Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
Public Health Specialty Training Programme, NHS England - West Midlands, Birmingham, United Kingdom.
Front Public Health. 2023 Sep 27;11:1235903. doi: 10.3389/fpubh.2023.1235903. eCollection 2023.
During the COVID-19 pandemic in the UK, those considered most vulnerable to adverse outcomes from infection were designated "clinically extremely vulnerable" and advised to "shield." This involved prolonged confinement at home with strict limits on face-to-face contact, beyond national restrictions. Shielding ended in September 2021 and was considered likely to have harmed mental health and wellbeing. As the UK moved toward a new phase of "living with COVID-19" the mental health and wellbeing experiences of those advised to shield may have diverged from the general population.
This study is a secondary analysis of nine "COVID-19 Survey" waves of Understanding Society, a longitudinal study of UK participants covering April 2020 to September 2021 alongside pre-pandemic baseline data. The prevalence of clinically significant psychological distress (General Health Questionnaire 12) and low life satisfaction were examined at each wave for participants with longitudinal responses across all waves, stratified by receipt of shielding guidance (Received = 410, Not received = 6,878). Mixed effects regression modeling examined associations between shielding guidance receipt and mental health and life satisfaction when adjusting for potential confounders including age and sex, pre-pandemic mental health/life satisfaction, and loneliness.
Those who received shielding guidance were more likely to experience poor mental health and low life satisfaction during the pandemic. However, this largely reflected differences in pre-pandemic baselines. Variation between waves broadly coincided with the changing burden of COVID-19 and associated restrictions, with similar patterns regardless of shielding guidance receipt. Regression modeling combining data across all waves indicated that receipt of shielding guidance did not independently predict adverse outcomes. However, poor pre-pandemic mental health and low life satisfaction, and frequent loneliness, as well as demographic factors including sex and age, consistently predicted adverse pandemic mental health and wellbeing.
While those who received shielding guidance did on average experience poorer mental health and life satisfaction during the pandemic, this study suggests this largely reflects existing inequalities. Drawing on data throughout the shielding program, it addresses an existing evidence gap. These findings reinforce the importance of addressing existing mental health inequalities in the recovery from the current pandemic and for future preparedness.
在英国 COVID-19 大流行期间，那些被认为最容易因感染而出现不良后果的人被指定为“临床极度脆弱”，并被建议“隔离”。这涉及到长时间在家中禁闭，除了国家限制外，还严格限制面对面接触。2021 年 9 月结束隔离，据认为这可能对心理健康和福祉造成了损害。随着英国进入“与 COVID-19 共存”的新阶段，被建议隔离的人的心理健康和福祉体验可能与一般人群不同。
本研究是对 Understanding Society 九次“COVID-19 调查”波的二次分析，这是一项对英国参与者的纵向研究，涵盖了 2020 年 4 月至 2021 年 9 月，同时还有疫情前的基线数据。对所有波次具有纵向反应的参与者，根据是否收到隔离指导（收到的为 410 人，未收到的为 6878 人），在每个波次检查临床显著心理困扰（一般健康问卷 12）和低生活满意度的流行率。混合效应回归模型调整了潜在混杂因素（包括年龄和性别、疫情前的心理健康/生活满意度和孤独感）后，检查了隔离指导的接收与心理健康和生活满意度之间的关联。
那些收到隔离指导的人在疫情期间更有可能经历不良的心理健康和低生活满意度。然而，这主要反映了疫情前基线的差异。波动大致与 COVID-19 的不断加重负担和相关限制相符，无论是否收到隔离指导，都有类似的模式。结合所有波次的数据进行回归建模表明，隔离指导的接收并不能独立预测不良结果。然而，较差的疫情前心理健康和生活满意度以及频繁的孤独感，以及包括性别和年龄在内的人口统计学因素，始终预测了疫情期间心理健康和福祉的不良结果。
虽然那些收到隔离指导的人在疫情期间平均经历了较差的心理健康和生活满意度，但本研究表明，这在很大程度上反映了现有的不平等现象。本研究利用整个隔离计划期间的数据，填补了现有证据的空白。这些发现强调了在从当前大流行中恢复和为未来做准备时，解决现有心理健康不平等问题的重要性。
