Pre-pandemic mental health and disruptions to healthcare, economic and housing outcomes during the COVID-19 pandemic: evidence from 12 UK longitudinal studies
Pre-pandemic mental health and disruptions to healthcare, economic and housing outcomes during the COVID-19 pandemic: evidence from 12 UK longitudinal studies
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DOI：
10.1192/bjp.2021.132
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发表时间：
2022-01-01
影响因子：
10.5
通讯作者：
Patalay, Praveetha
中科院分区：
文献类型：
--
作者：
Di Gessa, Giorgio;Maddock, Jane;Patalay, Praveetha
背景 COVID-19 大流行扰乱了人们的生活和生计，已经患有精神疾病的人可能尤其容易受到伤害。目标 量化医疗保健、经济活动和住房中断造成的心理健康不平等。方法 我们检查了 12 项英国纵向研究中 59 482 名参与者的数据，以及在 COVID-19 大流行之前和期间收集的数据。在每项研究中，我们估计了大流行前评估的心理困扰和大流行开始以来对医疗保健（药物获取、程序或预约）、经济活动（就业、收入或工作时间）和住房（地址或家庭组成的变化）的干扰之间的关联。各个研究的估计值被汇总。结果 在分析的数据集中，28% 至 77% 的参与者至少经历过一次中断，其中 2.3-33.2% 的参与者在两个或多个领域经历过中断。我们发现 1 s.d.大流行前较高的心理困扰与以下因素相关：(a) 任何医疗保健中断的几率增加（比值比 (OR) 1.30，95% CI 1.20-1.40），完全调整后的比值比范围为，程序中断的比值比为 1.24 (95% CI 1.09-1.41)，处方或药物中断的比值比为 1.33 (95% CI 1.20-1.49)访问； (b) 失业（比值比 1.13，95% CI 1.06-1.21）和收入（OR 1.12，95% CI 1.06 -1.19），以及工作时间/休假时间减少（比值比 1.05，95% CI 1.00-1.09）；(c) 至少在两个领域经历中断的可能性增加（或1.25，95% CI 1.18-1.32）或在一个领域（OR 1.11，95% CI 1.07-1.16），相对于无破坏。与住房中断没有关联（OR 1.00，95% CI 0.97-1.03）。结论 在大流行前经历心理困扰的人更有可能经历医疗保健和经济混乱，以及大流行期间跨多个领域的一系列混乱。如果未能解决这些干扰问题，就有可能进一步扩大心理健康不平等。
Background The COVID-19 pandemic has disrupted lives and livelihoods, and people already experiencing mental ill health may have been especially vulnerable. Aims Quantify mental health inequalities in disruptions to healthcare, economic activity and housing. Method We examined data from 59 482 participants in 12 UK longitudinal studies with data collected before and during the COVID-19 pandemic. Within each study, we estimated the association between psychological distress assessed pre-pandemic and disruptions since the start of the pandemic to healthcare (medication access, procedures or appointments), economic activity (employment, income or working hours) and housing (change of address or household composition). Estimates were pooled across studies. Results Across the analysed data-sets, 28% to 77% of participants experienced at least one disruption, with 2.3-33.2% experiencing disruptions in two or more domains. We found 1 s.d. higher pre-pandemic psychological distress was associated with (a) increased odds of any healthcare disruptions (odds ratio (OR) 1.30, 95% CI 1.20-1.40), with fully adjusted odds ratios ranging from 1.24 (95% CI 1.09-1.41) for disruption to procedures to 1.33 (95% CI 1.20-1.49) for disruptions to prescriptions or medication access; (b) loss of employment (odds ratio 1.13, 95% CI 1.06-1.21) and income (OR 1.12, 95% CI 1.06 -1.19), and reductions in working hours/furlough (odds ratio 1.05, 95% CI 1.00-1.09) and (c) increased likelihood of experiencing a disruption in at least two domains (OR 1.25, 95% CI 1.18-1.32) or in one domain (OR 1.11, 95% CI 1.07-1.16), relative to no disruption. There were no associations with housing disruptions (OR 1.00, 95% CI 0.97-1.03). Conclusions People experiencing psychological distress pre-pandemic were more likely to experience healthcare and economic disruptions, and clusters of disruptions across multiple domains during the pandemic. Failing to address these disruptions risks further widening mental health inequalities.