Background There are concerns that social mitigation measures related to the COVID-19 pandemic may have led to declines in child mental health and widened mental health inequalities, because affluent families had greater access to resources to cope with restrictions. We investigated how existing inequalities in child mental health changed during the first year of the COVID-19 pandemic, using population-representative longitudinal data.
Methods Data were from 14,854 observations of 7,929 children in the UK Household Longitudinal Study. Child mental health measures using the Strengths and Difficulties Questionnaire (SDQ) were taken at ages 5 and 8 during annual surveys between 2011 and 2019 and from children aged 5–11 over three waves of data collection between April 2020 and March 2021. In order to estimate the impact of the pandemic on inequalities, we modelled mental health using a mixed effects generalised linear model with an indicator for surveys taken during the pandemic, and interactions between the pandemic and sex, ethnicity, family structure, parent education, employment, household income and area deprivation on mental health. Models were weighted for survey design and non-response, and adjusted for age, year (linear trend), and sex.
Results Childhood mental health declined between 2011 and 2021. In most cases advantaged groups (including children with coupled parents, highly educated parents, employed parents and higher income households) experienced a more rapid decline in mental health during COVID-19 than less advantaged groups, leading to narrowing of inequalities. Before the pandemic, for example, not having an employed parent was associated with a 1.63 point higher SDQ score (95% confidence intervals: 0.90 to 2.35), while during the pandemic this gap reduced to -0.50 points (95% CI: -1.70 to 0.69). Disadvantages related to male sex and living in deprived areas were maintained during COVID-19, while the mental health advantage of ethnic minorities increased. These patterns were apparent for both internalising and externalising mental health symptoms, and when SDQ scores were treated as a binary outcome indicating mental health difficulties.
Conclusion UK children have experienced a ‘levelling down’ of mental health during COVID-19, with mental health becoming worse overall, and children from more advantaged groups experiencing the most rapid declines. Understanding what has created this pattern will be important for developing interventions and policies to improve child mental health in all sociodemographic groups, and prevent inequalities becoming re-established during the pandemic recovery.
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