assessing connectivity to colleagues was not applicable to them (e.g., respondents who may not work or had been furloughed) and they have been excluded from analysis of this item. Differences arose across subgroups such as age, sex, background, and health status:

• Around half of the 30-59 year olds (47.7%) and 18-29 year olds (46.9%) reported feeling connected to their colleagues compared to a fifth (19.3%) of the 60+ age group.
• The middle age group (20.4%) were more likely to feel connected to their community compared to young adults (18.0%) and the 60+ age group (16.6%).
• Women were more likely (44.1%) than men (39.4%) to report feeling connected to colleagues, whereas men were more likely to report feeling connected to their community (20.9%) than women (16.7%).
• Respondents from the higher SEG were more likely to feel connected to colleagues (45.7%) than those from the lower SEG (32.8%). Respondents from higher SEG were also more likely to feel connected to their community (20.6%) than those from lower SEG (15.3%).
• Respondents with a pre-existing mental health condition were less likely to feel connected to colleagues (24.8%) compared to respondents without a pre-existing condition (43.8%). Respondents with a pre-existing mental health condition were also less likely to report feeling connected to their community (8.9%) compared to those with no pre-existing mental health condition (20.2%).
• Respondents with a pre-existing physical health condition were less likely to feel connected to colleagues (21.9%) than those without a pre-existing physical health condition (44.9%). 16.3% of respondents with a pre-existing physical health condition felt connected to their community compared to a 19.3% without a pre-existing physical health.

4.3.2 Emotional support

This section presents a breakdown of sources of emotional support respondents used in the month prior to Wave 3. Sources of emotional support included family, counsellors, GP, and NHS services. The findings for the whole sample are displayed in Table 4.1 below, indicating the percentage of people who had contacted a particular source at least once in the month before the Wave 3 survey.

Friends and family were the most used source of support, and NHS 24 was least used. Young adults (18-29 years old) were most likely to make use of the supports available. Women were more likely to have sought support from friends and family, while men were more likely to access resources online or by telephone.

Table 4.1: Percentage of respondents who used sources of emotional support at least once in the month before Wave 3 survey

Source of support	Respondents accessing in month prior to Wave 3 survey (%)
Friends or family	41.1
Professional counselling or therapy (via telephone, online or face-to-face)	6.5
GP or community health worker (e.g. health visitor, midwife, pharmacist)	8.8
NHS 24 111 telephone service	3.0
NHS Inform/Shielding support telephone line	5.3

Differences in use of support:

• Young adults (18-29 years) were the most likely to have made use of all sources of emotional support compared to the other age groups:
• Young adults were more likely to have contacted friends and family for emotional support (65.6%) than the other age groups (30-5 years: 40.9%, 60+: 23.0%).
• Young adults were also more likely to have used professional counselling or therapy services (12.2%) than the other age groups (30-59 years: 8.0%, 60+: 0.1%).
• Young adults were more likely to report having contact with a GP or community health worker (13.9%) than the other age groups (30-59 years: 9.4%, 60+: 4.0%) and were more likely to report using NHS 24 (5.5%) than the other age groups (30-59 years: 3.3%, 60+: 0.4%).
• The youngest age group were also more likely to report using NHS Inform/Shielding support telephone line (10.1%) than the other age groups (30-59 years: 5.2%, 60+: 2.1%).
• Women were more likely to have contacted friends and family for emotional support (50.4%) than men (30.7%).
• Respondents with a pre-existing mental health condition were more likely (63.7%) to have contacted friends and family for emotional support than those with no pre-existing condition (37.6%), and were also more likely to have used professional counselling or therapy services (16.2%) compared to those with no pre-existing condition (5.1%). They also were more likely to report contact with GP or community health worker (18.3%) than those with no pre-existing mental health condition (7.4%).
• Respondents with a pre-existing physical health condition were less likely (36.5%) to have contacted friends and family for emotional support than those with no pre-existing condition (42.1%), and were also less likely (2.8%) to have used professional counselling or therapy services than those with no pre-existing physical health condition (7.4%). Those with a pre-existing physical health condition were also less likely (0.2%) to have used NHS 24 than those with no pre-existing physical health condition (3.6%).

4.4. Finances during easing of lockdown

Respondents were asked questions around work status and financial security during the Wave 3 study period. Overall, just over half of respondents (56.7%) reported that their job had changed in some way during the COVID-19 pandemic. As displayed in Figure 4.1, at Wave 3 the most commonly reported changes were:

• 15.3% of the sample were working from home,
• 10.4% were furloughed,
• 6.6% of respondents had returned to work.

To assess perceived financial coping during COVID-19 in Wave 3 of the SCOVID study, respondents were asked: "How well would you say you are managing financially these days?" Responses were: 'living comfortably', 'doing alright', 'just about getting by', 'finding it quite difficult', 'finding it very difficult'. For this report we have grouped responses to reflect respondents reporting financial coping (living comfortably, doing alright, and just about getting by) and those who were experiencing difficulties (finding it quite difficult, and finding it very difficult).

At the time of the Wave 3 survey the majority of respondents reported financial coping (89.5%).

Particular subgroups within the sample did report experiencing financial difficulties, these include respondents in the younger age groups, those in the lower SEG, carers, those living in rural areas, and respondents with pre-existing mental health conditions. Specifically:

• The younger age groups were more likely to report financial difficulties (18-29 14.5%, 30-59 13.2%) compared to those in the 60+ age group (3.4%).
• Respondents with caring responsibilities were more likely (17.6%) to report financial difficulties than those without caring responsibilities (9.2%).
• Respondents from the lower SEG were more likely (14.8%) to report financial difficulties than those from higher SEG (8.0%).
• Respondents who lived in rural areas were more likely (14.5%) to report financial difficulties than those living in urban areas (9.4%).
• Respondents with a pre-existing mental health condition were more likely to report financial difficulties (24.6%) compared to those with no pre-existing condition (8.3%).

4.5 Sources of stress

Respondents were asked to indicate what sources of stress they had experienced around the time of the Wave 3 survey. Of the overall sample, just under half of respondents (44.0%) felt cut off from friends and family and over a quarter of respondents (27.0%) were finding the restrictions on socialising difficult to cope with. A tenth of respondents (10.1%) reported experiencing more arguments with the people they lived with. See Annex 6 for more sources of stress for the whole sample.

• Women, and respondents with a pre-existing mental or health condition most frequently reported feeling cut off from friends and family.
• The youngest age group, women, and respondents with a pre-existing mental health condition were most likely to report struggling with the restrictions on socialising.
• The youngest age group, women and respondents with a pre-existing mental health condition were most likely to report an increase in arguments with the people they lived with.
• o For those who reported experiencing increased arguments, they were most frequently reported as occurring with a husband, wife or partner (72.1%), a parent (15.2%), or with children (11.9%).

4.6 Interpersonal harm

This section gives a brief overview of the findings about respondents' recent experiences of physical harm, bullying, or psychological harm in the two weeks before the Wave 3 survey.

Overall, 5.3% of respondents reported that they had been physically harmed by another person in the prior two weeks. Additionally, 8.7% of respondents reported experiences of being bullied, controlled, intimidated or psychologically hurt by somebody else.

Particular groups within the sample reported higher rates of interpersonal harm than their subgroup counterpoint:

• Young adults (18-29 years) reported more physical and psychological harm that the other age groups
• Men reported higher rates of physical harm than women.
• Those in the lower SEG reported higher rates of physical harm than those in higher SEG.
• Those with a pre-existing mental health condition reported higher physical and psychological harm than those without a pre-existing condition.
• Those with a pre-existing physical health condition reported lower physical harm and psychological harm than those without a pre-existing condition.

4.7. Trust in authorities

Trust is an important indicator of how confident people are in society more widely. In Wave 3 of the SCOVID study, trust in the authorities (police, NHS, UK, and Scottish governments) was assessed. Differences in levels of trust by groups can be found in Annex 7.

Police

Around two thirds of respondents (68.1%) said that they trusted the police to some extent and around a quarter (26.7%) of these respondents reported trusting the police completely.

NHS

The majority of respondents (88.2%) reported trusting the NHS to some extent and around half (47.2%) of these respondents endorsed trusting the NHS completely.

Trust in government

Respondents were asked to what extent they felt the UK and Scottish governments could be trusted. Just under a quarter of respondents (23.6%) said that they felt the UK government could be trusted to some extent, while two thirds (65.7%) said they did not trust it at all or did not trust it very much.

Over half of all respondents (59.1%) said that they felt the Scottish government could be trusted to some extent, while a third (30.2%) said they did not trust it at all or did not trust it very much.