{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T18:26:06Z","timestamp":1788027966694,"version":"build-2784847793"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T00:00:00Z","timestamp":1681776000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000279","name":"Nuffield Foundation","doi-asserted-by":"publisher","award":["WEL\/FR-000022583"],"award-info":[{"award-number":["WEL\/FR-000022583"]}],"id":[{"id":"10.13039\/501100000279","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014013","name":"UK Research and Innovation","doi-asserted-by":"crossref","award":["ES\/S002588\/1"],"award-info":[{"award-number":["ES\/S002588\/1"]}],"id":[{"id":"10.13039\/100014013","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["221400\/Z\/20\/Z"],"award-info":[{"award-number":["221400\/Z\/20\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["205407\/Z\/16\/Z"],"award-info":[{"award-number":["205407\/Z\/16\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>There has been much research into the mental health impact of the Coronavirus Disease 2019 (COVID-19) pandemic and how it is related to time-invariant individual characteristics. However, there is still a lack of research showing long-term trajectories of mental health across different stages of the pandemic. And little is known regarding the longitudinal association of time-varying factors with mental health outcomes. This study aimed to provide a longitudinal profile of how mental health in adults changed across different stages of the COVID-19 pandemic and to examine their longitudinal associations with time-varying contextual (e.g., COVID-19 policy response and pandemic intensity) and individual level factors.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>This study used data from a large panel study of over 57,000 adults living in England, who were followed up regularly for 2 years between March 2020 and April 2022. Mental health outcomes were depressive and anxiety symptoms. Depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-9) and anxiety symptoms by the Generalized Anxiety Disorder assessment (GAD-7). Entropy balancing weights were applied to restore sample representativeness. After weighting, approximately 50% of participants were female, 14% from ethnic minority backgrounds, with a mean age of 48 years. Descriptive analyses showed that mental health changes were largely in line with changes in COVID-19 policy response and pandemic intensity. Further, data were analysed using fixed-effects (FE) models, which controlled for all time-invariant confounders (observed or not). FE models were fitted separately across 3 stages of the COVID-19 pandemic, including the first national lockdown (21\/03\/2020\u201323\/08\/2020), second and third national lockdowns (21\/09\/2020\u201311\/04\/2021), and \u201cfreedom\u201d period (12\/04\/2021\u201314\/11\/2021). We found that more stringent policy response (measured by stringency index) was associated with increased depressive symptoms, in particular, during lockdown periods (\u03b2 = 0.23, 95% confidence interval (CI) = [0.18 to 0.28], <jats:italic>p<\/jats:italic> &lt; 0.001; \u03b2 = 0.30, 95% CI = [0.21 to 0.39], <jats:italic>p<\/jats:italic> &lt; 0.001; \u03b2 = 0.04, 95% CI = [\u22120.03 to 0.12], <jats:italic>p<\/jats:italic> = 0.262). Higher COVID-19 deaths were also associated with increased depressive symptoms, but this association weakened over time (\u03b2 = 0.29, 95% CI = [0.25 to 0.32], <jats:italic>p<\/jats:italic> &lt; 0.001; \u03b2 = 0.09, 95% CI = [0.05 to 0.13], <jats:italic>p<\/jats:italic> &lt; 0.001; \u03b2 = \u22120.06, 95% CI = [\u22120.30 to 0.19], <jats:italic>p<\/jats:italic> = 0.655). Similar results were also found for anxiety symptoms, for example, stringency index (\u03b2 = 0.17, 95% CI = [0.12 to 0.21], <jats:italic>p<\/jats:italic> &lt; 0.001; \u03b2 = 0.13, 95% CI = [0.06 to 0.21], <jats:italic>p<\/jats:italic> = 0.001; \u03b2 = 0.10, 95% CI = [0.03 to 0.17], <jats:italic>p<\/jats:italic> = 0.005), COVID-19 deaths (\u03b2 = 0.07, 95% CI = [0.04 to 0.10], <jats:italic>p<\/jats:italic> &lt; 0.001; \u03b2 = 0.04, 95% CI = [0.00 to 0.07], <jats:italic>p<\/jats:italic> = 0.03; \u03b2 = 0.16, 95% CI = [\u22120.08 to 0.39], <jats:italic>p<\/jats:italic> = 0.192). Finally, there was also evidence for the longitudinal association of mental health with individual level factors, including confidence in government\/healthcare\/essentials, COVID-19 knowledge, COVID-19 stress, COVID-19 infection, and social support. However, it is worth noting that the magnitudes of these longitudinal associations were generally small. The main limitation of the study was its non-probability sample design.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our results provided empirical evidence on how changes in contextual and individual level factors were related to changes in depressive and anxiety symptoms. While some factors (e.g., confidence in healthcare, social support) clearly acted as consistent predictors of depressive and\/or anxiety symptoms, other factors (e.g., stringency index, COVID-19 knowledge) were dependent on the specific situations occurring within society. This could provide important implications for policy making and for a better understanding of mental health of the general public during a national or global health crisis.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pmed.1004144","type":"journal-article","created":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T17:20:37Z","timestamp":1681838437000},"page":"e1004144","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":38,"title":["Depressive and anxiety symptoms in adults during the COVID-19 pandemic in England: A panel data analysis over 2 years"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2060-3768","authenticated-orcid":true,"given":"Feifei","family":"Bu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7808-4943","authenticated-orcid":true,"given":"Andrew","family":"Steptoe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6952-334X","authenticated-orcid":true,"given":"Daisy","family":"Fancourt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,4,18]]},"reference":[{"key":"pmed.1004144.ref001","doi-asserted-by":"crossref","first-page":"e124","DOI":"10.1016\/S2468-2667(20)30288-7","article-title":"Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study","volume":"6","author":"MJ Carr","year":"2021","journal-title":"Lancet Public Health"},{"key":"pmed.1004144.ref002","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/S2215-0366(20)30482-X","article-title":"Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study","volume":"8","author":"D Fancourt","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"pmed.1004144.ref003","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/S2215-0366(20)30168-1","article-title":"Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science","volume":"7","author":"EA Holmes","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"pmed.1004144.ref004","doi-asserted-by":"crossref","first-page":"m1515","DOI":"10.1136\/bmj.m1515","article-title":"Covid-19: Mental health consequences of pandemic need urgent research, paper advises","volume":"369","author":"E. Mahase","year":"2020","journal-title":"BMJ"},{"key":"pmed.1004144.ref005","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1016\/S2215-0366(20)30308-4","article-title":"Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population","volume":"7","author":"M Pierce","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"pmed.1004144.ref006","first-page":"1","article-title":"Longitudinal changes in mental health and the COVID-19 pandemic: evidence from the UK Household Longitudinal Study","author":"M Daly","year":"2020","journal-title":"Psychol Med"},{"key":"pmed.1004144.ref007","first-page":"1","article-title":"Mental health before and during the COVID-19 pandemic in two longitudinal UK population cohorts","author":"ASF Kwong","year":"2020","journal-title":"Br J Psychiatry"},{"key":"pmed.1004144.ref008","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.jad.2021.09.098","article-title":"A systematic review and meta-analysis of longitudinal cohort studies comparing mental health before versus during the COVID-19 pandemic in 2020","volume":"296","author":"E Robinson","year":"2022","journal-title":"J Affect Disord"},{"key":"pmed.1004144.ref009","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1016\/S2215-0366(21)00151-6","article-title":"Mental health responses to the COVID-19 pandemic: a latent class trajectory analysis using longitudinal UK data","volume":"8","author":"M Pierce","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"pmed.1004144.ref010","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.jad.2022.05.025","article-title":"Psychological distress associated with the second COVID-19 wave: Prospective evidence from the UK Household Longitudinal Study","volume":"310","author":"M Daly","year":"2022","journal-title":"J Affect Disord"},{"key":"pmed.1004144.ref011","doi-asserted-by":"crossref","DOI":"10.1192\/bjo.2022.58","article-title":"Mental health and well-being during the second wave of COVID-19: longitudinal analyses of the UK COVID-19 Mental Health and Wellbeing study (UK COVID-MH)","volume":"8","author":"K Wetherall","year":"2022","journal-title":"BJPsych Open"},{"key":"pmed.1004144.ref012","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.jad.2021.04.050","article-title":"Government response moderates the mental health impact of COVID-19: A systematic review and meta-analysis of depression outcomes across countries","volume":"290","author":"Y Lee","year":"2021","journal-title":"J Affect Disord"},{"key":"pmed.1004144.ref013","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.jpsychires.2022.03.026","article-title":"Associations of lockdown stringency and duration with Google searches for mental health terms during the COVID-19 pandemic: A nine-country study","volume":"150","author":"PA de la Rosa","year":"2022","journal-title":"J Psychiatr Res"},{"key":"pmed.1004144.ref014","doi-asserted-by":"crossref","first-page":"e417","DOI":"10.1016\/S2468-2667(22)00060-3","article-title":"Policy stringency and mental health during the COVID-19 pandemic: a longitudinal analysis of data from 15 countries","volume":"7","author":"LB Aknin","year":"2022","journal-title":"Lancet Public Health"},{"key":"pmed.1004144.ref015","doi-asserted-by":"crossref","first-page":"106713","DOI":"10.1016\/j.ypmed.2021.106713","article-title":"Do predictors of adherence to pandemic guidelines change over time? A panel study of 22,000 UK adults during the COVID-19 pandemic","volume":"153","author":"L Wright","year":"2021","journal-title":"Prev Med (Baltim)"},{"key":"pmed.1004144.ref016","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S0165-0327(03)00198-8","article-title":"Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9)","volume":"81","author":"B L\u00f6we","year":"2004","journal-title":"J Affect Disord"},{"key":"pmed.1004144.ref017","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A Brief Measure for Assessing Generalized Anxiety Disorder","volume":"166","author":"RL Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"key":"pmed.1004144.ref018","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1038\/s41562-021-01079-8","article-title":"A global panel database of pandemic policies (Oxford COVID-19 Government Response Tracker)","volume":"5","author":"T Hale","year":"2021","journal-title":"Nat Hum Behav"},{"key":"pmed.1004144.ref019","unstructured":"UK Health Security Agency. Coronavirus (COVID-19) in the UK 2022. https:\/\/coronavirus.data.gov.uk\/ (accessed May 23, 2022)."},{"key":"pmed.1004144.ref020","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.jclinepi.2014.11.003","article-title":"A brief form of the Perceived Social Support Questionnaire (F-SozU) was developed, validated, and standardized","volume":"68","author":"S Kliem","year":"2015","journal-title":"J Clin Epidemiol"},{"key":"pmed.1004144.ref021","unstructured":"Office for National Statistics. Population estimates for the UK, England and Wales, Scotland and Northern Ireland 2019. https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/populationandmigration\/populationestimates\/bulletins\/annualmidyearpopulationestimates\/mid2018 (accessed May 13, 2020)."},{"key":"pmed.1004144.ref022","volume-title":"Econometric Analysis of Cross Section and Panel Data","author":"JM Wooldridge","year":"2010","edition":"2"},{"key":"pmed.1004144.ref023","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1177\/1536867X1001000403","article-title":"Frequentist Q-values for Multiple-test Procedures","volume":"10","author":"RB Newson","year":"2011","journal-title":"Stata J"},{"key":"pmed.1004144.ref024","doi-asserted-by":"crossref","first-page":"114820","DOI":"10.1016\/j.socscimed.2022.114820","article-title":"Covid-19 vaccination, fear and anxiety: Evidence from Google search trends","volume":"297","author":"H Awijen","year":"2022","journal-title":"Soc Sci Med"},{"key":"pmed.1004144.ref025","unstructured":"World Health Organization. The impact of COVID-19 on mental, neurological and substance use services: results of a rapid assessment. 2020."},{"key":"pmed.1004144.ref026","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.jpsychires.2020.09.020","article-title":"The early impact of COVID-19 on mental health and community physical health services and their patients\u2019 mortality in Cambridgeshire and Peterborough, UK","volume":"131","author":"S Chen","year":"2020","journal-title":"J Psychiatr Res"},{"key":"pmed.1004144.ref027","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1515\/REVNEURO.2006.17.5.533","article-title":"A behavioral homeostasis theory of habituation and sensitization: II. Further developments and predictions","volume":"17","author":"EM Eisenstein","year":"2006","journal-title":"Rev Neurosci"},{"key":"pmed.1004144.ref028","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1037\/0033-2909.119.3.488","article-title":"The relationship between social support and physiological processes: a review with emphasis on underlying mechanisms and implications for health","volume":"119","author":"BN Uchino","year":"1996","journal-title":"Psychol Bull"},{"key":"pmed.1004144.ref029","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12888-018-1736-5","article-title":"Associations between loneliness and perceived social support and outcomes of mental health problems: A systematic review","volume":"18","author":"J Wang","year":"2018","journal-title":"BMC Psychiatry"},{"key":"pmed.1004144.ref030","doi-asserted-by":"crossref","first-page":"100012","DOI":"10.1016\/j.lanepe.2020.100012","article-title":"Attitudes towards vaccines and intention to vaccinate against COVID-19: Implications for public health communications","volume":"1","author":"E Paul","year":"2021","journal-title":"Lancet Reg Health Eur"},{"key":"pmed.1004144.ref031","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1177\/03400352211041135","article-title":"Prevalence and source analysis of COVID-19 misinformation in 138 countries","volume":"48","author":"MS Al-Zaman","year":"2021","journal-title":"IFLA J"},{"key":"pmed.1004144.ref032","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1001\/jamapsychiatry.2015.1977","article-title":"Inflammation and Specific Symptoms of Depression","volume":"73","author":"M Jokela","year":"2016","journal-title":"JAMA Psychiat"},{"key":"pmed.1004144.ref033","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1007\/s13760-021-01748-5","article-title":"Is there a common pathophysiological mechanism between COVID-19 and depression?","volume":"121","author":"L da Silva Lopes","year":"2021","journal-title":"Acta Neurol Belg"},{"key":"pmed.1004144.ref034","article-title":"Long-term psychological consequences of long Covid: a propensity score matching analysis comparing trajectories of depression and anxiety symptoms before and after contracting long Covid vs short Covid","author":"D Fancourt","year":"2022","journal-title":"MedRxiv"},{"key":"pmed.1004144.ref035","first-page":"1","article-title":"Perceived risk crowds out trust? 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