Dr Apostolos Davillas and Professor Andrew Jones explore new evidence from the first three months of the UK response to the pandemic, highlighting the inequality in psychological distress in the UK.
The nature of the economic and policy response to COVID-19 has created specific gradients in both exposure to the disease itself and in exposure to the economic impact of the lockdown. Lockdown, social distancing, self-isolation, the economic impact of shutting down parts of the economy and the focusing of resources within the health and social care systems on coping with the pandemic may all have had an indirect impact on psychological distress and the mental health of the population. Given the characteristics of the policy and institutional responses, the burden of this psychological distress may have been unequally distributed within the population.
To explore the impact of the UK response to the pandemic in terms of health equity, we first examine inequality in psychological distress, i.e. to what extent the mental well-being levels vary within the population (total inequality). We then decompose the observed total inequality in psychological distress to estimate its share that is attributable to adverse circumstances, pre-existing to the COVID-19 outbreak (inequality of opportunity (IOp)). A preliminary version of these results is available as a working paper via SSRN: “The COVID pandemic and its impact on inequality of opportunity in psychological distress in the UK”. Focusing on circumstances that individuals experience before the onset of the pandemic in the UK is important for the scope of our analysis, that explores whether the opportunities that individuals’ have before the pandemic are associated with inequality in their mental wellbeing during the pandemic.
To do this, we use Understanding Society, which has launched a COVID-19 survey to examine the impact of the coronavirus pandemic. From April 2020, selected participants from the Understanding Society survey have been approached to complete monthly surveys that focus on the impact of the COVID-19 pandemic. The COVID-19 Understanding Society survey is ideal for the needs of our analysis as it allows us to access annual longitudinal data, before the onset of the pandemic, and then monthly data during the UK response to the pandemic.
We compare measures of ex ante IOp in psychological distress, as measured by the General Health Questionnaire (GHQ), before (Wave 9) and at the initial peak (April 2020) and subsequent months (May and June 2020) of the COVID-19 pandemic. Availability of repeated monthly releases of the COVID-19 Understanding Society make it possible to follow a similar set of individuals and explore the evolution of IOp in mental wellbeing at different stages of the UK response to the pandemic.
Moreover, the breadth of the available data allows us to provide additional insights into the possible impact of the pandemic, broadening the list of circumstances beyond those that have typically been used in this literature to capture factors that are specific to the policy debate concerning the adverse consequences of COVID-19 for social inequality. These include:
- working in industries that are more affected by the pandemic;
- individuals’ employment status;
- the presence of children in households and living in multigenerational households or as lone parents;
- housing tenure and conditions.
Our analysis shows that the prevalence of psychological distress increased from 17.4% to 28.1% between Wave 9 and the peak of the first wave of the pandemic (April 2020) with some reversion to earlier levels since then (May and June 2020). There has been a systematic increase in total inequality in the Likert GHQ-12 score (our measure of mental well-being). However, measures of IOp have not increased, suggesting that there is no increase in the relative IOp in mental wellbeing during the COVID-19 pandemic. Specifically, Figure 1 shows that there has been a substantial increase in total inequality in the Likert GHQ-12 score between Wave 9 and April 2020, which persists up to June 2020. However, we find that the levels of explained variation, reflecting absolute IOp, do not vary substantially before and after the onset of the pandemic in the UK (see the red bars). Given the increase in the total inequality in mental health (blue bars), this means that the share of inequality explained by the full set of circumstances has decreased during the first three months of the UK response to the pandemic.
Figure 1: Total and explained variance of GHQ-12 Likert score at UKHLS Wave 9 and at April-June COVID-19 Waves.
Decomposition analysis shows that, in the pre-COVID-19 period, the largest contributors to IOp in mental wellbeing were financial strain, employment status and housing conditions (Figure 2). In contrast, during the peak (of the first wave) of the pandemic (April 2020) these three factors decline in their shares, most notably for financial strain. Demographic factors (age and gender) account for the largest share in April 2020. As the pandemic has progressed, in May and June, the contribution of demographics has dropped from the peak levels of April and the contribution of other factors, such as housing conditions, household composition and neighbourhood characteristics have begun to explain a larger share (Figure 2).
Figure 2: Decomposition analysis of GHQ-12 Likert score at UKHLS Wave 9 and the COVID-19 April, May and June 2020.
Notes: Factor’s contributions are ordered according to their contributions in June 2020 COVID Wave.
In line with the evidence on physical health, our results show a substantial worsening of the overall levels of GHQ during the peak (of the first wave) of the pandemic. In addition, there is a statistically significant increase in total inequality in the Likert GHQ-12 score. Nevertheless, IOp does not seem to have increased. Our results suggest that, with respect to psychological distress, the greater total inequality that is evident, is broadly diffused across the population. This is consistent with the notion that the pandemic is, to some extent, a leveller as far as pre-existing circumstances are considered. Greater unexplained variation may prove challenging for policy makers and it will be interesting to see whether this finding persists in future waves of the UKHLS COVID-19 survey.
Apostolos Davillas is a Lecturer in Health Economics, Norwich Medical School at the University of East Anglia (UEA). He is also a Research Affiliate at HEDG, University of York, a Research Associate at ISER, University of Essex and a GLO Fellow. His research covers a range of topics such as the determinants of health, health care demand, utilisation of health services and health care costs, the economics of obesity, disability, and socio-economic inequalities in health and health care.
Andrew Jones is Professor of Economics at the University of York, UK, where he was Head of the Department of Economics and Related Studies from 2011 to 2015. He does research in microeconometrics and health economics with particular interests in the determinants of health, the economics of addiction and socioeconomic inequalities in health and health care.