Understanding inequalities in mental health by family structure during COVID-19 lockdowns: evidence from the UK Household Longitudinal Study.

IF 3.6 3区 医学 Q1 PSYCHIATRY
Michael J Green, Peter Craig, Evangelia Demou, S Vittal Katikireddi, Alastair H Leyland, Anna Pearce
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Abstract

Purpose: The COVID-19 pandemic increased psychiatric distress and impacts differed by family structure. We aimed to identify mechanisms contributing to these inequalities.

Methods: Survey data were from the UK Household Longitudinal Study. Psychiatric distress (GHQ-12) was measured in April 2020 (first UK lockdown; n = 10,516), and January 2021 (lockdown re-introduced following eased restrictions; n = 6,893). Pre-lockdown family structure comprised partner status and presence of children (< 16 years). Mediating mechanisms included: active employment, financial strain, childcare/home-schooling, caring, and loneliness. Monte Carlo g-computation simulations were used to adjust for confounding and estimate total effects and decompositions into: controlled direct effects (effects if the mediator was absent), and portions eliminated (PE; representing differential exposure and vulnerability to the mediator).

Results: In January 2021, after adjustment, we estimated increased risk of distress among couples with children compared to couples with no children (RR: 1.48; 95% CI 1.15-1.82), largely because of childcare/home-schooling (PE RR: 1.32; 95% CI 1.00-1.64). Single respondents without children also had increased risk of distress compared to couples with no children (RR: 1.55; 95% CI 1.27-1.83), and the largest PE was for loneliness (RR: 1.16; 95% CI 1.05-1.27), though financial strain contributed (RR: 1.05; 95% CI 0.99-1.12). Single parents demonstrated the highest levels of distress, but confounder adjustment suggested uncertain effects with wide confidence intervals. Findings were similar in April 2020 and when stratified by sex.

Conclusion: Access to childcare/schooling, financial security and social connection are important mechanisms that need addressing to avoid widening mental health inequalities during public health crises.

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了解 COVID-19 封锁期间因家庭结构造成的心理健康不平等:来自英国家庭纵向研究的证据。
目的:COVID-19 大流行增加了精神压力,不同家庭结构造成的影响也不同。我们旨在找出造成这些不平等的机制:调查数据来自英国家庭纵向研究。精神压力(GHQ-12)是在 2020 年 4 月(英国首次实施封锁;n = 10,516 人)和 2021 年 1 月(在放宽限制后重新实施封锁;n = 6,893 人)进行测量的。禁闭前的家庭结构包括伴侣状况和是否有子女(结果:在 2021 年 1 月,经过调整后,我们估计有子女的夫妇与无子女的夫妇相比,受困扰的风险更高(RR:1.48;95% CI 1.15-1.82),这主要是由于儿童保育/家庭教育(PE RR:1.32;95% CI 1.00-1.64)。与没有子女的夫妇相比,没有子女的单身受访者也有更高的困扰风险(RR:1.55;95% CI 1.27-1.83),最大的困扰风险是孤独感(RR:1.16;95% CI 1.05-1.27),尽管经济压力也有影响(RR:1.05;95% CI 0.99-1.12)。单亲家庭的痛苦程度最高,但混杂因素调整表明效果不确定,置信区间较大。2020年4月的调查结果与按性别分层时的结果相似:获得儿童保育/学校教育、经济保障和社会联系是需要解决的重要机制,以避免在公共卫生危机期间扩大心理健康不平等。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.60
自引率
2.70%
发文量
43
审稿时长
>12 weeks
期刊介绍: Annals of General Psychiatry considers manuscripts on all aspects of psychiatry, including neuroscience and psychological medicine. Both basic and clinical neuroscience contributions are encouraged. Annals of General Psychiatry emphasizes a biopsychosocial approach to illness and health and strongly supports and follows the principles of evidence-based medicine. As an open access journal, Annals of General Psychiatry facilitates the worldwide distribution of high quality psychiatry and mental health research. The journal considers submissions on a wide range of topics including, but not limited to, psychopharmacology, forensic psychiatry, psychotic disorders, psychiatric genetics, and mood and anxiety disorders.
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