Association between psychological distress trajectories from adolescence to midlife and mental health during the pandemic: Evidence from two British birth cohorts

Abstract Background Some studies suggest worsening mental health in the early stages of the pandemic, for individuals with pre-existing mental health conditions the evidence is mixed. We examined whether different life-course trajectories of psychological distress from adolescence to midlife were associated with psychological distress, lower life satisfaction and feelings of loneliness at different stages during the pandemic. Methods This study is a secondary analysis of two nationally representative British Birth cohorts, the National Child Development Study (1958) and 1970 British Cohort Study, from birth to later mid-life. We used latent variable mixture models to identify pre-pandemic longitudinal trajectories of psychological distress and a modified poisson model with robust standard errors to estimate associations with mental health outcomes during the pandemic from May 2020 to March 2021. Findings Our analysis identified five distinct pre-pandemic trajectories of psychological distress in both cohorts. All trajectories with prior symptoms of psychological distress were associated with a greater relative risk of mental health outcomes during the pandemic. This was the case irrespective of age of onset, severity, longevity and proximal occurrence. Those who had experienced more than one prior episode of high psychological distress, and more recent occurrences, faced the greatest risk of poor mental health during the pandemic. Interpretation Whilst any prior episode of poor mental health put individuals at greater risk of severe mental health symptoms, those with chronic and more recent occurrence are likely to require greater mental health support.