Summary: Anxiety and depression that occurred as a result of the COVID-19 pandemic appear to trigger a second “midlife crisis” in those aged 50 and older. Researchers say women struggled more than men with psychological distress during the pandemic, and this may exacerbate and accelerate neurodegeneration, mental health, and overall health disorders.
Source: King’s College London
British adults experienced highest-ever levels of poor mental health during the COVID-19 pandemic, triggering a second ‘midlife crisis’.
Findings also showed that women struggled more than men during the pandemic, which researchers say could be because women took on a larger share of unpaid care work such as housework, homeschooling and caring responsibilities.
New research from the Centre for Society and Mental Health and the UCL Centre for Longitudinal Studies is published today in PLOS Medicine.
Researchers analysed data collected over four decades from more than 16,000 adults, born in 1946, 1958 and 1970, who are taking part in three British birth cohort studies. The participants’ levels of psychological distress were assessed repeatedly over the course of their adult lives, through a series of questions that captured symptoms of depression and anxiety.
The participants were also surveyed at three points during the first year of the pandemic: in May 2020, September/October 2020 and February/March 2021.
By autumn 2020, those born in 1958 and 1970 had higher levels of psychological distress, on average, than they had ever experienced in adulthood. Those born in 1946 had similar levels of psychological distress to their previous midlife peak in their early 50s.
Psychological distress is known to peak in midlife, before improving again as people get older. This is often referred to as the ‘midlife crisis’ in mental health.
Women struggled more than men with their mental health across all age groups, widening the already substantial gender inequalities in mental health that existed before the pandemic.
The researchers explained that this unforeseen second midlife mental health crisis may accelerate and exacerbate the onset of chronic mental health and other related health difficulties, disproportionately affecting women and increasing pressures on the NHS.
“We know that anxiety and depression are among the top leading causes of disease worldwide. On top of the suffering they cause, mental health problems are closely linked to numerous physical health problems – right up to and including increased morbidity.
“The fact that we are observing an unexpected new peak of the very mental health problems that can lead to these long-term trajectories is deeply concerning,” said Lead author Dr Darío Moreno-Agostino from the ESRC Centre for Society and Mental Health
About this psychology research news
Original Research: Open access.
“Long-term psychological distress trajectories and the COVID-19 pandemic in three British birth cohorts: A multi-cohort study” by Darío Moreno-Agostino et al. PLOS Medicine
Long-term psychological distress trajectories and the COVID-19 pandemic in three British birth cohorts: A multi-cohort study
Growing evidence suggests that population mental health outcomes have worsened since the pandemic started. The extent that these changes have altered common age-related trends in psychological distress, where distress typically rises until midlife and then falls after midlife in both sexes, is unknown. We aimed to analyse whether long-term pre-pandemic psychological distress trajectories were disrupted during the pandemic, and whether these changes have been different across cohorts and by sex.
Methods and findings
We used data from three nationally representative birth cohorts comprising all people born in Great Britain in a single week of 1946 (National Survey of Health and Development, NSHD), 1958 (National Child Development Study, NCDS), or 1970 (British Cohort Study, BCS70). The follow-up data used spanned 39 years in NSHD (1982 to 2021), 40 years in NCDS (1981 to 2001), and 25 years in BCS70 (1996 to 2021). We used psychological distress factor scores, as measured by validated self-reported questionnaires (NSHD: Present State Examination, Psychiatric Symptoms Frequency, and 28- and 12-item versions of General Health Questionnaire; NCDS and BCS70: Malaise Inventory; all: 2-item versions of Generalized Anxiety Disorder scale and Patient Health Questionnaire).
We used a multilevel growth curve modelling approach to model the trajectories of distress across cohorts and sexes and obtained estimates of the differences between the distress levels observed during the pandemic and those observed at the most recent pre-pandemic assessment and at the peak in the cohort-specific pre-pandemic distress trajectory, located at midlife. We further analysed whether pre-existing cohort and sex inequalities had changed with the pandemic onset using a difference-in-differences (DiD) approach.
The analytic sample included 16,389 participants. By September/October 2020, distress levels had reached or exceeded the levels of the peak in the pre-pandemic life-course trajectories, with larger increases in younger cohorts (standardised mean differences [SMD] and 95% confidence intervals of SMDNSHD,pre-peak = −0.02 [−0.07, 0.04], SMDNCDS,pre-peak = 0.05 [0.02, 0.07], and SMDBCS70,pre-peak = 0.09 [0.07, 0.12] for the 1946, 1958, and 1970 birth cohorts, respectively). Increases in distress were larger among women than men, widening pre-existing sex inequalities (DiD and 95% confidence intervals of DiDNSHD,sex,pre-peak = 0.17 [0.06, 0.28], DiDNCDS,sex,pre-peak = 0.11 [0.07, 0.16], and DiDBCS70,sex,pre-peak = 0.11 [0.05, 0.16] when comparing sex inequalities in the pre-pandemic peak in midlife to those observed by September/October 2020).
As expected in cohort designs, our study suffered from high proportions of attrition with respect to the original samples. Although we used non-response weights to restore sample representativeness to the target populations (those born in the United Kingdom in 1946, 1958, and 1970, alive and residing in the UK), results may not be generalisable to other sections within the UK population (e.g., migrants and ethnic minority groups) and countries different than the UK.
Pre-existing long-term psychological distress trajectories of adults born between 1946 and 1970 were disrupted during the COVID-19 pandemic, particularly among women, who reached the highest levels ever recorded in up to 40 years of follow-up data. This may impact future trends of morbidity, disability, and mortality due to common mental health problems.