Socioeconomic position and mental health during the COVID-19 pandemic: a cross-sectional analysis of the CovidLife study

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has been linked to an increase in mental health problems. This study examined their association with socioeconomic position (SEP), as well as potential confounding and mediating factors. Methods: We analysed data from the CovidLife study (N=14,387; 66.4% female; mean [SD] age, 57.4 [13.9] years). Data were collected in an online survey of UK adults (aged 18 years or over) between 17 April and 7 June 2020. SEP measures included area deprivation (the Scottish Index of Multiple Deprivation [SIMD]), education level, household income, and employment status. Mental health was measured using the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7) scale. Worry indices were derived using principal component analysis. Logistic regression was used to estimate the associations between SEP and mental health. Results: Low SEP was associated with increased odds of depression and anxiety (odds ratio [OR] range 1.18-2.69). These associations remained significant after adjusting for age, sex, relationship status, and psychiatric history. Multivariable adjustment for medical worry and isolation during the pandemic had the largest attenuating effects (ranges 18-60% and 4-46%, respectively) on mental health outcomes. When adding further adjustment for the remaining SEP markers and all potential confounding and mediating factors, depression was associated with high area deprivation and low education level and income, whilst anxiety was only associated with low education level. No dose-response relationship was observed. Conclusions: SEP was inversely associated with mental health, which was mostly explained by medical worry and isolation during the COVID-19 pandemic. Mental health interventions might target these factors to prevent widening inequalities in mental health. Future studies should use longitudinal data to investigate the association.