Scottish COVID-19 Mental Health Tracker Study Wave 5 Report

4. Conclusions

Tracking the mental health and wellbeing of the Scottish population during the COVID-19 pandemic has been important to understand the wider implications of the pandemic and lockdown, beyond those who have been directly impacted by the virus. This report outlines the cross-sectional trends across Wave 1 to Wave 5 of the Scottish COVID-19 Tracker Study, especially looking at the mental health findings for certain at-risk subgroups. To allow for a more focussed report, four mental health outcome measures were reported: suicidal thoughts, depressive symptoms, anxiety symptoms and mental wellbeing. It is also important to note that as data collection for Wave 1 began in May 2020, after COVID-19 pandemic restrictions had already been put into place, this report is unable to identify how mental health and wellbeing has changed from before the pandemic. Additionally, due to loss to follow-up across the waves of the study, we were unable to conduct a robust longitudinal analysis of changes in rates of mental health outcomes over the waves.

Across the subgroups investigated in this report, particular age and sex groups tended to report worse mental outcomes across the waves of the SCOVID study than their age and sex counterparts:

• Young women
• Young men
• Young adults
• Women

Particular intersectional factors also appeared to increase the risk of poor mental health within the overall sample (see Annex 5), and within some of subgroups listed above:

• a pre-existing mental health condition,
• a pre-existing physical health condition,
• unpaid caring responsibilities,
• young dependents,
• and vaccine hesitancy.

Pandemic restrictions and mental health

Looking across the waves, overall there was a trend for the overall sample, and young women, young adults, and women, to report poorer mental health at times of higher restrictions (i.e., Wave 1: Spring 2020, Wave 3: Autumn 2020 and Wave 4: Winter 2021) and better mental health at times of fewer restrictions (i.e., Wave 2: summer 2020 and Wave 5: Summer 2021). This suggests that people's mental health and wellbeing were impacted by the COVID-19 restrictions and lockdowns, although it appears that as restrictions eased these mental health outcomes tended to improve. This is consistent with findings from the UK COVID-MH study, that found for the whole sample there was an increase in depressive symptoms, defeat, entrapment, and loneliness during the lockdown in February 2021, coinciding with SCOVID Wave 4 (Wetherall et al., under review). Additionally, the UK Household Longitudinal Study (UKHLS) indicated that easing lockdown measures rapidly improved mental health, particularly in those from lower socio-economic backgrounds (Serrano-Alarcon et al., 2021).

In contrast, there were some subgroups that reported the converse, for example young men and those with a pre-existing physical health condition appeared to report better rates of mental health and wellbeing when restrictions were in place, and worse rates when restrictions were lifted. We cannot state why some subgroups appeared to experience the opposite pattern, an interpretation could be that for some there may be a lag between restrictions being in place and their negative impact upon mental health, so that it is taking longer for them to feel the consequences of the restrictions. Alternatively, those with physical health conditions may already be restricted in their day-today movement, and the changes made to increase connection remotely during lockdowns may have benefited this group.

Overall, evidence from Wave 5, when restrictions had been eased in the Summer 2021, suggests that there has been an overall improvement in mental health and wellbeing, although this is not consistent across all subgroups reported in this study. Across the waves, young adults and women that had a pre-existing mental health condition, a pre-existing physical health condition, unpaid caring responsibilities, or vaccine hesitancy appeared to be at higher risk of poor mental health. In addition, and women with dependents under 5 years also appeared to be at risk for poor mental health. In particular, we propose that those who fall into multiple vulnerable groups may be at elevated risk for poor mental health.

SCOVID findings in context of other research

As noted, the SCOVID study does not have pre-pandemic figures, and therefore we cannot state whether mental health outcome trends have changed from pre-pandemic levels. However, a recent systematic review of studies with pre-pandemic longitudinal data, primarily from Europe and North America, suggests an overall worsening of mental health during the pandemic, including an increase in depressive and mood disorder symptoms, and this was more pronounced at the start of the pandemic (March/April 2020) and gradually decreased as over time (Robinson et al., 2021). This review also found that particular subgroups appeared to report more of an increase in symptoms, including those with a pre-existing physical health condition, in contrast they did not find notable differences by gender or those with a pre-existing mental health condition. A further review looking at suicidal thoughts and behaviour in research conducted during the pandemic (mainly in Western countries) suggests that event markers of suicidal outcomes have increased from pre-pandemic levels, with younger people and women reporting higher rates of suicidal thoughts (Dube et al., 2021). Thus far there has been no evidence of an increase in suicide rates in the UK or globally (Pirkis et al., 2021).

Additionally, evidence from the UCL COVID-19 Social Study, based in the UK, investigated trajectories of depression and anxiety symptoms between March and July 2020, and found that young people and women experienced high anxiety at the start of lockdown, which decreased over time, but that young people with lower incomes and pre-existing mental health conditions experienced higher and increasing levels of depressive and anxiety symptoms (Saunders et al., 2021). Further, the Co-Space Study in the UK found that rates of anxiety, stress, and depression of parent/carers increased from November 2020 to January/February 2021 (during lockdown), surpassing rates in the first lockdown, and parents/carers of younger children in particular felt they could not meet the needs of both their child and their work commitments (Shum et al., 2021). Additionally, 40% of young carers reported their mental health was worse during the pandemic (Carers Trust, 2021), with young carers in Scotland experiencing increased worries during COVID-19, both for the health of their families, and their economic security (Maclean and Hay, 2021). This breadth of research suggests that the findings from the SCOVID final report are supported in the wider literature that has been conducted during the COVID-19 pandemic.