Inequalities in Children's Mental Health Before and During the COVID-19 Pandemic: Findings from the UK Household Longitudinal Study

Background: There are concerns that social mitigation measures adopted during the COVID-19 pandemic may have led to declines in child mental health and widened inequalities. We investigated how existing inequalities in child mental health changed during the first year of COVID-19.Methods: Data were from 16,361 observations of 9,272 children in the population representative UK Household Longitudinal Study. Child mental health was measured using the Strengths and Difficulties Questionnaire (SDQ) at ages 5 and 8 in annual surveys between 2011-2019, and at ages 5-11 in July 2020, September 2020, and March 2021. Inequalities in cross-sectional SDQ scores among 5- and 8-year-olds, before and during the pandemic, were described. Interactions between time (before/after pandemic onset) and: sex, ethnicity, family structure, parental education, employment, household income, and area deprivation on mental health were modelled using a mixed effects generalised linear model.Findings: A trend towards poorer mental health between 2011-2019 continued during the first year of the pandemic. In most cases advantaged groups (children with coupled parents, highly educated parents, employed parents and higher household income) experienced more rapid declines in mental health during COVID-19 than less advantaged groups, leading to narrowed inequalities. For example, having no parent employed compared to at least one was associated with a 2·45 (95% CI: 1·83-3·08) point higher SDQ score (worse mental health) before the pandemic but only 0·05 (-1·07 to 1·18) higher score during COVID-19. Disadvantages related to male sex and living in deprived areas were maintained, and the mental health advantage of ethnic minorities increased.Interpretation: UK children experienced a ‘levelling down’ during COVID-19, where the mental health of children has largely converged with narrower inequalities but at a worse level overall. Interventions during the pandemic recovery must improve mental health of all children and ensure inequalities do not re-emerge.Funding Information: NM, AP and MG were funded by the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). AP additional received funding from Wellcome Trust University Award (205412/Z/16/Z). MB and JM were funded by the Economic and Social Research Council (ES/S007253/1).Declaration of Interests: We declare no competing interests.Ethics Approval Statement: The University of Essex Ethics Committee has approved all data collection on Understanding Society main study and COVID-19 surveys.