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More than a million people in England are waiting for mental health support due to soaring demand exacerbated by the pandemic. On top of this, an estimated eight million people with mental health concerns are not seeking NHS help.
Meanwhile, rising costs have driven the most vulnerable to even greater despair. A YouGov survey showed that in 2022, 62% of those with mental health difficulties reported feeling more anxious about being able to pay their bills than the previous year.
In our research, published across one new and one recent study, we found that the COVID pandemic disproportionately affected the mental health and financial circumstances of adults with long-term psychological difficulties.
Our findings highlight the importance of targeting services to this group.
We used data, collected over more than 30 years, from participants in the 1958 National Child Development Study and the 1970 British Birth Cohort Study.
In each group, we identified five different mental health trajectories experienced by respondents from adolescence to midlife. For example, the largest number of participants followed a trajectory with few or no symptoms. People on another trajectory faced persistent severe symptoms, while a different trajectory saw the onset of mental health problems in respondents’ early 30s, which generally improved thereafter.
We compared how people with different histories of mental health in adulthood fared emotionally and financially during the pandemic between March 2020 and March 2021, when they were aged 50 (participants in the 1970 British Birth Cohort Study) and 62 (1958 National Child Development Study).
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Our findings
We found different mental health trajectories had distinct risks of poor mental health outcomes during the pandemic. But overall, participants who had faced poor mental health at any time in adulthood (before the COVID pandemic) were more likely to report psychological distress, feelings of loneliness and reduction in life satisfaction during the pandemic, compared with those who had no pre-pandemic mental ill health.
In fact, compared with people who had never had psychological problems in adulthood, a history of mental health difficulties doubled to quadrupled the likelihood of facing poor mental health during the pandemic.
While any pre-pandemic poor mental health put people at greater risk, those with chronic and more recent occurrences of psychological difficulties were more likely to face poor mental health during the pandemic.
Further, poor mental health doubled the likelihood of experiencing financial hardship during the pandemic. Up to one in five adults with a history of poor mental health reported they were “much worse off” financially a year into the pandemic, compared with one in ten who had never had psychological problems in adulthood.
Even adults who hadn’t experienced mental health problems in decades were up to one-and-a-half times as likely to say they faced worsening financial circumstances, compared with their peers who had never had psychological difficulties.
Despite the economic policy measures taken by the government during COVID, people who had faced psychological distress in various stages of their lives before the pandemic were more likely to borrow from banks and take payment holidays from mortgages and other loans, potentially increasing their debt.
Why are finances and mental health linked?
It’s not entirely clear whether poor mental health leads to financial problems, or whether financial problems lead to poor mental health. But it’s likely to be both.
We know people with poor mental health are more likely to experience financial problems, including poverty, unemployment, underemployment, and dependency on public benefits. This in turn can trigger and exacerbate mental health difficulties.
Likewise, social and economic disadvantages (such as food insecurity, income insecurity and reduced economic resources) can increase the risk of mental illness.
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The long-term view of mental health
Our research highlights the importance of examining mental health across life and helps us to better understand the impact of adverse events and economic shocks on mental health and finances. Our studies show that mental health is a lifelong journey with peaks and dips that can have lasting effects.
The detailed data, captured over many decades, we had access to allowed us to account for a wide range of social, economic and health issues in early life and adulthood when examining the impact of the pandemic on people’s mental health and finances.
That said, as with all observational studies, there are limitations. We cannot assume the outcomes we’ve observed are a direct result of the pandemic in all cases. Also, interviews during the pandemic were conducted online, and all mental health measures are self-reported.
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Long COVID: what we know about how the condition affects mental health
Recent research has suggested that the impact of the COVID pandemic on population mental health has been minimal. But this is not the case for everyone. People’s experiences of mental health are diverse, and as our study shows, the likelihood of psychological difficulties during the pandemic was greater for people who had poor mental even decades ago, compared with their peers who had never had psychological difficulties.
People with poorer mental health are more likely to be vulnerable to the end of COVID financial support, increases in the cost of living, and economic recession. Given the cycle of poor mental health and personal debt, longer-term solutions to improve mental health support and access to financial guidance and assistance are vital to prevent further entrenching of inequalities.
Vanessa Moulton receives funding from the Economic and Social Research Council (grant number ES/V012789/1) and the Health Foundation (grant number 789112). The funders had no roles in study design, data collection and analysis, decision to publish, or preparation of this work.
George Ploubidis receives funding from the Economic and Social Research Council (grant number ES/V012789/1) and the Health Foundation (grant number 789112). The funders had no roles in study design, data collection and analysis, decision to publish, or preparation of this work.
