Coronavirus (COVID-19): mental health tracker study - wave 1 report

Executive Summary

The objective of this report is to present findings of Wave 1 of the Scottish COVID-19 (SCOVID) Mental Health Tracker Study. These findings are based on questionnaire data collected between 28^th May and 21^st June 2020 (a period which coincided with the Phase 1 easing of lockdown measures in Scotland) and draws on a nationally representative sample of 2514 adults. The primary focus of this report is the mental health and wellbeing outcomes as reported by these respondents, as well as other lifestyle factors which describe the circumstances and experiences of these respondents at the time of the questionnaire.

Wave 1 of the SCOVID Mental Health Tracker Study shows that 35.7% of the sample reported high levels of psychological distress and a possible psychiatric disorder (based on responses to the GHQ-12: General Health Questionnaire). Just over a quarter of the sample (25.3%) reported levels of depressive symptoms indicating a possible need for treatment, and nearly a fifth (19.1%) reported anxiety symptoms of a similar level. Furthermore, 10.2% of respondents reported suicidal thoughts within the week prior to the Wave 1 survey, with 3.6% thinking about suicide more than half of the days during that week.

Although there is no directly comparable pre-COVID-19 data available, the findings indicate that participants are reporting higher rates of psychological distress than might have been expected in non-COVID-19 pandemic circumstances. For example, in the Wave 1 SCOVID Mental Health Tracker Study, 35.7% of the sample were found to have high levels of psychological distress based on responses to the GHQ 12: General Health Questionnaire. This compares with only 17% of the 2019 Scottish Health Survey sample (McLean et al., 2019) and 29.2% of participants in the UK-based Understanding Society COVID-19 Study conducted in late April 2020 (Li and Wang, 2020).

It is important to note that this report suggests that particular subgroups within the sample are reporting higher levels of mental health problems and financial concerns during Wave 1 than the sample average. These groups are: young adults (18-29 years), women, individuals with pre-existing mental health conditions, and individuals in the lower socio-economic group (SEG)^[1]. Respondents who identified as BAME (Black, Asian and Minority Ethnic) also frequently reported worse mental health indicators, however it must be noted that the sample size for respondents who identified as BAME is quite small, and therefore, the findings should be treated with caution.

Key Findings

Depressive symptoms

• A quarter (25.3%) of the sample met the cut-off for moderate to severe depressive symptoms, which indicates depressive symptoms that may need treatment.
• Women (27.6%) were more likely to meet the cut-off for depressive symptoms indicating moderate to severe depression than men (25.3%).
• Young adults (18-29 years) were more likely to have moderate to severe levels of depressive symptoms (44.7%) than those aged 30-59 years (25.9%) and 60+ years (25.3%).
• Individuals with a pre-existing mental health condition (64.5%) were more likely to report moderate to severe levels of depressive symptoms compared to those without a pre-existing mental health condition (19.6%).^[2]
• Higher levels of depressive symptoms were reported by those from the lower SEG (31.2%) compared to those from higher SEG (21.9%).
• Individuals of BAME background (37.4%) reported higher levels of depressive symptoms compared to White (24.9%) respondents.
• Respondents who were in the high-risk for COVID-19 group reported lower levels of depressive symptoms than those not at high risk, and this finding is repeated across the mental health outcomes. A possible explanation is that this age group is primarily made up of those aged 60+ (73.7% aged 60+ compared to 17.8% in the non-high risk group) and this older age group's mental health appears to be more protected.
• Findings in this category were based on responses to questions on the mental health measure called the Patient Health Questionnaire (PHQ-9; Kroenke et al., 2001), which assesses frequency of depressive symptoms over the previous two weeks.

Anxiety symptoms

• Nearly one fifth (19.1%) of respondents met the cut-off for moderate to severe anxiety symptoms, which indicates possible generalised anxiety disorder and a possible need for treatment.
• Women (22.1%) reported higher rates of moderate to severe anxiety symptoms than men (15.8%).
• 18-29 year olds (33.5%) were more likely to report at least moderate to severe anxiety symptoms than 30-59 year olds (19.6%), and 60+ year olds (7.2%).
• Individuals with a pre-existing mental health condition (55.5%) reported higher rates of moderate to severe anxiety symptoms than those without this background (13.8%).
• Those from the lower SEG (23.6%) were more likely to report at least moderate to severe anxiety symptoms than those from the higher SEG (16.4%).
• Anxiety symptoms were assessed using the mental health measure called the Generalised Anxiety Disorder (GAD-7; Spitzer et al., 2006) scale, which asks about frequency of anxiety symptoms in the last 2 weeks.
• Suicidal thoughts
• Overall, 10.2% of respondents reported suicidal thoughts within the week prior to the Wave 1 questionnaire, with 3.6% thinking about suicide more than half of the days in that week.
• Young adults (18-29 years) reported the highest levels of suicidal thoughts within that week (21.1%), higher than those aged 30-59 years (10.2%) and 60+ years (2.3%).
• There were no differences between men and women in levels of suicidal thoughts reported.
• Those with a pre-existing mental health conditions were 4.5 times more likely to report suicidal thoughts in the week prior to the questionnaire than those without pre-existing mental health conditions (32.6% vs. 7.1%).
• Individuals from the lower SEG were more likely to report suicidal thoughts in the week prior to responding to the Wave 1 questionnaire compared to those in the higher SEG (12.9% vs. 8.7%).
• People living in urban areas (11.0%) reported higher suicidal thoughts in the week prior to responding to the Wave 1 questionnaire compared to those living in rural areas (7.6%).
• Those of BAME background (17.9%) reported higher suicidal thoughts in the week prior to responding to the Wave 1 questionnaire compared to White study respondents (10.0%).

General Health Questionnaire (GHQ-12)

• Over one third (35.7%) of the sample scored above the GHQ-12 cut-off score indicating high levels of psychological distress and a possible psychiatric disorder.
• A greater proportion of women reported these high GHQ-12 scores than did men (40.8% vs. 30.3%).
• Over half of 18-29 year olds (51.5%) reported high GHQ-12 scores compared to 38.5% of 30-59 year olds and 16.9% of 60+ year olds.
• Over half of respondents who had pre-existing mental health conditions (67.4%) reported high GHQ-12 scores compared to a third (31.1%) of respondents who did not have any pre-existing mental health condition.
• Respondents from lower SEG were more likely to report a high GHQ-12 score (39.6%) than those from higher SEG (33.4%).

Mental wellbeing

• Mental wellbeing was measured using the Short Warwick-Edinburgh Mental Well-being Scale: respondents are awarded a wellbeing score by adding together 7 questions (range: very low wellbeing =7, very high wellbeing =35). Scores were adjusted using Rasch transformation. Average scores (means) are used to investigate differences between subgroups.
• The average score for mental wellbeing in the current sample was 21.28, which is lower than the Health Survey for England (2012) which found an average score of 23.61. This suggests that mental wellbeing is lower than would have been expected^[3].
• No differences on mental wellbeing were found between men (average score 21.55) and women (average score 21.07).
• Respondents in the older age group (60+ years old) scored higher on mental wellbeing (average score 23.82) than those aged 30-59 years (average score 20.77), and compared to young adults (18-29 years) who scored the lowest (average score 19.13).
• Respondents in the higher SEG scored significantly higher (average score 21.84) on the mental wellbeing scale than those in the lower SEG (average score 20.40).
• White respondents reported higher mental wellbeing scores (average score 21.36) compared to those in the BAME group (M=19.63).
• Respondents who indicated having no pre-existing mental health conditions scored higher mental wellbeing (average score 22.00) than those with a pre-existing mental health condition (average score 16.50).

Loneliness and social networks

• Loneliness was measured using 3 items, with a score of 3 indicating no loneliness and a score of 9 equating to very high loneliness. Respondents were asked to rate perceptions of their loneliness before the COVID-19 pandemic, and their loneliness at the time of the Wave 1 questionnaire. Mean scores were used to compare groups.
• Overall, perceptions of loneliness increased from pre-COVID-19 (average score 4.67) to Wave 1 (5.18).
• The largest increase in loneliness was seen in the 60+ age group, however young adults (18-29 years) reported the highest levels of loneliness pre-COVID-19 and during COVID-19.
• Women reported higher levels of loneliness than men (5.32 vs. 5.02).
• Individuals with a pre-existing mental health condition (6.46) reported higher loneliness and lower levels of social support than those with no pre-existing mental health condition (4.98).
• Those from a lower SEG (5.39) reported higher loneliness and lower levels of social support than those from the higher SEG (5.04).
• Around 43% of individuals reported feeling moderately or extremely connected to their family in the past week, and 36.4% felt a little bit connected to their friends.
• Over half (56%) of individuals felt not at all connected to their colleagues and over 40% not at all connected to their community in the week prior to the Wave 1 questionnaire.
• Family and friends were the most common source of emotional support both prior to (48.7%) and during (46.6%) the COVID-19 pandemic.

Distress and stress

• Respondents were asked 'How distressed have you been in the past week?' on a scale of 0, indicating No distress and 10, indicating Extreme distress.
• Of all the subgroups the highest levels of distress were seen in those with a pre-existing mental health condition; they had more than twice the level of distress than those with no previous mental health condition.
• The second highest was reported in those from a BAME background.
• Across the whole sample key sources of stress were feeling cut-off from friends and family (45.8%) and poor sleep (35.2%).

Financial management

• Respondents were asked to reflect on how well they were managing financially before COVID-19.
• 72% of respondents indicated they were 'doing alright' or 'living comfortably' prior to COVID-19, however reports of these financial circumstance ratings reduced to 65.5% during Wave 1.
• Overall, 19.2% of people felt their financial situation had worsened during the COVID-19 pandemic, and 76.2% reported that it had stayed the same.
• Young adults (18-29 years) were more likely to perceive that their financial situation had worsened (28.7%) compared to those aged 30-59 years (20.8%) and 60+ years (9.1%).