US, UK adults report pandemic-related distress, disruptions

Distressed person on steps of dilapidated building
Distressed person on steps of dilapidated building

Doug Turetsky / Flickr cc

A pair of new studies highlights the effects of the COVID-19 pandemic on adults, one showing the fallout of unstable housing on Americans' mental and physical health and the other describing how UK residents who were depressed or anxious before the pandemic experienced more disruptions to their jobs and access to healthcare after it began.

Psychological distress, poor physical health

Yesterday in JAMA Network Open, Johns Hopkins University and University of California Los Angeles researchers analyzed self-reported health and psychological status among nationally representative survey respondents worried about eviction or foreclosure in November 2020.

Among 1,218 study respondents, 128 (12%) reported that they were behind on rent or mortgage payments or didn't know if they could afford the next payment. Just over half (51%) of all participants were women, 46% were 30 to 54 years old, 45% were 55 and older, 69% were White, and 13% each were Black or Hispanic.

Of the 128 housing-insecure respondents, 42 (34%) said they were behind on rent or mortgage payments, 55 (38%) said they had little to no confidence that they could afford the next payment, and 31 (28%) reported both.

Of all participants, 46% reported moderate to severe psychological distress, and 18% said they were in fair to poor health. Respondents with unstable housing reported more distress (57% vs 45% in housing-secure participants) and poorer health (30% vs 16%).

Renters were more likely than owners to lack secure housing (64% vs 27%). Other risk factors for unstable housing included Black race (37% vs 8% among other races), age of 30 to 54 years (64% vs 38% of other age groups), 2019 income of less than $35,000 (52% vs 27% who earned more), sharing housing with children (47% vs 29% of those with no children), and residence in a metropolitan county (92% vs 84% in non-urban counties).

The study authors noted that they survey was conducted after the Centers for Disease Control and Prevention issued a nationwide eviction moratorium, which may have mitigated the associations in the study.

"Interventions that reduce housing insecurity during the COVID-19 pandemic will promote the health of the US population, and those interventions that consider equity in their implementation may mitigate entrenched health disparities resulting from structural racism and exacerbated by the pandemic," they concluded.

Broader health and economic effects

Another study, published yesterday in the British Journal of Psychiatry, involved data from 59,482 participants in 12 longitudinal UK studies collected roughly 3 years before and during the first 8 to 10 months of the COVID-19 pandemic.

University College London researchers led the study, which estimated the link between psychological distress before the pandemic and that amid pandemic-related disrupted healthcare access (to medications, procedures, or appointments), economic activity (employment, income, or working hours), and housing (change of address or household composition).

Across the datasets, 28% to 77% of participants reported experiencing one or more disruptions, and 2.3% to 33.2% experienced disruptions in at least two areas. Relative to participants who had average levels of depression or anxiety before the pandemic, those who had high levels of psychological distress were 24% more likely to experience delayed medical procedures amid the pandemic, 12% more likely to lose their job, and 33% more likely to have had disrupted access to prescriptions or medications.

Higher (one standard deviation) psychological distress before the pandemic was tied to increased likelihood of healthcare disruptions (odds ratio [OR], 1.30), with fully adjusted ORs of 1.24 for disrupted procedures to 1.33 for interrupted access to prescriptions or medications.

The association between prepandemic distress was tied to job loss (OR, 1.13), loss of income (OR, 1.12), and furloughs or reduced working hours (OR, 1.05). It was also linked with increased odds of experiencing a disruption in two or more areas (OR, 1.25) or in one area (OR, 1.11), compared with no disruption. There was no link to housing disruptions (OR, 1.00).

Women, younger adults, racial minorities, and those with fewer job qualifications were more likely than others to report psychological distress before the pandemic.

"Our findings highlight that the wider health and economic impacts of the pandemic have been disproportionately experienced by those with mental health difficulties, potentially leading to worsening longer term outcomes, even post-pandemic, for those already experiencing poor mental health," senior author Praveetha Patalay, PhD, said in a University College London press release.

Lead author Giorgio Di Gessa, PhD, called for policymakers to consider the study findings in terms of providing healthcare and economic support in the future. "Failing to address these disruptions risks widening health inequalities further," he said in the release. "Special care should be taken by pharmacists and primary care staff to ensure people with mental health difficulties do not miss appointments, procedures and prescriptions."

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