Did the Socio-Economic Gradient in Depression in Later-Life Deteriorate or Weaken during the COVID-19 Pandemic? New Evidence from England Using Path Analysis.

It is well established that there is a socioeconomic gradient in adult mental health. However, little is known about whether and how this gradient has been exacerbated or mitigated by the COVID-19 pandemic. This study aims to identify the modifiable pathways involved in the association between socioeconomic position (SEP) and mental health during the COVID-19 pandemic. The analysis included 5107 adults aged 50+ living in England and participating in the English Longitudinal Study of Ageing Wave nine (2018-2019) and the COVID-19 study (June 2020). Mental health was measured using a shortened version of the Centre for Epidemiologic Studies Depression scale. Path analysis with multiple mediator models was used to estimate the direct effect of SEP (measured by educational qualification and household wealth) on mental health (measured by depression), along with the indirect effects of SEP via three mediators: COVID-19 infection symptoms, service accessibility and social contact. The results show that the prevalence of depression for the same cohort increased from 12.6% pre-pandemic to 19.7% during the first wave of the pandemic. The risk of depression increased amongst older people who experienced COVID-19 infection, difficulties accessing services and less frequent social contact. The total effects of education and wealth on depression were negatively significant. Through mediators, wealth and education were indirectly associated with depression. Wealth also directly affected the outcome. The findings suggest that the socioeconomic gradient in depression among older people may have deteriorated during the initial phase of the pandemic and that this could in part be explained by increased financial hardship, difficulties in accessing services and reduced social contact.