Elise Paul

Objectives: The fourth National Survey of Sexual Attitudes and Lifestyles (Natsal-4; conducted 2022–2024) identified substantial changes in reported sexual and reproductive health (SRH) in Britain compared with Natsal-3 (2010–2012). Lower response rates in Natsal-4 necessitated mixed-mode adaptations, raising concerns that estimates of change over time could be biased by changes in who took part (participation bias) and how they answered questions (reporting and instrument bias). Methods: We identified two birth cohorts of participants eligible to be sampled in Natsal-3 and Natsal-4, enabling comparison of people of the same generation across the two surveys: those born 1964–1980 (ie, Gen-X ) and 1981–1994 (ie, Millennials ). If bias remained stable between surveys, we would expect consistent estimates from members of the same birth cohort when sampled in each survey for events occurring before Natsal-3 data collection (ie, before 2010) and for outcomes where prevalence can logically only increase or only decrease over time. Results: In Natsal-4 compared with Natsal-3, a higher proportion of Gen-X and Millennial cohorts reported having had same-sex sex before 2010; a lower proportion of men reported opposite-sex sex before 16 years old; and a lower proportion of women reported a first pregnancy outcome and live birth before 2010 (all of which should be stable across surveys). The largest change in bias was observed among women and men in the Gen-X cohort through their increased reporting of never having had a sexual experience and never having had sex, which logically should only decrease over time. Conclusions: Evidence of changing bias between Natsal-3 and Natsal-4 was observed in key SRH estimates, which may be due to changes in participation or reporting. Resulting overestimations or underestimations of the magnitude of change over time in cross-survey comparisons have implications for interpreting apparent population-level trends to inform SRH policy and practice.

This study describes the causes and frequency of different types of discrimination during the COVID-19 pandemic using mixed methods. Quantitative data on seven types of discrimination were collected from adults in the UCL Covid-19 Social Study in July 2020 and July 2021 (N = 15,154). From those reporting discrimination in July 2020, qualitative thematic analysis classified responses on discrimination from eight free-text questions collected October-November 2020 (N = 1,121). Younger age, belonging to an ethnic minority group, lower household income (< £30,000), higher educational attainment, and having a physical or mental health condition increased the likelihood of having experienced at least one type of discrimination in 2020 and 2021. Descriptions of discrimination related to health and disability, age, social class, race, and gender. Qualitative findings indicate that although there may have been fewer face-to-face instances of discrimination reported, systemic consequences of stigma were heightened during the first year of the pandemic.

Background: It remains unclear whether financial support interventions (e.g., furlough, mortgage freezes, foodbanks, Universal Credit) provide protection against the negative impact of financial adversity on mental health. Methods: Data were from adults who took part in the UCL COVID -19 Social Study between 1 April 2020 and 4 April 2022 who had variability over time in depression (N = 27,297) and anxiety symptoms (N = 26,452). Fixed-effects Poisson regressions examined the associations between an index of financial adversity (e.g., job or income loss) with depression and anxiety symptoms and controlled for other adversities and loneliness. Interaction terms between financial adversity and having used i) any, ii) charity based, iii) government based, iv) work based, and v) other forms of financial supports were examined. Results: Experiencing financial adversity had a negative impact on mental health. Only charity based support (e.g., foodbanks) consistently attenuated the impact of financial adversity on mental health, whilst work based support exacerbated the impact. Government based support only attenuated the impact of facing limited financial adversity on depression symptoms. Conclusion: Findings suggest that most financial interventions are insufficient for alleviating mental health difficulties resulting from financial adversity.

This study describes the causes and frequency of different types of discrimination during the COVID-19 pandemic using mixed methods. Quantitative data on seven types of discrimination were collected from adults in the UCL Covid-19 Social Study in July 2020 and July 2021 (N=15,154). From those reporting discrimination in July 2020, qualitative thematic analysis classified responses on discrimination from eight free-text questions collected October-November 2020 (N = 1,121). Younger age, belonging to an ethnic minority group, lower household income (< £30,000), higher educational attainment, and having a physical or mental health condition increased the likelihood of having experienced at least one type of discrimination in 2020 and 2021. Descriptions of discrimination related to health and disability, age, social class, race, and gender. Qualitative findings indicate that although there may have been fewer face-to-face instances of discrimination reported, systemic consequences of stigma were heightened during the first year of the pandemic.

Background Relationship breakdowns or conflict are frequent precipitants for self-harm thoughts and behaviours, but the majority who experience these stressful life events do not think about or engage in self-harm. Understanding factors that attenuate or exacerbate this risk is therefore needed. The aim of this paper is to investigate whether relationship breakdowns, loss, and conflict lead to more frequent self-harm thoughts and behaviours. We also examine whether coping styles and neuroticism, posited by diathesis-stress models of suicide risk to interact with these events, attenuate or exacerbate the risk for self-harm thoughts and behaviours from these events. Methods This study utilised data collected during the COVID-19 pandemic, which acted as a natural experiment by leading to a greater prevalence of relationship breakdowns than usual. Data from 21,581 adults who participated in the UCL COVID-19 Social Study between 28 February 2021 and 4 April 2022 were utilised. Poisson regression models which controlled for socio-demographics and a diagnosed mental health condition were used to examine the impact of four predictor variables (separation or divorce, family problem, an ‘other’ relationship breakdown [e.g., friend or colleague], and the death of a close relative or friend) with the number of times self-harm thoughts and behaviours were reported over the study period. Interactions between these events and coping styles (problem-focused, emotion-focused, socially supported, and avoidant coping) were also examined. Results Variables representing relationship breakdowns, loss, and conflict were associated with an increased frequency of self-harm thoughts (incidence rate ratio [RRR] range: 1.04 to 1.77) and behaviours (RRR range: 1.48 to 1.96). The use of more avoidant coping strategies (e.g., substance use, denial) increased the risk for both outcomes but unexpectedly attenuated associations between predictor variables and self-harm thoughts. Socially supported coping increased the likelihood of both outcomes, but not in sensitivity analyses which excluding ‘venting’ from the scale. Problem-focused coping strategies (e.g., active planning) attenuated the impact of separation or divorce and having had a family problem on the frequency of self-harm behaviours. Conclusions Findings underscore the importance of interpersonal loss and conflict for the frequency of thinking about and engaging in self-harm and suggest that the magnitude of these associations may depend on different coping styles.

Background: Demographic and infection-related characteristics have been identified as risk factors for long COVID, but research on the influence of health behaviours (e.g., exercise, smoking) immediately preceding the index infection is lacking. The aim of this study was to examine whether specific health behaviours in the month preceding infection with COVID-19 act as upstream risk factors for long COVID as well as well as three specific long COVID symptoms. Methods: One thousand five hundred eighty-one UK adults from the UCL COVID-19 Social Study and who had previously been infected with COVID-19 were analysed. Health behaviours in the month before infection were weekly exercise frequency, days of fresh air per week, sleep quality, smoking, consuming more than the number of recommended alcoholic drinks per week (> 14), and the number of mental health care behaviours (e.g., online mental health programme). Logistic regressions controlling for covariates (e.g., COVID-19 infection severity, socio-demographics, and pre-existing health conditions) examined the impact of health behaviours on long COVID and three long COVID symptoms (difficulty with mobility, cognition, and self-care). Results: In the month before infection with COVID-19, poor quality sleep increased the odds of long COVID (odds ratio [OR]: 3.53; (95% confidence interval [CI]: 2.01 to 6.21), as did average quality sleep (OR: 2.44; 95% CI: 1.44 to 4.12). Having smoked (OR: 8.39; 95% CI: 1.86 to 37.91) increased and meeting recommended weekly physical activity guidelines (3h hours) (OR: 0.05; 95% CI: 0.01 to 0.39) reduced the likelihood of difficulty with self-care (e.g., washing all over or dressing) amongst those with long COVID. Conclusions: Results point to the importance of sleep quality for long COVID, potentially helping to explain previously demonstrated links between stress and long COVID. Results also suggest that exercise and smoking may be modifiable risk factors for preventing the development of difficulty with self-care.

Background Long COVID is increasingly recognised as public health burden. Ongoing inflammatory processes have been found to underlie the post-acute sequalae, as in other viral infections. Psychological stress can trigger increases in circulating markers of inflammation, with higher inflammation in turn associated with a greater propensity for developing chronic illness. However, research on risk factors for long COVID has focused almost entirely on demographic and infection-related characteristics, to the exclusion of psychosocial predictors such as stress immediately preceding the index infection. Research on whether stressors predict the development of specific long COVID symptoms is also needed, because some long COVID symptoms may be more debilitating than others and have different risk factors. Methods Data from 1,962 UK adults who had previously been infected with COVID-19 and who took part in the UCL COVID-19 Social Study were analysed. The number of adverse experiences (e.g., job loss) and the number of adversity worries measured within the two months prior to COVID-19 infection were used to predict the development of self-reported long COVID and the presence of three specific long COVID symptoms (difficulty with mobility, cognition, and self-care). Logistic regression analyses controlled for a range of COVID-19 infection characteristics, socio-demographics, and health-related factors. Results One in five who had been infected with COVID-19 had either been diagnosed with or believed themselves to have had long COVID. Odds of self-reported long COVID increased by 1.31 (95% confidence interval [CI]: 1.04 to 1.64) for each additional worry about adversity in the two months prior to COVID-19 infection. The number of adversity experiences corresponded with increased odds of difficulty with self-care (e.g., dressing, washing all over) by 1.68 (95% CI: 1.08 to 2.61). Discussion Results suggest a central role of stress in the time preceding the acute COVID-19 infection for the development of long COVID and point to the importance of prioritising and monitoring COVID-19 patients who have been affected by stress for ongoing care and prevention. A more comprehensive understanding of whether psychosocial circumstances in the time period leading up to infection could aid in identifying early in the disease who is most likely to be negatively impacted due to ongoing symptoms.