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Mental health and health behaviours before and during the initial phase of the COVID-19 lockdown: longitudinal analyses of the UK Household Longitudinal Study
  1. Claire L Niedzwiedz1,
  2. Michael James Green2,
  3. Michaela Benzeval3,
  4. Desmond Campbell2,
  5. Peter Craig2,
  6. Evangelia Demou2,
  7. Alastair Leyland2,
  8. Anna Pearce2,
  9. Rachel Thomson2,
  10. Elise Whitley2,
  11. Srinivasa Vittal Katikireddi2,4
  1. 1 Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  2. 2 MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
  3. 3 Institute of Social and Economic Research, University of Essex, Colchester, UK
  4. 4 Public Health Scotland, UK
  1. Correspondence to Srinivasa Vittal Katikireddi, MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow G3 7HR, UK; vittal.katikireddi{at}


Background There are concerns that COVID-19 mitigation measures, including the ‘lockdown’, may have unintended health consequences. We examined trends in mental health and health behaviours in the UK before and during the initial phase of the COVID-19 lockdown and differences across population subgroups.

Methods Repeated cross-sectional and longitudinal analysis of the UK Household Longitudinal Study, including representative samples of over 27,000 adults (aged 18+) interviewed in four survey waves between 2015 and 2020. A total of 9748 adults had complete data for longitudinal analyses. Outcomes included psychological distress (General Health Questionnaire-12), loneliness, current cigarette smoking, use of e-cigarettes and alcohol consumption. Cross-sectional prevalence estimates were calculated and multilevel Poisson regression assessed associations between time period and the outcomes of interest, as well as differential associations by age, gender, education level and ethnicity.

Results Psychological distress increased 1 month into lockdown with the prevalence rising from 19.4% (95% CI 18.7% to 20.1%) in 2017–2019 to 30.6% (95% CI 29.1% to 32.3%) in April 2020 (RR=1.3, 95% CI 1.2 to 1.4). Groups most adversely affected included women, young adults, people from an Asian background and those who were degree educated. Loneliness remained stable overall (RR=0.9, 95% CI 0.6 to 1.5). Smoking declined (RR=0.9, 95% CI=0.8,1.0) and the proportion of people drinking four or more times per week increased (RR=1.4, 95% CI 1.3 to 1.5), as did binge drinking (RR=1.5, 95% CI 1.3 to 1.7).

Conclusions Psychological distress increased 1 month into lockdown, particularly among women and young adults. Smoking declined, but adverse alcohol use generally increased. Effective measures are required to mitigate negative impacts on health.


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  • CN and MG contributed equally

  • Twitter Srinivasa Katikireddi @vkatikireddi.

  • Acknowledgements We would like to thank the participants of the Understanding Society study. The Understanding Society COVID-19 study is funded by the Economic and Social Research Council (ES/K005146/1) and the Health Foundation (2076161). Fieldwork for the survey is carried out by Ipsos MORI and Kantar. Understanding Society is an initiative funded by the Economic and Social Research Council and various government departments, with scientific leadership by the Institute for Social and Economic Research, University of Essex.

  • Contributors SVK and CLN conceived the idea for the study. CLN, MJG and SVK conducted the analysis, drafted the manuscript and had full access to the study datasets and act as guarantors. CLN, MJG, MB, DDC, PC, ED, AHL, AP, RMT, EW and SVK contributed to the study design, interpretation of the findings and critically revised the manuscript. All authors approved the final version of the paper.

  • Funding MJG, DC, PC, ED, AL, AP, EW and SVK acknowledge funding from the Medical Research Council (MC_UU_12017/13) and Scottish Government Chief Scientist Office (SPHSU13). In addition, CLN acknowledges funding from a Medical Research Council Fellowship (MR/R024774/1); AP acknowledges funding from the Wellcome Trust (205412/Z/16/Z); RT acknowledges funding from a Wellcome Trust Research Fellowship for Health Professionals (218105/Z/19/Z); and SVK acknowledges funding from an NRS Senior Clinical Fellowship (SCAF/15/02). MB acknowledges funding from the Economic and Social Research Council (ES/N00812X/1). The funders had no role in the study design, data collection, data analysis, data interpretation, or writing of the report.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Understanding Society deidentified survey participant data are available through the UK Data Service (URLs:; Researchers who would like to use Understanding Society need to register with the UK Data Service (URL: before being allowed to download datasets.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.