Impact of 15 years of social, political and economic shocks on population mental health in the UK: a longitudinal, Bayesian quasi-experimental analysis.

Abstract

Background: Mental health in the UK has worsened over the last 15 years, a period marked by major systemic shocks.

Objective: We investigated annual changes in population-level psychological distress and the impact of five systemic shocks: the referendum on European Union membership (Brexit), two COVID-19 lockdowns, Russia's invasion of Ukraine and the UK Government's 2022 'mini-budget'.

Methods: We used longitudinal survey data from the UK Household Longitudinal Study, including 87 857 between years 2009 and 2024. We used Bayesian time series models to evaluate annual changes in psychological distress and the association with each shock, including subgroup analyses by age group, sex, ethnicity, deprivation quintile and employment status.

Outcomes: We found evidence of increasing psychological distress from 2009 to 2023 (+1.085 point increase in 12-item General Health Questionnaire scores; credible interval (CrI) 0.987 to 1.184). In interrupted time series models, we observed increased psychological distress immediately after the Brexit referendum (+0.117, CrI 0.029 to 0.205) and the first COVID-19 lockdown (+0.649; CrI 0.531 to 0.767), with more insidious monthly increases in psychological distress after the Russian invasion of Ukraine (+0.010, CrI 0.004 to 0.023) and the 2022 mini-budget (+0.015, CrI 0.005 to 0.034). We found considerable sociodemographic variation by age, sex, ethnicity, deprivation and employment status.

Conclusions: We found that some systemic shocks had detrimental effects on population mental health in the UK, being most pronounced for the Brexit referendum and first COVID-19 lockdown.

Clinical implications: Our results demonstrate that population mental health can change in response to systemic shocks. This should inform the design of responsive clinical and public mental health provision.