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Article ; Online: Associations of cognitive impairment with self-isolation and access to health and care during the COVID-19 pandemic in England

Brian Beach / Nicholas Steel / Andrew Steptoe / Paola Zaninotto

Scientific Reports, Vol 13, Iss 1, Pp 1-

2023 Volume 8

Abstract: Abstract This research explored experiences across three cognitive function groups (no impairment, mild impairment, and dementia) with respect to shielding (either self-isolating or staying at home), COVID-19 infection, and access to health/care services ...

Abstract	Abstract This research explored experiences across three cognitive function groups (no impairment, mild impairment, and dementia) with respect to shielding (either self-isolating or staying at home), COVID-19 infection, and access to health/care services during the COVID-19 pandemic. Analyses were conducted using data from the English Longitudinal Study of Ageing (ELSA) COVID-19 sub-study collected in 2020. We report bivariate estimates across our outcomes of interest by cognitive function group along with multivariate regression results adjusting for demographic, socioeconomic, geographic, and health characteristics. Rates of shielding were high across all cognitive function groups and three measured time points (April, June/July, and Nov/Dec 2020), ranging from 74.6% (95% confidence interval 72.9–76.2) for no impairment in Nov/Dec to 96.7% (92.0–98.7) for dementia in April (bivariate analysis). 44.1% (33.5–55.3) of those with dementia experienced disruption in access to community health services by June/July compared to 34.9% (33.2–36.7) for no impairment. A higher proportion of those with mild impairment reported hospital-based cancellations in June/July (23.1% (20.1–26.4)) and Nov/Dec (16.3% (13.4–19.7)) than those with no impairment (18.0% (16.6–19.4) and 11.7% (10.6–12.9)). Multivariate adjusted models found that those with dementia were 2.4 (1.1–5.0) times more likely than those with no impairment to be shielding in June/July. All other multivariate analyses found no statistically significant differences between cognitive function groups. People with dementia were more likely than people with no impairment to be shielding early in the pandemic, but importantly they were no more likely to experience disruption to services or hospital treatment.
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Depressive and anxiety symptoms in adults during the COVID-19 pandemic in England

Feifei Bu / Andrew Steptoe / Daisy Fancourt

PLoS Medicine, Vol 20, Iss 4, p e

A panel data analysis over 2 years.

2023 Volume 1004144

Abstract: Background 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 ... ...

Abstract	Background 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. Methods and findings 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 (21/03/2020-23/08/2020), second and third national lockdowns (21/09/2020-11/04/2021), and "freedom" period (12/04/2021-14/11/2021). We found that more stringent policy response (measured by stringency index) was associated with increased depressive symptoms, in particular, during lockdown periods (β = 0.23, 95% ...
Keywords	Medicine ; R
Subject code	150
Language	English
Publishing date	2023-04-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Depression and anxiety in people with cognitive impairment and dementia during the COVID-19 pandemic

Brian Beach / Andrew Steptoe / Paola Zaninotto

PLoS Medicine, Vol 20, Iss 4, p e

Analysis of the English Longitudinal Study of Ageing.

2023 Volume 1004162

Abstract: Background Some studies have identified declines in mental health during the Coronavirus Disease 2019 (COVID-19) pandemic in different age groups, including older people. As anxiety and depression are common neuropsychiatric symptoms among people with ... ...

Abstract	Background Some studies have identified declines in mental health during the Coronavirus Disease 2019 (COVID-19) pandemic in different age groups, including older people. As anxiety and depression are common neuropsychiatric symptoms among people with cognitive impairment, the mental health experiences of older people during the pandemic should take cognitive function into consideration, along with assessments made prior to the pandemic. This study addresses evidence gaps to test whether changes in depression and anxiety among older people through the COVID-19 pandemic were associated with cognitive impairment. It also investigates whether associations varied according to key sources of sociodemographic inequality. Methods and findings Using data from the English Longitudinal Study of Ageing (ELSA) collected from 2018/2019 to November/December 2020, we estimated changes in depression and anxiety for people aged 50+ in England across 3 cognitive function groups: no impairment, mild cognitive impairment, and dementia. Conditional growth curve models were estimated for continuous measures over 3 time points (N = 5,286), with mixed-effects logistic regression used for binary measures. All models adjusted for demographics (age, gender, ethnicity, and cohabiting partnership), socioeconomics (education, wealth, and employment status), geography (urban/rural and English region), and health (self-rated and the presence of multimorbidity). We found that depression (measured with CES-D score) worsened from 2018/2019 to November/December 2020 for people with mild cognitive impairment (1.39 (95% CI: 1.29 to 1.49) to 2.16 (2.02 to 2.30)) or no impairment (1.17 (95%CI: 1.12 to 1.22) to 2.03 (1.96 to 2.10)). Anxiety, using a single-item rating of 0 to 10 also worsened among those with mild cognitive impairment (2.48 (2.30 to 2.66) to 3.14 (2.95 to 3.33)) or no impairment (2.20 (2.11 to 2.28) to 2.85 (2.77 to 2.95)). No statistically significant increases were found for those with dementia. Using a clinical cutoff for likely ...
Keywords	Medicine ; R
Subject code	150
Language	English
Publishing date	2023-04-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Facilitators and barriers to compliance with COVID-19 guidelines

Liam Wright / Elise Paul / Andrew Steptoe / Daisy Fancourt

BMC Public Health, Vol 22, Iss 1, Pp 1-

a structural topic modelling analysis of free-text data from 17,500 UK adults

2022 Volume 22

Abstract: Abstract Background During the COVID-19 pandemic, the UK government implemented a series of guidelines, rules, and restrictions to change citizens’ behaviour to tackle the spread of the virus, such as the promotion of face masks and the imposition of ... ...

Abstract	Abstract Background During the COVID-19 pandemic, the UK government implemented a series of guidelines, rules, and restrictions to change citizens’ behaviour to tackle the spread of the virus, such as the promotion of face masks and the imposition of lockdown stay-at-home orders. The success of such measures requires active co-operation on the part of citizens, but compliance was not complete. Detailed research is required on the factors that aided or hindered compliance with these measures. Methods To understand the facilitators and barriers to compliance with COVID-19 guidelines, we used structural topic modelling, a text mining technique, to extract themes from over 26,000 free-text survey responses from 17,500 UK adults, collected between 17 November and 23 December 2020. Results The main factors facilitating compliance were desires to reduce risk to oneself and one’s family and friends and to, a lesser extent, the general public. Also of importance were a desire to return to normality, the availability of activities and technological means to contact family and friends, and the ability to work from home. Identified barriers were difficulties maintaining social distancing in public (due to the actions of other people or environmental constraints), the need to provide or receive support from family and friends, social isolation, missing loved ones, and mental health impacts, perceiving the risks as low, social pressure to not comply, and difficulties understanding and keep abreast of changing rules. Several of the barriers and facilitators raised were related to participant characteristics. Notably, women were more likely to discuss needing to provide or receive mental health support from friends and family. Conclusion The results demonstrated an array of factors contributed to compliance with guidelines. Of particular policy importance, the results suggest that government communication that emphasizes the potential risks of the virus and provides simple, consistent guidance on how to reduce the spread of the ...
Keywords	COVID-19 ; Compliance ; Adherence ; Non-pharmaceutical interventions ; Free-text data ; Structural topic modelling ; Public aspects of medicine ; RA1-1270
Subject code	320
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Correction to

Liam Wright / Elise Paul / Andrew Steptoe / Daisy Fancourt

BMC Public Health, Vol 22, Iss 1, Pp 1-

Guidelines: a structural topic modelling analysis of free-text data from 17,500 UK adults

2022 Volume 5

Keywords	Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2022-03-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: High polygenic predisposition for ADHD and a greater risk of all-cause mortality

Olesya Ajnakina / Diana Shamsutdinova / Theresa Wimberley / Søren Dalsgaard / Andrew Steptoe

BMC Medicine, Vol 20, Iss 1, Pp 1-

a large population-based longitudinal study

2022 Volume 10

Abstract: Abstract Background Attention deficit hyperactivity disorder (ADHD) is a highly heritable, neurodevelopmental disorder known to associate with more than double the risk of death compared with people without ADHD. Because most research on ADHD has focused ...

Abstract	Abstract Background Attention deficit hyperactivity disorder (ADHD) is a highly heritable, neurodevelopmental disorder known to associate with more than double the risk of death compared with people without ADHD. Because most research on ADHD has focused on children and adolescents, among whom death rates are relatively low, the impact of a high polygenic predisposition to ADHD on accelerating mortality risk in older adults is unknown. Thus, the aim of the study was to investigate if a high polygenetic predisposition to ADHD exacerbates the risk of all-cause mortality in older adults from the general population in the UK. Methods Utilising data from the English Longitudinal Study of Ageing, which is an ongoing multidisciplinary study of the English population aged ≥ 50 years, polygenetic scores for ADHD were calculated using summary statistics for (1) ADHD (PGS-ADHDsingle) and (2) chronic obstructive pulmonary disease and younger age of giving first birth, which were shown to have a strong genetic correlation with ADHD using the multi-trait analysis of genome-wide association summary statistics; this polygenic score was referred to as PGS-ADHDmulti-trait. All-cause mortality was ascertained from the National Health Service central register that captures all deaths occurring in the UK. Results The sample comprised 7133 participants with a mean age of 64.7 years (SD = 9.5, range = 50–101); of these, 1778 (24.9%) died during a period of 11.2 years. PGS-ADHDsingle was associated with a greater risk of all-cause mortality (hazard ratio [HR] = 1.06, 95% CI = 1.02–1.12, p = 0.010); further analyses showed this relationship was significant in men (HR = 1.07, 95% CI = 1.00–1.14, p = 0.043). Risk of all-cause mortality increased by an approximate 11% for one standard deviation increase in PGS-ADHDmulti-trait (HR = 1.11, 95% CI = 1.06–1.16, p < 0.001). When the model was run separately for men and women, the association between PGS-ADHDmulti-trait and an increased risk of all-cause mortality was significant in men (HR = ...
Keywords	Attention deficit hyperactivity disorder ; Mortality ; Genome-wide association studies ; Polygenic predisposition ; Healthy ageing ; Medicine ; R
Subject code	310
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Television viewing and cognitive decline in older age

Daisy Fancourt / Andrew Steptoe

Scientific Reports, Vol 9, Iss 1, Pp 1-

findings from the English Longitudinal Study of Ageing

2019 Volume 8

Abstract: Abstract There has been significant interest in the effects of television on cognition in children, but much less research has been carried out into the effects in older adults. This study aimed to explore whether television viewing behaviours in adults ... ...

Abstract	Abstract There has been significant interest in the effects of television on cognition in children, but much less research has been carried out into the effects in older adults. This study aimed to explore whether television viewing behaviours in adults aged 50 or over are associated with a decline in cognition. Using data from the English Longitudinal Study of Aging involving 3,662 adults aged 50+, we used multivariate linear regression models to explore longitudinal associations between baseline television watching (2008/2009) and cognition 6 years later (2014/2015) while controlling for demographic factors, socio-economic status, depression, physical health, health behaviours and a range of other sedentary behaviours. Watching television for more than 3.5 hours per day is associated with a dose-response decline in verbal memory over the following six years, independent of confounding variables. These results are found in particular amongst those with better cognition at baseline and are robust to a range of sensitivity analyses exploring reverse causality, differential non-response and stability of television viewing. Watching television is not longitudinally associated with changes in semantic fluency. Overall our results provide preliminary data to suggest that television viewing for more than 3.5 hours per day is related to cognitive decline.
Keywords	Medicine ; R ; Science ; Q
Subject code	120
Language	English
Publishing date	2019-02-01T00:00:00Z
Publisher	Nature Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Attitudes towards vaccines and intention to vaccinate against COVID-19

Elise Paul / Andrew Steptoe / Daisy Fancourt

The Lancet Regional Health. Europe, Vol 1, Iss , Pp 100012- (2021)

Implications for public health communications

2021

Abstract: Background: Negative attitudes towards vaccines and an uncertainty or unwillingness to receive vaccinations are major barriers to managing the COVID-19 pandemic in the long-term. We estimate predictors of four domains of negative attitudes towards ... ...

Abstract	Background: Negative attitudes towards vaccines and an uncertainty or unwillingness to receive vaccinations are major barriers to managing the COVID-19 pandemic in the long-term. We estimate predictors of four domains of negative attitudes towards vaccines and identify groups most at risk of uncertainty and unwillingness to receive a COVID-19 vaccine in a large sample of UK adults. Methods: Data were cross-sectional and from 32,361 adults in the UCL COVID-19 Social Study. Ordinary least squares regression analyses examined the impact of socio-demographic and COVID-19 related factors on four types of negative vaccine attitudes: mistrust of vaccine benefit, worries about unforeseen effects, concerns about commercial profiteering, and preference for natural immunity. Multinomial regression examined the impact of socio-demographic and COVID-19 related factors, negative vaccine attitudes, and prior vaccine behaviour on uncertainty and unwillingness to be vaccinated for COVID-19. Findings: 16% of respondents displayed high levels of mistrust about vaccines across one or more domains. Distrustful attitudes towards vaccination were higher amongst individuals from ethnic minority backgrounds, with lower levels of education, lower annual income, poor knowledge of COVID-19, and poor compliance with government COVID-19 guidelines. Overall, 14% of respondents reported unwillingness to receive a vaccine for COVID-19, whilst 23% were unsure. The largest predictors of both COVID-19 vaccine uncertainty and refusal were low-income groups (< £16,000, a year), having not received a flu vaccine last year, poor adherence to COVID-19 government guidelines, female gender, and living with children. Amongst vaccine attitudes, intermediate to high levels of mistrust of vaccine benefit and concerns about future unforeseen side effects were the most important determinants of both uncertainty and unwillingness to vaccinate against COVID-19. Interpretation: Negative attitudes towards vaccines are a major public health concern in the UK. ...
Keywords	COVID-19 ; Attitudes towards vaccines ; Vaccine refusal ; Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2021-02-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Predictors of self-reported adherence to COVID-19 guidelines. A longitudinal observational study of 51,600 UK adults

Liam Wright / Andrew Steptoe / Daisy Fancourt

The Lancet Regional Health. Europe, Vol 4, Iss , Pp 100061- (2021)

2021

Abstract: Background: In the absence of a vaccine, governments have focused on social distancing, self-isolation, and increased hygiene procedures to reduce the transmission of SARS-CoV-2 (COVID-19). Compliance with these measures requires voluntary cooperation ... ...

Abstract	Background: In the absence of a vaccine, governments have focused on social distancing, self-isolation, and increased hygiene procedures to reduce the transmission of SARS-CoV-2 (COVID-19). Compliance with these measures requires voluntary cooperation from citizens. Yet, compliance is not complete. Existing research on the predictors of compliance is almost exclusively based on cross-sectional data, raising the possibility of reverse causality and confounding. Methods: Using data from the UCL COVID-19 Social Study, a large weekly online panel of UK adults from first three months of lockdown in the UK (n = 51,600), we tested whether within-person changes in confidence in government, mental wellbeing, social experiences and awareness of COVID-19 were longitudinally related to self-reported compliance levels with guidelines from authorities using random intercept cross-lagged panel models. Findings: We found evidence of a small longitudinal association between increased confidence in government to tackle the pandemic and higher self-reported compliance, but little evidence that factors such as mental health and wellbeing, worries about future adversities, and social isolation and loneliness were related to later compliance. We found higher self-reported compliance was longitudinally related to higher depressive symptoms. We found that low compliance was related to lower leisure engagement, providing care, and working outside the home. Interpretation: Our results suggest that to effectively manage the pandemic, governments should ensure that confidence is maintained. Funding: Nuffield Foundation, Wellcome Trust and the MARCH Mental Health Network. MARCH is funded by the Cross-Disciplinary Mental Health Network Plus initiative supported by UK Research and Innovation.
Keywords	Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2021-05-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Are adversities and worries during the COVID-19 pandemic related to sleep quality? Longitudinal analyses of 46,000 UK adults.

Liam Wright / Andrew Steptoe / Daisy Fancourt

PLoS ONE, Vol 16, Iss 3, p e

2021 Volume 0248919

Abstract: Background There are concerns that both the experience of adversities during the COVID-19 pandemic and worries about experiencing adversities will have substantial and lasting effects on mental health. One pathway through which both experience of and ... ...

Abstract	Background There are concerns that both the experience of adversities during the COVID-19 pandemic and worries about experiencing adversities will have substantial and lasting effects on mental health. One pathway through which both experience of and worries about adversity may impact health is through effects on sleep. Methods We used data from 46,284 UK adults in the COVID-19 Social Study assessed weekly from 01/04/2020-12/05/2020 to study the association between adversities and sleep quality. We studied six categories of adversity including both worries and experiences of: illness with COVID-19, financial difficulty, loss of paid work, difficulties acquiring medication, difficulties accessing food, and threats to personal safety. We used random-effect within-between models to account for all time-invariant confounders. Results Both the total number of adversity experiences and total number of adversity worries were associated with lower quality sleep. Each additional experience was associated with a 1.16 (95% CI = 1.10, 1.22) times higher odds of poor quality sleep while each additional worry was associated with a 1.20 (95% CI = 1.17, 1.22) times higher odds of poor quality sleep. When considering specific experiences and worries, all worries and experiences were significantly related to poorer quality sleep except experiences relating to employment and finances. Having a larger social network offered some buffering effects on associations but there was limited further evidence of moderation by other social or psychiatric factors. Conclusion Poor sleep may be a mechanism by which COVID-19 adversities are affecting mental health. This highlights the importance of interventions that support adaptive coping strategies during the pandemic.
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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