期刊
BRITISH JOURNAL OF PSYCHIATRY
卷 220, 期 1, 页码 21-30出版社
CAMBRIDGE UNIV PRESS
DOI: 10.1192/bjp.2021.132
关键词
COVID-19; healthcare; economic; psychological distress; adverse outcomes; inequalities
类别
资金
- National Core Studies, an initiative - UK Research and Innovation
- National Institute for Health Research
- Health and Safety Executive
- Medical Research Council [MC_PC_20030]
- MRC [MC_PC_20030, MC_PC_19009] Funding Source: UKRI
The COVID-19 pandemic has led to mental health inequalities, with individuals experiencing higher levels of psychological distress more likely to experience disruptions in healthcare and economic activities.
Background The COVID-19 pandemic has disrupted lives and livelihoods, and people already experiencing mental ill health may have been especially vulnerable. Aims Quantify mental health inequalities in disruptions to healthcare, economic activity and housing. Method We examined data from 59 482 participants in 12 UK longitudinal studies with data collected before and during the COVID-19 pandemic. Within each study, we estimated the association between psychological distress assessed pre-pandemic and disruptions since the start of the pandemic to healthcare (medication access, procedures or appointments), economic activity (employment, income or working hours) and housing (change of address or household composition). Estimates were pooled across studies. Results Across the analysed data-sets, 28% to 77% of participants experienced at least one disruption, with 2.3-33.2% experiencing disruptions in two or more domains. We found 1 s.d. higher pre-pandemic psychological distress was associated with (a) increased odds of any healthcare disruptions (odds ratio (OR) 1.30, 95% CI 1.20-1.40), with fully adjusted odds ratios ranging from 1.24 (95% CI 1.09-1.41) for disruption to procedures to 1.33 (95% CI 1.20-1.49) for disruptions to prescriptions or medication access; (b) loss of employment (odds ratio 1.13, 95% CI 1.06-1.21) and income (OR 1.12, 95% CI 1.06 -1.19), and reductions in working hours/furlough (odds ratio 1.05, 95% CI 1.00-1.09) and (c) increased likelihood of experiencing a disruption in at least two domains (OR 1.25, 95% CI 1.18-1.32) or in one domain (OR 1.11, 95% CI 1.07-1.16), relative to no disruption. There were no associations with housing disruptions (OR 1.00, 95% CI 0.97-1.03). Conclusions People experiencing psychological distress pre-pandemic were more likely to experience healthcare and economic disruptions, and clusters of disruptions across multiple domains during the pandemic. Failing to address these disruptions risks further widening mental health inequalities.
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