{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T12:44:45Z","timestamp":1792500285102,"version":"4.5.0"},"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2023,4,4]],"date-time":"2023-04-04T00:00:00Z","timestamp":1680566400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Economic and Social Research Council (ESRC) Centre for Society and Mental Health at King's College London","award":["ES\/S012567\/1"],"award-info":[{"award-number":["ES\/S012567\/1"]}]},{"name":"National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London"},{"name":"National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust"},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MC_UU_00019\/3"],"award-info":[{"award-number":["MC_UU_00019\/3"]}],"id":[{"id":"10.13039\/501100000265","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\"><jats:title>Background<\/jats:title><jats:p>Growing evidence suggests that population mental health outcomes have worsened since the pandemic started. The extent that these changes have altered common age-related trends in psychological distress, where distress typically rises until midlife and then falls after midlife in both sexes, is unknown. We aimed to analyse whether long-term pre-pandemic psychological distress trajectories were disrupted during the pandemic, and whether these changes have been different across cohorts and by sex.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods and findings<\/jats:title><jats:p>We used data from three nationally representative birth cohorts comprising all people born in Great Britain in a single week of 1946 (National Survey of Health and Development, NSHD), 1958 (National Child Development Study, NCDS), or 1970 (British Cohort Study, BCS70). The follow-up data used spanned 39 years in NSHD (1982 to 2021), 40 years in NCDS (1981 to 2001), and 25 years in BCS70 (1996 to 2021). We used psychological distress factor scores, as measured by validated self-reported questionnaires (NSHD: Present State Examination, Psychiatric Symptoms Frequency, and 28- and 12-item versions of General Health Questionnaire; NCDS and BCS70: Malaise Inventory; all: 2-item versions of Generalized Anxiety Disorder scale and Patient Health Questionnaire). We used a multilevel growth curve modelling approach to model the trajectories of distress across cohorts and sexes and obtained estimates of the differences between the distress levels observed during the pandemic and those observed at the most recent pre-pandemic assessment and at the peak in the cohort-specific pre-pandemic distress trajectory, located at midlife. We further analysed whether pre-existing cohort and sex inequalities had changed with the pandemic onset using a difference-in-differences (DiD) approach. The analytic sample included 16,389 participants. By September\/October 2020, distress levels had reached or exceeded the levels of the peak in the pre-pandemic life-course trajectories, with larger increases in younger cohorts (standardised mean differences [SMD] and 95% confidence intervals of SMD<jats:sub>NSHD,pre-peak<\/jats:sub>= \u22120.02 [\u22120.07, 0.04], SMD<jats:sub>NCDS,pre-peak<\/jats:sub>= 0.05 [0.02, 0.07], and SMD<jats:sub>BCS70,pre-peak<\/jats:sub>= 0.09 [0.07, 0.12] for the 1946, 1958, and 1970 birth cohorts, respectively). Increases in distress were larger among women than men, widening pre-existing sex inequalities (DiD and 95% confidence intervals of DiD<jats:sub>NSHD,sex,pre-peak<\/jats:sub>= 0.17 [0.06, 0.28], DiD<jats:sub>NCDS,sex,pre-peak<\/jats:sub>= 0.11 [0.07, 0.16], and DiD<jats:sub>BCS70,sex,pre-peak<\/jats:sub>= 0.11 [0.05, 0.16] when comparing sex inequalities in the pre-pandemic peak in midlife to those observed by September\/October 2020). As expected in cohort designs, our study suffered from high proportions of attrition with respect to the original samples. Although we used non-response weights to restore sample representativeness to the target populations (those born in the United Kingdom in 1946, 1958, and 1970, alive and residing in the UK), results may not be generalisable to other sections within the UK population (e.g., migrants and ethnic minority groups) and countries different than the UK.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Conclusions<\/jats:title><jats:p>Pre-existing long-term psychological distress trajectories of adults born between 1946 and 1970 were disrupted during the COVID-19 pandemic, particularly among women, who reached the highest levels ever recorded in up to 40 years of follow-up data. This may impact future trends of morbidity, disability, and mortality due to common mental health problems.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pmed.1004145","type":"journal-article","created":{"date-parts":[[2023,4,4]],"date-time":"2023-04-04T17:22:02Z","timestamp":1680628922000},"page":"e1004145","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":31,"title":["Long-term psychological distress trajectories and the COVID-19 pandemic in three British birth cohorts: A multi-cohort study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0459-657X","authenticated-orcid":true,"given":"Dar\u00edo","family":"Moreno-Agostino","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4174-2126","authenticated-orcid":true,"given":"Helen L.","family":"Fisher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alissa","family":"Goodman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephani L.","family":"Hatch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Morgan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Richards","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3913-6859","authenticated-orcid":true,"given":"Jayati","family":"Das-Munshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8198-5790","authenticated-orcid":true,"given":"George B.","family":"Ploubidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,4,4]]},"reference":[{"issue":"10159","key":"pmed.1004145.ref001","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(18)32279-7","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"392","author":"GBD 2017 Disease and Injury Incidence and Prevalence Collaborators","year":"2018","journal-title":"Lancet"},{"issue":"2","key":"pmed.1004145.ref002","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/S2215-0366(21)00395-3","article-title":"Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"9","author":"GBD 2019 Mental Disorders Collaborators","year":"2022","journal-title":"Lancet Psychiatry"},{"issue":"10312","key":"pmed.1004145.ref003","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1016\/S0140-6736(21)02143-7","article-title":"Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic","volume":"398","author":"DF Santomauro","year":"2021","journal-title":"Lancet"},{"key":"pmed.1004145.ref004","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.jad.2020.08.001","article-title":"Impact of COVID-19 pandemic on mental health in the general population: A systematic review","volume":"277","author":"J Xiong","year":"2020","journal-title":"J Affect Disord"},{"issue":"1","key":"pmed.1004145.ref005","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s12992-020-00589-w","article-title":"Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis","volume":"16","author":"N Salari","year":"2020","journal-title":"Glob Health"},{"key":"pmed.1004145.ref006","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.jad.2020.11.117","article-title":"Prevalence of mental health problems during the COVID-19 pandemic: A systematic review and meta-analysis","volume":"281","author":"T Wu","year":"2021","journal-title":"J Affect Disord"},{"issue":"2","key":"pmed.1004145.ref007","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1017\/S0033291721000015","article-title":"The psychological impact of COVID-19 pandemic lockdowns: a review and meta-analysis of longitudinal studies and natural experiments","volume":"51","author":"G Prati","year":"2021","journal-title":"Psychol Med"},{"issue":"4","key":"pmed.1004145.ref008","doi-asserted-by":"crossref","first-page":"e227629","DOI":"10.1001\/jamanetworkopen.2022.7629","article-title":"Psychological distress before and during the COVID-19 pandemic among adults in the United Kingdom based on coordinated analyses of 11 longitudinal studies","volume":"5","author":"K Patel","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"5","key":"pmed.1004145.ref009","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1017\/S1041610220004135","article-title":"Loneliness, physical activity, and mental health during COVID-19: a longitudinal analysis of depression and anxiety in adults over the age of 50 between 2015 and 2020","volume":"33","author":"B Creese","year":"2021","journal-title":"Int Psychogeriatr"},{"issue":"6","key":"pmed.1004145.ref010","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1192\/bjp.2020.242","article-title":"Mental health before and during the COVID-19 pandemic in two longitudinal UK population cohorts","volume":"218","author":"ASF Kwong","year":"2021","journal-title":"Br J Psychiatry"},{"issue":"3","key":"pmed.1004145.ref011","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1136\/jech-2020-215060","article-title":"Mental health and health behaviours before and during the initial phase of the COVID-19 lockdown: longitudinal analyses of the UK Household Longitudinal Study","volume":"75","author":"CL Niedzwiedz","year":"2021","journal-title":"J Epidemiol Community Health"},{"issue":"10","key":"pmed.1004145.ref012","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.1004145.ref013","article-title":"Immediate and longer-term changes in the mental health and well-being of older adults in England during the COVID-19 pandemic","author":"P Zaninotto","year":"2021","journal-title":"JAMA Psychiatry"},{"issue":"8","key":"pmed.1004145.ref014","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1017\/S003329172000327X","article-title":"Psychological distress from early adulthood to early old age: evidence from the 1946, 1958 and 1970 British birth cohorts","volume":"52","author":"D Gondek","year":"2022","journal-title":"Psychol Med"},{"issue":"2","key":"pmed.1004145.ref015","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1017\/S0033291716002464","article-title":"Psychological distress in mid-life: evidence from the 1958 and 1970 British birth cohorts","volume":"47","author":"GB Ploubidis","year":"2017","journal-title":"Psychol Med"},{"issue":"2","key":"pmed.1004145.ref016","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/S2215-0366(15)00505-2","article-title":"Estimating the true global burden of mental illness","volume":"3","author":"D Vigo","year":"2016","journal-title":"Lancet Psychiatry"},{"issue":"1","key":"pmed.1004145.ref017","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1037\/cap0000272","article-title":"The Impact of Inequality on Mental Health Outcomes During the COVID-19 Pandemic: A Systematic Review","volume":"62","author":"B Gibson","year":"2021","journal-title":"Can Psychol"},{"issue":"1","key":"pmed.1004145.ref018","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1093\/ije\/dyi201","article-title":"Cohort Profile: The 1946 National Birth Cohort (MRC National Survey of Health and Development)","volume":"35","author":"M Wadsworth","year":"2006","journal-title":"Int J Epidemiol"},{"issue":"1","key":"pmed.1004145.ref019","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1093\/ije\/dyi183","article-title":"Cohort profile: 1958 British birth cohort (National Child Development Study)","volume":"35","author":"C Power","year":"2006","journal-title":"Int J Epidemiol"},{"key":"pmed.1004145.ref020","first-page":"20220718","article-title":"Cohort Profile Update: The 1970 British Cohort Study (BCS70).","volume":"2022","author":"A Sullivan","journal-title":"Int J Epidemiol"},{"key":"pmed.1004145.ref021","volume-title":"COVID-19 Survey in Five National Longitudinal Studies: Waves 1, 2 and 3 User Guide (Version 3)","author":"M Brown","year":"2021"},{"key":"pmed.1004145.ref022","volume-title":"Mental health during lockdown: evidence from four generations\u2014Initial findings from the COVID-19 Survey in Five National Longitudinal Studies","author":"M Henderson","year":"2020"},{"key":"pmed.1004145.ref023","volume-title":"Education, health and behaviour","author":"M Rutter","year":"1970"},{"issue":"6","key":"pmed.1004145.ref024","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s001270050153","article-title":"Validity of the Malaise Inventory in general population samples","volume":"34","author":"B Rodgers","year":"1999","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"4","key":"pmed.1004145.ref025","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1332\/175795919X15683588979486","article-title":"A longitudinal examination of the measurement equivalence of mental health assessments in two British birth cohorts","volume":"10","author":"GB Ploubidis","year":"2019","journal-title":"Longit Life Course Stud"},{"key":"pmed.1004145.ref026","volume-title":"Measurement and classification of psychiatric symptoms: An instruction manual for the PSE and CATEGO program","author":"JK Wing","year":"1974"},{"issue":"5","key":"pmed.1004145.ref027","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1136\/jech.51.5.549","article-title":"Development of a scale to measure symptoms of anxiety and depression in the general UK population: the psychiatric symptom frequency scale","volume":"51","author":"M Lindelow","year":"1997","journal-title":"J Epidemiol Community Health"},{"issue":"1","key":"pmed.1004145.ref028","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1017\/S0033291796004242","article-title":"The validity of two versions of the GHQ in the WHO study of mental illness in general health care","volume":"27","author":"DP Goldberg","year":"1997","journal-title":"Psychol Med"},{"key":"pmed.1004145.ref029","volume-title":"Harmonisation and Measurement Properties of Mental Health Measures in Six British Cohorts","author":"E McElroy","year":"2020"},{"issue":"11","key":"pmed.1004145.ref030","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1097\/01.MLR.0000093487.78664.3C","article-title":"The Patient Health Questionnaire-2: validity of a two-item depression screener","volume":"41","author":"K Kroenke","year":"2003","journal-title":"Med Care"},{"issue":"5","key":"pmed.1004145.ref031","doi-asserted-by":"crossref","first-page":"317","DOI":"10.7326\/0003-4819-146-5-200703060-00004","article-title":"Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection","volume":"146","author":"K Kroenke","year":"2007","journal-title":"Ann Intern Med"},{"key":"pmed.1004145.ref032","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1002\/9781118489772.ch21","volume-title":"The Wiley Handbook of Psychometric Testing: A multidisciplinary reference on survey, scale and test development","author":"W-C Lee","year":"2018"},{"key":"pmed.1004145.ref033","volume-title":"Deriving highest qualification in NCDS and BCS70","author":"B Dodgeon","year":"2011"},{"issue":"4","key":"pmed.1004145.ref034","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1007\/BF02294825","article-title":"Measurement invariance, factor analysis and factorial invariance","volume":"58","author":"W. Meredith","year":"1993","journal-title":"Psychometrika"},{"issue":"1","key":"pmed.1004145.ref035","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1207\/S15328007SEM0801_7","article-title":"A primer on maximum likelihood algorithms available for use with missing data","volume":"8","author":"CK Enders","year":"2001","journal-title":"Struct Equ Model"},{"key":"pmed.1004145.ref036","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.jclinepi.2021.02.019","article-title":"Missing at random assumption made more plausible: evidence from the 1958 British birth cohort","volume":"136","author":"T Mostafa","year":"2021","journal-title":"J Clin Epidemiol"},{"key":"pmed.1004145.ref037","unstructured":"Muth\u00e9n LK Muth\u00e9n BO. Mplus User\u2019s Guide. 8th ed. Los Angeles, CA; 1998\u20132017."},{"key":"pmed.1004145.ref038","volume-title":"Stata Statistical Software: Release 17","author":"StataCorp","year":"2021"},{"issue":"3","key":"pmed.1004145.ref039","doi-asserted-by":"crossref","first-page":"e0247959","DOI":"10.1371\/journal.pone.0247959","article-title":"Gender differences in unpaid care work and psychological distress in the UK COVID-19 lockdown","volume":"16","author":"B Xue","year":"2021","journal-title":"PLoS ONE"},{"issue":"12","key":"pmed.1004145.ref040","doi-asserted-by":"crossref","DOI":"10.1073\/pnas.2018494118","article-title":"A multicountry perspective on gender differences in time use during COVID-19","volume":"118","author":"LM Giurge","year":"2021","journal-title":"Proc Natl Acad Sci U S A"},{"key":"pmed.1004145.ref041","doi-asserted-by":"crossref","first-page":"n722","DOI":"10.1136\/bmj.n722","article-title":"Domestic violence during the pandemic","volume":"372","author":"G Feder","year":"2021","journal-title":"BMJ"},{"issue":"8","key":"pmed.1004145.ref042","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1177\/0020764021995556","article-title":"COVID-19 and the violence against women and girls: \u2019The shadow pandemic\u2019","volume":"67","author":"AS Sri","year":"2021","journal-title":"Int J Soc Psychiatry"},{"key":"pmed.1004145.ref043","article-title":"Bereavement from COVID-19, gender, and reports of depression among older adults in Europe","author":"H Wang","year":"2021","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"key":"pmed.1004145.ref044","unstructured":"Johns Hopkins University & Medicine Coronavirus Resource Centre. Mortality analyses. 2022 [cited 2022 Apr 6]. Available from: https:\/\/coronavirus.jhu.edu\/data\/mortality."},{"issue":"1","key":"pmed.1004145.ref045","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s00127-020-01927-4","article-title":"Impact on mental health care and on mental health service users of the COVID-19 pandemic: a mixed methods survey of UK mental health care staff","volume":"56","author":"S Johnson","year":"2021","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"pmed.1004145.ref046","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.jad.2022.02.056","article-title":"Mental health and perceived impact during the first Covid-19 pandemic year: A longitudinal study in Dutch case-control cohorts of persons with and without depressive, anxiety, and obsessive-compulsive disorders","volume":"305","author":"AAL Kok","year":"2022","journal-title":"J Affect Disord"},{"key":"pmed.1004145.ref047","unstructured":"Institute for Government. Timeline of UK government coronavirus lockdowns. 2021 [cited 2021 Nov 4]. Available from: https:\/\/www.instituteforgovernment.org.uk\/charts\/uk-government-coronavirus-lockdowns."},{"key":"pmed.1004145.ref048","volume-title":"Brexit timeline: events leading to the UK\u2019s exit from the European Union","author":"N. Walker","year":"2021"},{"key":"pmed.1004145.ref049","first-page":"2020","article-title":"Understanding the impact of Brexit on health in the UK","author":"M Dayan","year":"2020","journal-title":"Nuffield Trust"},{"key":"pmed.1004145.ref050","volume-title":"Migrants in the UK: An Overview: Migration Observatory briefing","author":"C Rienzo","year":"2020"},{"key":"pmed.1004145.ref051","unstructured":"Office for National Statistics. Population estimates by ethnic group and religion, England and Wales. 2019 2021 [cited 2022 Apr 6]. Available from: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/populationandmigration\/populationestimates\/articles\/populationestimatesbyethnicgroupandreligionenglandandwales\/2019."},{"issue":"2\u20133","key":"pmed.1004145.ref052","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1017\/S0140525X0999152X","article-title":"The weirdest people in the world?","volume":"33","author":"J Henrich","year":"2010","journal-title":"Behav Brain Sci"}],"container-title":["PLOS Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1004145","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T18:21:10Z","timestamp":1729189270000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1004145"}},"subtitle":[],"editor":[{"given":"Lola","family":"Kola","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,4,4]]},"references-count":52,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmed.1004145","relation":{},"ISSN":["1549-1676"],"issn-type":[{"value":"1549-1676","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,4]]}}}