Scottish COVID-19 Mental Health Tracker Study: Wave 4 Report

Executive summary

Background

This report presents findings for a range of mental health outcomes for Wave 4 of the Scottish COVID-19 (SCOVID) Mental Health Tracker Study. The tracker study began in May 2020 and looks at the impacts of the pandemic on mental health and wellbeing among a sample of adults in Scotland. It uses an online questionnaire to collect information about depressive symptoms, anxiety, suicidal thoughts, psychological distress, and mental wellbeing. It also includes questions on other factors associated with mental wellbeing, such as loneliness and life satisfaction, as well as other contextual factors. The study has taken place at five points in time (waves) over a twelve month period.

The Wave 4 findings are based on questionnaire data collected between 4^th February and 9^th March 2021. This period coincided with a UK-wide lockdown that began on 5^th January 2021, with a strict stay at home message, limits on household mixing, school closures, and the closing of all non-essential retail and hospitality. Results are compared to previous waves of the study to show changes in mental health during the pandemic as restrictions change. In particular, we compare to Wave 3, which took place between 1^st October 2020 and 4^th November 2020, and roughly coincided with the increasing of COVID-19 restrictions in Scotland.

Two kinds of findings are reported: cross sectional (the Wave 4 findings) and longitudinal (changes across the waves). These are based on two different samples. The cross-sectional sample is made up of everyone who completed the Wave 4 questionnaire (n=1288). The longitudinal sample comprises respondents who completed all four waves of the study (n=1022). Only statistically significant differences between sub-groups or points in time are reported.

It is important to note that a number of demographic groups – especially young adults (18-29 years) – are under-represented in both samples. Although the sample at Wave 1 was representative of the Scottish population, many younger people have since been lost to follow up. This is a concern as previous waves of the study have shown that younger adults report higher rates of mental health problems than other age groups. To compensate for this attrition (i.e., loss to follow-up), a booster sample of young adults was added at Wave 3. However, respondents in the booster sample and those who have not completed every wave of the study are not included in the longitudinal analysis. Therefore findings for young adults are only reported in the cross-sectional analysis. Data has been weighted (i.e., adjusted to more accurately reflect the population of Scotland), which also has a risk of bias.

Key Findings

Wave 4 cross-sectional findings show:

• 32.3% of the sample reported psychological distress and evidence of a possible psychiatric disorder (based on responses to the GHQ-12),
• 23.5% reported moderate to severe depressive symptoms,
• 16.2% reported moderate to severe anxiety symptoms,
• 10.4% of respondents reported suicidal thoughts within the week prior to completing the Wave 4 survey.

Consistent with the cross-sectional findings from previous reports, particular subgroups within the sample reported higher rates of mental health problems during Wave 4. These groups include:

• young adults (18-29 years),
• women,
• individuals with a mental health condition,
• respondents with a physical health condition,
• individuals in a lower socio-economic group (SEG^[1]).

Longitudinal analysis suggests overall poorer mental health during Wave 4 compared to Wave 3, although this was not consistent across all mental health outcomes. Specifically:

• rates of suicidal thoughts increased from Wave 3 to Wave 4,
• rates of moderate to severe depressive symptoms increased from Wave 3 to Wave 4, and were higher than at all the previous waves,
• rates of anxiety symptoms did not change at Wave 4 from previous waves,
• levels of mental wellbeing increased from Wave 3 to Wave 4,
• feelings of loneliness increased from Wave 3 to Wave 4, bringing it to a similar level of that reported at Wave 1,
• defeat increased from Wave 3 to Wave 4,
• life satisfaction decreased from Wave 3 to Wave 4.

Suicidal thoughts

Wave 4 findings:

• Overall, one tenth (10.4%) of respondents reported suicidal thoughts within the week prior to the Wave 4 questionnaire.
• Young adults (18-29 years) reported the highest rates of suicidal thoughts (17.0%), higher than those aged 30-59 years (12.8%) and 60+ years (2.4%).
• There were no statistically significant differences between men and women in rates of suicidal thoughts reported.
• Those with a pre-existing mental health condition were more likely to report suicidal thoughts (25.6%) in the week prior to the questionnaire than those without a pre-existing mental health condition (8.5%).

Changes across the waves:

• For the overall sample, there was an increase in the proportion of respondents reporting suicidal thoughts from Wave 3 (8.6%) to Wave 4 (11.2%).
• The proportion of men aged 30-59 years reporting suicidal thoughts increased from Wave 3 (9.3%) to Wave 4 (14.2%).
• The proportion of those with no pre-existing mental health condition reporting suicidal thoughts in the week prior increased from 5.5% in Wave 3 to 8.5% in Wave 4, whereas those with a pre-existing mental health condition reported no change (Wave 3: 31.9%; Wave 4: 31.1%).
• Rates of suicidal thoughts increased for respondents who were key workers from Wave 3 (9.4%) to Wave 4 (15.0%).

Depressive symptoms^[2]

Wave 4 findings:

• Almost a quarter (23.5%) of the sample had moderate to severe depressive symptoms.
• Women (26.1%) were more likely to have depressive symptoms than men (20.8%).
• Young adults (18-29 years) were more likely to report depressive symptoms (35.8%) than those aged 30-59 years (25.3%) and 60+ years (11.9%).
• Individuals with a pre-existing mental health condition (63.5%) were more likely to report depressive symptoms compared to those without a pre-existing mental health condition (17.5%).
• Respondents with a pre-existing physical health condition (34.9%) were more likely to report depressive symptoms compared to those without a pre-existing physical health condition (20.3%).
• Higher rates of depressive symptoms were reported by those from the lower SEG (27.0%) compared to those from higher SEG (21.4%).

Changes across the waves:

• Rates of depressive symptoms increased from Wave 3 (21.1%) to Wave 4 (25.0%). Rates of depressive symptoms at Wave 4 (25.0%) were higher than at all the previous waves (Wave 1: 20.6%; Wave 2: 22.3%).
• Rates of depressive symptoms increased between Waves 3 and 4 for 30-59 year old men (15.6% to 23.6%) and for 60+ year old men (9.6% to 12.8%)
• Those with no pre-existing mental health condition reported higher rates of depressive symptoms at Wave 4 (18.7%) than at Wave 3 (14.0%), compared to those with a pre-existing mental health condition whose rates did not change (Wave 3: 66.6%; Wave 4: 65.7%).
• A higher proportion of the lower SEG reported depressive symptoms at Wave 4 (32.6%) than at Wave 3 (20.8%).
• For respondents with no dependents under 16 years old, rates of depressive symptoms increased from Wave 3 (19.8%) to Wave 4 (24.7%), compared to no change in rates among those with dependents under 16 years (Wave 3: 25.5%; Wave 4: 26.0%).
• Respondents who lived in a rural area reported an increase in the rates of depressive symptoms from Wave 3 (19.5%) to Wave 4 (30.1%), compared to no change in rates among those who lived in urban areas (Wave 3: 21.5%; Wave 4: 23.7%).

Anxiety symptoms^[3]

Wave 4 findings:

• Just over one sixth (16.2%) of respondents had moderate to severe anxiety symptoms.
• Women (19.5%) reported higher rates of anxiety symptoms than men (12.8%).
• 18-29 year olds (28.8%) were more likely to report anxiety symptoms than 30-59 year olds (15.5%), and 60+ year olds (8.2%).
• Individuals with a pre-existing mental health condition (48.9%) reported higher rates of anxiety symptoms than those without a pre-existing mental health condition (11.3%).
• Those from the lower SEG (21.4%) were more likely to report anxiety symptoms than those from the higher SEG (13.2%).
• Respondents with a pre-existing physical health condition were more likely to report moderate to severe anxiety symptoms (23.9%) than those with no pre-existing physical health condition (14.0%).

Changes across the waves:

• Looking at the sample as a whole, there were no statistically significant changes in rates of moderate to severe anxiety symptoms from Wave 3 (15.0%) to Wave 4 (15.3%).
• Respondents living with dependents aged 16 years or younger reported an increase in their rates of anxiety from Wave 3 (15.1%) to Wave 4 (18.5%), and rates for those with no dependents under 16 years did not change (Wave 3: 15.0%, Wave 4: 14.3%).
• Additionally, those living in rural areas reported a decrease in rates of anxiety symptoms from Wave 3 (17.5%) to Wave 4 (15.1%), compared to those in urban areas (Wave 3: 14.4%; Wave 4: 15.3%).

Psychological Distress / Possible Psychiatric Disorder (GHQ-12)^[4]

Wave 4 findings:

• Just under one third (32.2%) of the sample had high GHQ-12 scores, indicating high rates of psychological distress and a possible psychiatric disorder.
• A greater proportion of women (36.8%) reported psychological distress than men (27.3%).
• Half of 18-29 year olds (50.2%) reported psychological distress compared to 31.4% of 30-59 year olds and 20.5% of 60+ year olds.
• Around half of respondents who had a pre-existing mental health condition (52.8%) reported psychological distress compared to just under a third (29.3%) of respondents who did not have any pre-existing mental health condition.
• Individuals with a pre-existing physical health condition (37.7%) were more likely to report psychological distress than those with no pre-existing physical health condition (30.8%).

Changes across the waves:

• The proportion of respondents reporting psychological distress did not change from Wave 3 (27.8%) to Wave 4 (26.9%).
• The proportion of respondents with a pre-existing mental health condition that reported psychological distress decreased from Wave 3 (64.2%) to Wave 4 (48.1%).
• The proportion of respondents with a pre-existing physical health condition that reported psychological distress also decreased from Wave 3 (42.9%) to Wave 4 (37.5%).
• The proportion of individuals from the lower SEG that reported psychological distress decreased from Wave 3 (30.8%) to Wave 4 (26.6%).
• The proportion of those living in a rural area reporting psychological distress decreased from Wave 3 (37.2%) to Wave 4 (32.4%).

Mental wellbeing^[5]

Wave 4 findings:

• The average score for mental wellbeing was 21.72, out of a maximum of 35.
• Men reported higher mental wellbeing (average score 22.05) than women (average score 21.42).
• Respondents in the older age group (60+ years old) had higher mental wellbeing (average score 23.57) than those aged 30-59 years (average score 21.51) and young adults (18-29 years) (average score 19.61).
• Respondents in the higher SEG had higher (average score 22.28) mental wellbeing than those in the lower SEG (average score 20.75).
• Respondents with no pre-existing mental health condition had higher mental wellbeing (average score 22.36) than those with a pre-existing mental health condition (average score 17.41).
• Individuals with no physical health condition reported higher wellbeing (average score 21.93) than those with a physical health condition (average score 20.98).

Changes across the waves:

• There were no statistically significant changes in average mental wellbeing across Waves 1 to 3 (average score Wave 1: 21.86, Wave 2: 21.78, Wave 3: 21.94), but there was an increase at Wave 4 (average score 22.15).
• Respondents from the higher SEG reported an increase in mental wellbeing from Wave 3 (average score 22.22) to Wave 4 (average score 22.84).

Loneliness^[6] and Social Support^[7]

Wave 4 findings:

• The mean score for loneliness at Wave 4 was 5.01 out of a maximum of 9, and the mean score for levels of social support was 14.19 out of a maximum of 20.
• Women reported higher levels of loneliness than men (average score 4.80). There were no significant differences in levels of social support between men and women.
• Young adults (18-29 years) had higher levels of loneliness compared to other age groups. In contrast, young adults (18-29 years) reported the highest levels of social support, followed by individuals aged 60+ years and with 30-59 year olds reporting the lowest levels.
• Respondents in the lower SEG reported higher levels of loneliness and lower levels of social support than those in the higher SEG.
• People with a pre-existing physical health condition and people with a pre-existing mental health condition reported higher loneliness and lower levels of social support than those with no pre-existing health conditions.

Changes across the waves:

• For the whole sample, feelings of loneliness increased from Wave 3 (average score 4.71) to Wave 4 (average score 4.83), which brings it to a similar level of that reported at Wave 1 (average score 4.89).
• Respondents from the lower SEG reported that their loneliness increased from Wave 3 to Wave 4, compared to those in the higher SEG, whose levels of loneliness remained similar.
• Respondents who had caring responsibilities reported that their loneliness had increased from Wave 3 to Wave 4, compared to individuals with no caring responsibilities.
• Respondents who had dependents under 16 years old in their household reported an increase in levels of loneliness from Wave 3 to Wave 4, compared to those with no dependents.
• For the whole sample, social support average scores decreased from Wave 3 (average score 14.62) to Wave 4 (average score 14.41).
• Respondents with a pre-existing mental health condition reported that their social support increased from Wave 3 to Wave 4, while those without a mental health condition reported a decrease in social support.

Distress^[8] and life satisfaction^[9]

Wave 4 findings:

• The average level of distress (measured on a 10-point scale) was 2.79, indicating mild levels of distress on average.
• The groups reporting higher levels of distress using this scale were similar to those with higher psychological distress using the GHQ-12 measure: women, young adults (18-29 year olds) and people with a pre-existing mental health condition.
• The average life satisfaction for the sample was 5.87, which suggests that overall respondents were moderately satisfied with life.
• Young adults (18-29 year old) reported lower mean life satisfaction scores than the 30-59 year olds and the 60+ year old group.
• Respondents in the higher SEG reported higher mean life satisfaction scores than those in the lower SEG.
• People without a pre-existing physical condition and people with a pre-existing mental health condition reported experiencing higher life satisfaction than those with a pre-existing health condition.

Changes across the waves:

• The average level of distress did not change significantly from Wave 3 (2.62) to Wave 4 (2.71).
• Levels of distress increased from Wave 3 to Wave 4 for women aged 30-59 years and men aged 60+ years.
• Levels of life satisfaction decreased from Wave 3 (6.30) to Wave 4 (5.98).
• Women aged 60+, those without a pre-existing mental health condition and respondents from the lower SEG reported a decrease in their life satisfaction from Wave 3 to Wave 4.