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Background There is increasing awareness of the importance of patient activation (knowledge, skills, and confidence for managing one’s health and health care) among clinicians and policy makers, with emerging evidence showing higher levels of patient activation are associated with better health outcomes and experiences of health care. This study aimed to examine the association between patient activation and a wide range of specific types of healthcare service utilisation in England, including GP and non-GP primary care, elective and emergency hospital admissions, outpatient visits, and attendances at the Accident and Emergency department. Methods Data were derived from linked electronic patient records collected by primary and secondary healthcare providers in North West London between January 2016 and November 2019. Our analyses focused on adults (18+) with a valid Patient Activation Measure (PAM). After excluding patients with missing data, we had an analytical sample of 15,877 patients. Data were analysed using negative binomial regression and logistic regression models depending on the outcome variable. Results Patients had a mean activation score of 55.1 and a standard deviation (SD) of 17.7 (range: 0–100). They had an average of 5.4 GP visits (SD = 8.0), 26.8 non-GP visits (SD = 23.4) and 6.0 outpatient attendances (SD = 7.9) within a one-year follow-up. About 24.7% patients had at least one elective admission, 24.2% had one or more emergency admissions, and 42.3% had one or more A&E attendance within the follow-up. After accounting for a number of demographic and health factors, we found a linear (or proximately linear) association between patient activation and the number of GP visits, emergency admissions and A&E attendance, but a non-linear relationship between patient activation and the number of non-GP visits, the number of outpatient attendance and elective inpatient admission. Conclusions This study has provided strong empirical evidence from England linking patient activation with healthcare service utilisation. It suggests the value of supporting patient activation as a potential pathway to ease the burden of healthcare system.

BackgroundThere is growing research into the effects of psychological and social factors such as loneliness and isolation on cardiovascular disease (CVD). However, it is unclear whether individuals with particular clusters of CVD risk factors are more strongly affected by loneliness and isolation. This study aimed to identify latent clustering of modifiable risk factors among adults aged 50+ and explore the relationship between loneliness, social isolation and risk factor patterns.MethodsData from 8218 adults of English Longitudinal Study of Ageing were used in latent class analyses to identify latent classes of cardiovascular risk factors and predictors of class membership.ResultsThere were four latent classes: low-risk (30.2%), high-risk (15.0%), clinical-risk (42.6%) and lifestyle-risk (12.2%) classes. Loneliness was associated with a greater risk of being in the high-risk class (relative risk ratio (RRR) 2.40, 95% CI 2.40 to 1.96) and lifestyle-risk class (RRR 1.36, 95% CI 1.10 to 1.67) and a lower risk of being in the clinical-risk class (RRR 0.84, 95% CI 0.72 to 0.98) relative to the low-risk class. Social disengagement, living alone and low social contact were also differentially associated with latent class memberships.ConclusionThese findings supplement our existing knowledge of modifiable risk factors for CVD by showing how risk factors cluster together and how the risk patterns are related to social factors, offering important implications for clinical practice and preventive interventions.

Background There are concerns internationally that lockdown measures taken during the coronavirus disease 2019 (COVID-19) pandemic could lead to a rise in loneliness. As loneliness is recognised as a major public health concern, it is therefore vital that research considers the impact of the current COVID-19 pandemic on loneliness to provide necessary support. But it remains unclear, who is lonely in lockdown? Methods This study compared sociodemographic predictors of loneliness before and during the COVID-19 pandemic using cross-cohort analyses of data from UK adults captured before the pandemic (UK Household Longitudinal Study, n = 31,064) and during the pandemic (UCL (University College London) COVID-19 Social Study, n = 60,341). Results Risk factors for loneliness were near identical before and during the pandemic. Young adults, women, people with lower education or income, the economically inactive, people living alone and urban residents had a higher risk of being lonely. Some people who were already at risk of being lonely (e.g. young adults aged 18–30 years, people with low household income and adults living alone) experienced a heightened risk during the COVID-19 pandemic compared with people living before COVID-19 emerged. Furthermore, being a student emerged as a higher risk factor during lockdown than usual. Conclusions Findings suggest that interventions to reduce or prevent loneliness during COVID-19 should be targeted at those sociodemographic groups already identified as high risk in previous research. These groups are likely not just to experience loneliness during the pandemic but potentially to have an even higher risk than normal of experiencing loneliness relative to low-risk groups., Highlights • We compared data from 31,000 UK adults during 2017-2019 with 60,000 UK adults during the COVID-19 pandemic. • Some risk factors for loneliness were the same as in ordinary circumstances (e.g. women and people living alone). • Other groups experienced even greater risk of loneliness than usual (e.g. younger people and people of low income). • Some groups were at risk of loneliness who are not usually considered high risk (e.g. students).

ObjectiveThis study aimed to examine the association between loneliness, social isolation and cardiovascular disease (CVD), looking at both self-reported CVD diagnosis and CVD-related hospital admissions.MethodsData were derived from the English Longitudinal Study of Ageing linked with administrative hospital records and mortality registry data. The analytical sample size was 5850 for the analysis of self-reported CVD and 4587 of CVD derived from hospital records, with a follow-up up to 9.6 years. Data were analysed using survival analysis, accounting for competing risks events.ResultsThe mean age was 64 years (SD 8.3). About 44%–45% were men. Within the follow-up, 17% participants reported having newly diagnosed CVD and 16% had a CVD-related hospital admission. We found that loneliness was associated with an increased risk of CVD events independent of potential confounders and risk factors. The hazard of people with the highest level of loneliness was about 30% higher for onset CVD diagnosis (HR: 1.05, 95% CI: 1.01 to 1.09) and 48% higher for CVD-related hospital admissions (HR: 1.08, 95% CI: 1.03 to 1.14), compared with the least lonely. There was little evidence that social isolation was independently associated with the risk of either CVD diagnosis or admission.ConclusionsOur findings provided strong evidence for the relationship between loneliness and cardiovascular events. Loneliness should be considered as a psychosocial risk factor for CVD in both research and interventions for cardiovascular prevention.

Policy makers across the political spectrum have extolled the virtues of volunteering in achieving social policy aims. Yet little is known about the role that volunteering plays in addressing one of the significant challenges of an ageing population: the provision of care and support to people with dementia. We combine organisational survey data, secondary social survey data, and in-depth interviews with people with dementia, family carers and volunteers in order to better understand the context, role and challenges in which volunteers support people with dementia. Social policies connecting volunteering and dementia care in homes and communities often remain separate and disconnected and our paper draws on the concept of policy ‘assemblages’ to suggest that dementia care is a dynamic mixture of formal and informal volunteering activities that bridge and blur traditional policy boundaries. Linking home and community environments is a key motivation, benefit and outcome for volunteers, carers and those living with dementia. The paper calls to widen the definition and investigation of volunteering in social policy to include and support informal volunteering activity.

BackgroundThere is currently major concern about the impact of the global COVID-19 outbreak on mental health. But it remains unclear how individual behaviours could exacerbate or protect against adverse changes in mental health.AimsTo examine the associations between specific activities (or time use) and mental health and well-being among people during the COVID-19 pandemic.MethodData were from the UCL COVID-19 Social Study, a panel study collecting data weekly during the COVID-19 pandemic. The analytical sample consisted of 55 204 adults living in the UK who were followed up for the 11-week strict lockdown period from 21 March to 31 May 2020. Data were analysed using fixed-effects and Arellano–Bond models.ResultsChanges in time spent on a range of activities were associated with changes in mental health and well-being. After controlling for bidirectionality, behaviours involving outdoor activities such as gardening and exercising predicted subsequent improvements in mental health and well-being, whereas increased time spent following news about COVID-19 predicted declines in mental health and well-being.ConclusionsThese results are relevant to the formulation of guidance for people obliged to spend extended periods in isolation during health emergencies and may help the public to maintain well-being during future lockdowns and pandemics.

Background The coronavirus disease 2019 (COVID-19) pandemic has brought about significant behavioural changes, one of which is increased time spent at home. This could have important public health implications. This study aimed to explore longitudinal patterns of ‘home confinement’ (defined as not leaving the house/garden) during the COVID-19 pandemic, and the associated predictors and mental health outcomes. Methods Data were from the UCL COVID-19 Social Study. The analytical sample consisted of 25 390 adults in England who were followed up for 17 months (March 2020–July 2021). Data were analysed using growth mixture models. Results Our analyses identified three classes of growth trajectories, including one class showing a high level of persistent home confinement (the home-confined, 24.8%), one changing class with clear alignment with national containment measures (the adaptive, 32.0%), and one class with a persistently low level of confinement (the unconfined, 43.1%). A range of factors were associated with the class membership of home-confinement trajectories, such as age, gender, income, employment status, social relationships and health. The home-confined class had the highest number of depressive (diff = 1.34–1.68, p < 0.001) and anxiety symptoms (diff = 0.84–1.05, p < 0.001) at the end of the follow-up than the other two classes. Conclusions There was substantial heterogeneity in longitudinal patterns of home confinement during the COVID-19 pandemic. People with a persistent high level of confinement had the worst mental health outcomes, calling for special attention in mental health action plans, in particular targeted interventions for at-risk groups.

Background The interplay between social connections, leisure engagement and health is well investigated, highlighting how social connections and leisure engagement affect health outcomes; and reciprocally, how these health factors predict leisure engagement and aspects of our social connections. However, there remains a gap in our understanding of how genetic propensity for psychological and neurological traits may also influence leisure engagement and social connections. This is important for research, as an individual’s genetic propensity might not only influence health outcomes but also influence the social factors that are known to benefit health outcomes too. Methods In this study, we utilised the English Longitudinal Study of Ageing (ELSA), which is a large nationally representative sample of the English population aged ≥50 years. Polygenic propensity was measured using a polygenic score (PGS) approach. Eight independent exposure-wide regression analyses were run for social connection outcomes (loneliness, relationship strain, social support and contact with social network), and leisure engagement (group membership, volunteering, cultural engagement and hobbies). Fourteen PGSs for psychological traits (e.g., depression and neuroticism) and neurological traits (e.g., ADHD), were used as predictors, and each PGS was run independently within each exposure-wide analysis. Analyses adjusted for age, age2, sex, and 10 principal components accounting for ancestry; Bonferroni correction was applied due to multiple testing. To aid interpretability, each PGS was standardized to a mean of 0 (standard deviation (SD) of 1). Results A one SD increase in depression-PGS was associated with both higher loneliness (B=0.10, 95%CI=0.06–0.14, p Conclusion Results indicate that an individual’s polygenic propensity for depression, neuroticism and ADHD predict their social connections and leisure engagement, thus highlighting that common genetic markers for major mental and neurological health outcomes influence social connections and leisure engagement, potentially indicating a shared genetic overlap between them. Overall, this highlights the importance of considering the role of genetic influence when looking at the interplay between social connections, leisure engagement and health in future research.

Background Engaging in the arts is a health-related behavior that may be influenced by social inequalities. While it is generally accepted that there is a social gradient in traditional arts and cultural activities, such as attending classical music performances and museums, previous studies of arts engagement in the US have not adequately investigated whether similar demographic and socioeconomic factors are related to other forms of arts engagement. Methods Using cross-sectional data from the General Social Survey (GSS) in the US, we examined which demographic, socioeconomic, residential, and health factors were associated with attendance at arts events, participation in arts activities, membership of creative groups, and being interested in (but not attending) arts events. We combined data from 1993 to 2016 in four analytical samples with a sample size of 8684 for arts events, 4372 for arts activities, 4268 for creative groups, and 2061 for interested non-attendees. Data were analysed using logistic regression. Results More education was associated with increased levels of all types of arts engagement. Parental education demonstrated a similar association. Being female, compared to male, was also consistently associated with higher levels of engagement. Attendance at arts events was lower in participants with lower income and social class, poorer health, and those living in less urban areas. However, these factors were not associated with participation in arts activities or creative groups or being an interested non-attendee. Conclusions Overall, we found evidence for a social gradient in attendance at arts events, which was not as pronounced in participation in arts activities or creative groups or interest in arts events. Given the many benefits of engagement in the arts for education, health, and wider welfare, our findings demonstrate the importance of identifying factors to reduce barriers to participation in the arts across all groups in society.

Rising hospital admissions due to respiratory disease (RD) are a major challenge to hospitals. This study explored modifiable social risk factors among 4478 older adults from the English Longitudinal Study of Ageing. Data were linked with administrative hospital records and mortality registry data (follow-up 9.6 years) and analysed using survival analysis accounting for competing risks. Living alone and social disengagement but not social contact or loneliness were associated with an increased risk of RD admissions, independent of socio-demographic, health and behaviour factors. Providing support for disengaged adults living alone who are at risk of RD admissions should be explored.

Aims: This study aimed to examine potential heterogeneity in longitudinal changes in home-based arts engagement during the first national lockdown and following gradual easing of restrictions in the UK. Further, it sought to explore factors that were associated with patterns of longitudinal changes in home-based arts engagement. Methods: Data were from the UCL COVID-19 Social Study. The analytical sample consisted of 29,147 adults in the UK who were followed up for 22 weeks from 21st March to 21st August 2020. Data were analysed using growth mixture models. Results: Our analyses identified five classes of growth trajectories. There were two stable classes showing little change in arts engagement over time (64.4% in total), two classes showing initial increases in arts engagement followed by declines as restrictions were eased (29.8%), and one class showing slight declines during strict lockdown followed by an increase in arts engagement after the easing of restrictions (5.9%). A range of factors were found to be associated with class membership of these arts engagement trajectories, such as age, gender, education, income, employment status, and health. Conclusions: There is substantial heterogeneity in longitudinal changes in home-based arts engagement. For participants whose engagement changed over time, growth trajectories of arts engagement were related to changes in lockdown measures. These findings suggest that some individuals may have drawn on the arts when they needed them the most, such as during the strict lockdown period, even if they usually had lower levels of arts engagement before the pandemic. Overall, our results indicate the importance of promoting arts engagement during pandemics and periods of lockdown as part of public health campaigns.

BackgroundRecent studies have shown reduced physical activity at early stages of the COVID-19 pandemic. However, there is a lack of investigation on longitudinal changes in physical activity beyond lockdowns and stay at home orders. Moreover, it is unclear if there is heterogeneity in physical activity growth trajectories. This study aimed to explore longitudinal patterns of physical activity and factors associated with them.MethodsData were from the UCL COVID -19 Social Study. The analytical sample consisted of 35,915 adults in England who were followed up for 22 weeks from 24th March to 23rd August 2020. Data were analysed using growth mixture models.FindingsOur analyses identified six classes of growth trajectories, including three stable classes showing little change over time (62.4% in total), two classes showing decreasing physical activity (28.6%), and one class showing increasing physical activity over time (9%). A range of factors were found to be associated the class membership of physical activity trajectories, such as age, gender, education, income, employment status, and health.InterpretationThere is substantial heterogeneity in longitudinal changes in physical activity during the COVID-19 pandemic. However, a substantial proportion of our sample showed persistent physical inactivity or decreasing physical activity. Given the well-established linked between physical activity and health, persistent or increased physical inactivity is likely to have both immediate and long-term implications for people’s physical and mental health, as well as general wellbeing. More efforts are needed to promote physical activity during the pandemic and beyond.FundingNuffield Foundation, UK Research and Innovation, Wellcome Trust

BackgroundThere are concerns that key workers may be at a greater risk for psychological distress than non-key workers during the COVID-19 pandemic. However, little research has included key workers outside of the healthcare sector or has disaggregated key workers into different subgroups.AimsTo examine longitudinal changes in mental health over 12 months during the COVID-19 pandemic comparing four different groups of key workers with non-key workers.MethodLongitudinal data were from 21,874 adults living in England (21 March 2020 to 22 February 2021). Latent growth modelling (LGM) was utilised to compare growth trajectories of depressive and anxiety symptoms in non-key workers and four types of key workers: i) health and social care workers, ii) teachers and childcare workers, iii) public service workers, and iv) essential services key workers (e.g., food chain or utility workers).ResultsWhen accounting for both time-invariant and time-varying covariates, key workers in the essential services category had consistently higher levels of depressive and anxiety symptoms than non-key workers across the whole of the study period. There was little difference in mental health trajectories between health/social care, teachers/childcare and public service worker categories and non-key workers.ConclusionsOur findings suggest risk for poorer mental health during the COVID-19 pandemic varies within the broad category of key workers generally, and that those working in utility, food chain, and transport roles are especially at risk. Future research should focus on identifying which aspects of working conditions may be contributing to occupational stress in these groups.

Background Cognitive impairment is common in older people admitted to hospital, but previous research has focused on single conditions. Objective This project sits in phase 0/1 of the Medical Research Council Framework for the Development and Evaluation of Complex Interventions. It aims to develop an understanding of current health-care outcomes. This will be used in the future development of a multidomain intervention for people with confusion (dementia and cognitive impairment) in general hospitals. The research was conducted from January 2015 to June 2018 and used data from people admitted between 2012 and 2013. Design For the review of outcomes, the systematic review identified peer-reviewed quantitative epidemiology measuring prevalence and associations with outcomes. Screening for duplication and relevance was followed by full-text review, quality assessment and a narrative review (141 papers). A survey sought opinion on the key outcomes for people with dementia and/or confusion and their carers in the acute hospital (n = 78). For the analysis of outcomes including cost, the prospective cohort study was in a medical admissions unit in an acute hospital in one Scottish health board covering 10% of the Scottish population. The participants (n = 6724) were older people (aged ≥ 65 years) with or without a cognitive spectrum disorder who were admitted as medical emergencies between January 2012 and December 2013 and who underwent a structured nurse assessment. ‘Cognitive spectrum disorder’ was defined as any combination of delirium, known dementia or an Abbreviated Mental Test score of Data sources Scottish Morbidity Records 01 was linked to the Older Persons Routine Acute Assessment data set. Results In the systematic review, methodological heterogeneity, especially concerning diagnostic criteria, means that there is significant overlap in conditions of patients presenting to general hospitals with confusion. Patients and their families expect that patients are discharged in the same or a better condition than they were in on admission or, failing that, that they have a satisfactory experience of their admission. Cognitive spectrum disorders were present in more than one-third of patients aged ≥ 65 years, and in over half of those aged ≥ 85 years. Outcomes were worse in those patients with cognitive spectrum disorders than in those without: length of stay 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year mortality or re-admission 62.4% vs. 51.5%, respectively (all p Limitations A lack of diagnosis and/or standardisation of diagnosis for dementia and/or delirium was a limitation for the systematic review, the quantitative study and the economic study. The economic study was limited to in-hospital costs as data for social or informal care costs were unavailable. The survey was conducted online, limiting its reach to older carers and those people with cognitive spectrum disorders. Conclusions Cognitive spectrum disorders are common in older inpatients and are associated with considerably worse health-care outcomes, with significant overlap between individual cognitive spectrum disorders. This suggests the need for health-care systems to systematically identify and develop care pathways for older people with cognitive spectrum disorders, and avoid focusing on only condition-specific pathways. Future work Development and evaluation of a multidomain intervention for the management of patients with cognitive spectrum disorders in hospital. Study registration This study is registered as PROSPERO CRD42015024492. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.

Purpose of review In this review, we synthesise recent research on the association between loneliness and cardiovascular disease (CVD). We present evidence for mechanisms underlying this association and propose directions for future research. Recent findings Loneliness is related to increased risk of early mortality and CVD comparable to other well-established risk factors such as obesity or smoking. Summary Loneliness has been linked to higher rates of incident CVD, poorer CVD patient outcomes, and early mortality from CVD. Loneliness likely affects risk for these outcomes via health-related behaviours (e.g. physical inactivity and smoking), biological mechanisms (e.g. inflammation, stress reactivity), and psychological factors (e.g. depression) to indirectly damage health.

There is widespread concern about the potential impact on health and social care services of the ageing population and long-term health conditions, such as dementia. To effectively plan services it is important to understand current need and use and identify gaps in provision. Using data from the Cognitive Function and Ageing Study Wales (CFAS Wales), we used logistic regression to model the relationship between health (self-rated health, cognitive impairment, and activities of daily living), and the use of health and care services. CFAS Wales is a longitudinal cohort study of people aged 65 years and over, in two areas in Wales, UK, over-sampling those aged 75 years and over. Participants (n = 3593) answered a wide range of health and lifestyle questions and completed a variety of cognitive and physical health assessments. Data from 3153 people from wave 1 and 1968 people from wave 2 were analysed. As anticipated we found poorer health, on some indicators, predicted greater service use, including social care, hospital, general practitioner, and nursing services. However, cognitive impairment did not predict greater service use, except for social care. Controlling for age, sex, socio-economic status, social connection indices and area environment, conversely we found lower reported uptake of allied health services by people with cognitive impairment. Further analysis showed that people with a cognitive impairment were less likely to report having a sight-check or seeing a dentist in the previous year, a finding replicated in wave 2. These differences were not explained by transportation issues. In contrast, we did not find a significant difference in reported uptake of hearing checks or physiotherapist use, with mixed evidence of differences in chiropodist visits. Not accessing these preventative services may not only exacerbate existing conditions but have further downstream negative consequences for health and well-being in people who are cognitively impaired., Highlights • Medical and social care service use typically increased as health decreased. • Allied health services uptake decreased for those with a cognitive impairment. • Cognitive impairment significantly lowered odds of sight checks and dentist visits. • Inequalities in sight and dental checks remain after factoring in accessibility. • Routine health checks remain important even if facing other health challenges.

Summary Background & aims The COVID-19 pandemic has led to the implementation of stay-at-home and lockdown measures. It is currently unknown if the experience of lockdown leads to long term changes in individual's eating behaviors. The objectives of this study were: i) to derive longitudinal trajectories of change in eating during UK lockdown, and ii) to identify risk factors associated with eating behavior trajectories. Method Data from 22,374 UK adults from the UCL COVID-19 Social study (a panel study collecting weekly data during the pandemic) were analyzed from 28th March to 29th May 2020. Latent Class Growth Analysis was used to derive trajectories of change in eating. These were then associated with prior socio-economic, health-related and psychological factors using multinomial regression models. Results Analyses suggested five trajectories, with the majority (64%) showing no change in eating. In contrast, one trajectory was marked by persistently eating more, whereas another by persistently eating less. Overall, participants with greater depressive symptoms were more likely to report any change in eating. Loneliness was linked to persistently eating more (OR = 1.07), whereas being single or divorced, as well as stressful life events, were associated with consistently eating less (OR = 1.69). Overall, higher education status was linked to lower odds of changing eating behavior (OR = 0.54–0.77). Secondary exploratory analyses suggest that participants self-reported to have overweight were more commonly categorised into the group consistently eating more, whereas participants with underweigh persistently ate less. Conclusion In this study, we found that one third of the sample report changes in quantities eaten throughout the first UK lockdown period. Findings highlight the importance of adjusting public health programs to support eating behaviors in future lockdowns both in this and potential future pandemics. This is particularly important as part of on-going preventive efforts to prevent nutrition-related chronic diseases.

AimsDue to a prolonged period of national and regional lockdown measures during the coronavirus (COVID-19) pandemic, there has been an increase reliance on informal care and a consequent increase in care intensity for informal carers. In light of this, the current study compared the experiences of carers and non-carers on various mental health and wellbeing measures across 5 key time points during the pandemic.MethodsData analysed were from the UCL COVID -19 Social Study. Our study focused on 5 time points in England: (i) the first national lockdown (March-April 2020; N=12,053); (ii) the beginning of lockdown rules easing (May 2020; N=24,374); (iii) further easing (July 2020; N=21,395); (iv) new COVID-19 restrictions (September 2020; N=4,792); and (v) the three-tier system restrictions (October 2020; N=4,526). We considered 5 mental health and wellbeing measures-depression, anxiety, loneliness, life satisfaction and sense of worthwhile. Propensity score matching were applied for the analyses.ResultsWe found that informal carers experienced higher levels of depressive symptoms and anxiety than non-carers across all time points. During the first national lockdown, carers also experienced a higher sense of life being worthwhile. No association was found between informal caring responsibilities and levels of loneliness and life satisfaction.ConclusionGiven that carers are an essential national health care support, especially during a pandemic, it is crucial to integrate carers’ needs into healthcare planning and delivery. These results highlight there is a pressing need to provide adequate and targeted mental health support for carers during and following this pandemic.

PurposeThe coronavirus disease 2019 (COVID-19) pandemic has put a great strain on people’s mental health. A growing number of studies have shown worsening mental health measures globally during the pandemic. However, there is a lack of empirical study on how people support their mental health during the COVID-19 pandemic. This study aimed to examine a number of formal and informal mental health supports. Further, it explored factors that might be associated with the use of different types mental health support.MethodData from 26,740 adults in the UCL COVID -19 Social Study were analysed between 13thApril, 2020 and 3rdJuly, 2020. Data were analysed using logistic and Poisson regression models.ResultsAbout 45% of people reported talking to friends or family members to support their mental health, 43% engaging in self-care activities, 20% taking medication, 9% speaking to mental health professionals, 8% talking to a GP or other health professional, and another 8% using helpline or online services. Gender, education, living status, loneliness, pre-existing mental health conditions, general depression and anxiety, coping and personality were found to be associated with the use of mental health support.ConclusionWhile the negative impacts caused by the COVID-19 pandemic are inevitable, people can play an active role in managing their mental health. Understanding the patterns and predictors of various kinds of mental health support during the pandemic is crucial for future service planning and delivery through recognising potential barriers to mental health care faced by certain groups.

Background: Smoking is often colloquially considered “social”. However, the relationship between smoking with current and future social isolation and loneliness is unclear. Therefore, we examined these relationships over a 12-year follow-up. Methods: In this cohort study, we used a nationally representative sample of community dwelling adults aged 50 years and over from the English Longitudinal Study of Ageing (N=8780) (45% male, mean age of 67 years, standard deviation of 10). We examined associations of self-reported smoking status at baseline assessment, with social isolation (low social contact, social disengagement, domestic isolation), and loneliness (3-item UCLA loneliness scale), measured at baseline, and follow-up at 4, 8 and 12 years after. Findings: At baseline, smokers were more likely to be lonely and socially isolated than non-smokers, having less frequent social interactions with family and friends, having less frequent engagement with community and cultural activities, and being more likely to live alone. Smoking at baseline was associated with larger reductions in social contact, increases in social disengagement, and loneliness over time. No evidence was found for the association between smoking and changes in cohabitation status. These findings were independent of all identified confounders, including age, sex, social class and the presence of physical and mental health diagnoses. Interpretation: Smoking is associated with the development of increasing social isolation and loneliness in older adults. The idea that smoking might be prosocial appears a misconception. The intersection of these public health priorities requires further attention. Funding: UK Economic and Social Research Council & Imperial College London. Declaration of Interests: All authors have completed the ICMJE uniform disclosure form and declare: support from the National Institute of Ageing, a consortium of UK government departments coordinated by the Economic and Social Research Council; Imperial College London; and the Wellcome Trust for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: The study received ethical approval from the National Research Ethics Service and all participants provided informed consent.

Background: In response to the COVID-19 pandemic, governments around the world instituted various public-health measures. Our project aimed to highlight the most significant similarities and differences in key mental-health indicators between four Western and Northern European countries, and identify the population subgroups with the poorest mental-health outcomes during the first months of the pandemic.Methods: We analysed time-series survey data of 205,084 individuals from seven studies from Denmark, France, the Netherlands, and the UK to assess the impact of the pandemic and associated lockdowns. All analyses focused on the initial lockdown phase (March-July 2020). The main outcomes were loneliness, anxiety, and COVID-19-related worries and precautionary behaviours.Findings: COVID-19-related worries were consistently high in each country but decreased during the gradual reopening phases. While only 7% of the respondents reported high levels of loneliness in the Netherlands, percentages were higher in the rest of the three countries (13-18%). In all four countries, younger individuals and individuals with a history of mental illness expressed the highest levels of loneliness.Interpretation: The pandemic and associated country lockdowns had a major impact on the mental health of populations, and certain subgroups should be closely followed to prevent negative long-term consequences. Younger individuals and individuals with a history of mental illness would benefit from tailored publichealth interventions to prevent or counteract the negative effects of the pandemic. Individuals across Western and Northern Europe have thus far responded in psychologically similar ways despite differences in government approaches to the pandemic. (C) 2021 The Authors. Published by Elsevier Ltd.

Purpose The coronavirus disease 2019 (COVID-19) pandemic has put a great strain on people’s mental health. A growing number of studies have shown worsening mental health measures globally during the pandemic. However, there is a lack of empirical study on how people support their mental health during the COVID-19 pandemic. This study aimed to examine a number of formal and informal mental health support. Further, it explored factors that might be associated with the use of different types mental health support. Methods Data from 26,720 adults in the UCL COVID-19 Social Study were analysed between 13th April 2020 and 3rd July 2020. Data were analysed using logistic and Poisson regression models. Results About 45% of people reported talking to friends or family members to support their mental health, 43% engaging in self-care activities, 20% taking medication, 9% speaking to mental health professionals, 8% talking to a GP or other health professional, and another 8% using helpline or online services. Gender, education, living status, loneliness, pre-existing mental health conditions, general depression and anxiety, coping and personality were found to be associated with the use of mental health support. Conclusion While the negative impacts caused by the COVID-19 pandemic are inevitable, people can play an active role in managing their mental health. Understanding the patterns and predictors of various kinds of mental health support during the pandemic is crucial for future service planning and delivery through recognising potential barriers to mental health care faced by certain groups.

Loneliness and social isolation have been identified as important predictors of various health outcomes, but little research has investigated their influence on falls. This study aimed to investigate the longitudinal association between loneliness, social isolation and falls amongst older adults in England, looking at both self-reported falls and falls that require hospital admissions. This study drew on large scale, nationally representative data from the English Longitudinal Study of Ageing linked with Hospital Episode Statistics. Data were analysed using survival analysis, with self-reported falls (total sample = 4013) and falls require hospital admission being modelled separately (total sample = 9285). There was a 5% increase in the hazard of self-reported falls relative to one point increase in loneliness independent of socio-demographic factors (HR: 1.05, 95% CI: 1.02–1.08), but the association was explained away by individual differences in health and life-style measures (HR: 1.03, 95% CI: 1.00–1.07). Both living alone (HR: 1.18, 95% CI: 1.07–1.32) and low social contact (HR: 1.04, 95% CI: 1.01–1.07) were associated with a greater hazard of self-reported falls even after controlling for socio-demographic, health and life-style differences. Similar results were also found for hospital admissions following a fall. Our findings were robust to a variety of model specifications.

This study examines the relationship between dementia and institutionalisation directly after hospital discharges in older people and explores potential mediators of the association. Our analyses are based on linked Scottish administrative health and social care data, including 79,983 hospital stays for 43,753 patients aged 65 or over. Our results show that dementia patients are more likely to be discharged to care institutions compared with non-dementia patients (odds ratio = 17). Further analyses reveal that this can be partially explained by the fact that dementia patients are more likely to have injury-related admissions and long hospital stays. This indirect effect accounts for around 6% of the total effect. We also investigate the effect of receiving home care, finding no evidence that it influences the likelihood of institutionalisation from hospitals in older people.

Background The COVID-19 pandemic and nationally mandated restrictions to control the virus were anticipated to increase the incidence of mental health issues. So far, little evidence has been found of increases in the use of mental health services. Heterogeneous mental health has been found in general population cohorts during the first 6 months of the pandemic. This study aimed to explore changes in the likelihood of clinically significant mental health issues during 14 months of the pandemic, and to identify individual risk factors for poor mental health. Methods A cohort was formed of 33 703 adults in England who provided data between March, 2020, and April, 2021 (11 023 [32·7%] aged 60 years or older; 25 567 [75·9%] women; and 1628 [4·8%] from Black, Asian, and Minority Ethnic groups). Trajectories of meeting criteria for clinically significant depression or anxiety each month were estimated with growth mixture modelling through validated screening measure cutoffs (Patient Health Questionnaire-9 scores ≥10 or Generalised Anxiety Disorder Assessment-7 scores ≥8). Sociodemographic and personality-related (Big Five Inventory) risk factors associated with trajectory class membership were identified in multivariable regression models. The study was approved by the University College London Research Ethics Committee (reference 12467/005). Findings We identified five trajectories for depression and five for anxiety. Participants (general population weighted) in the largest trajectory class (depression: n=20 818 [62%]; anxiety: n=21 167 [63%]) had a less than 5% probability of reporting clinically significant symptoms of depression or anxiety throughout the study period. However, other trajectories represented participants with clinically significant mental health issues: high likelihood of distress throughout the study period (depression: n=4444 [13%]; anxiety: n=4214 [13%]); distress early in the pandemic that decreased within the first four months (depression: n=3 052 (9%); anxiety: n=3 050 [9%]); distress that emerged around five months after the pandemic began (depression: n=2157 [6%]; anxiety: n=2 111 [6%]); and a moderate likelihood of such problems throughout the pandemic study period (March, 2020, to April, 2021) (depression: n=3230 [10%]; anxiety: n=3 159 [9%]). Being in younger age groups (compared with being older than 60 years), female, a carer, having an existing mental health diagnosis, socialising daily pre-pandemic, and higher neuroticism scores were all independently associated with poorer mental health outcomes. Participants from Black, Asian, and Minority Ethnic groups or those living alone were more likely to follow trajectories that changed little in relation to the course of the pandemic. Interpretation Almost four in ten people followed trajectories with a greater than 50% chance of reporting clinically significant levels of depression or anxiety symptoms during the study period. Sociodemographic, health, and personality factors were associated with differential mental health trajectories. These findings might support targeted public health interventions for those in the highlighted at-risk groups, given the likelihood of developing mental health issues during the course of the pandemic. Funding This work was supported by the Nuffield Foundation (grant number WEL/FR-000022583), UK Research and Innovation (grant number ES/S002588/1), and Wellcome Trust (grant number 221400/Z/20/Z and 201292/Z/16/Z).

RATIONALE: The negative impact of the COVID-19 pandemic on mental health is well evidenced. However, there is little research on how individuals' coping strategies were related to changes in mental health over time. METHODS: The current study used data from the COVID-19 Social Study in the United Kingdom (N = 26,505) to explore whether coping strategies (problem-focused, emotion-focused, avoidant, and socially-supportive) were associated with (i) better mental health as lockdown was introduced, and (ii) faster recovery over time. RESULTS: People with greater use of problem-focused, avoidant, and supportive coping displayed more mental health symptoms, while greater use of emotion-focused coping was associated with fewer mental health symptoms. Symptoms decreased over time for all coping strategies, but only socially-supportive coping was associated with a faster decrease in anxiety and depressive symptoms, indicating a potential protective effect of social support on psychological distress. CONCLUSIONS: Problem-, avoidant- and emotion-focused coping strategies were not associated with faster improvements in mental health. Suggesting the adoption of one of these coping styles in itself is not necessarily a driver of improvements in mental health; rather, specific attributes of the behaviours expressed as part of this coping style appear to be important in and of themselves.

Objective To explore the recent 20 years' herbal administration rules in TCM treatments of ovarian cysts (OCs) based on data mining. Methods A prescription database for ovarian cysts was established by ACCESS 2007. Importing the database into SPSS17.0 and SPSS Modeler14.1. SPSS17.0 was used for descriptive and cluster analyses, while SPSS Modeler14.1 was used for association rules analysis. Results After screening, 363 prescriptions were obtained. The 10 most frequently-used Chinese herbal medicines are Zedoaria (Rhizoma Curcumae), Poria cocos (Poria), Common buried rubber (Rhizoma Sparganii), Red peony root (Radix Paeoniae Rubra), Peach seed (Semen Persicae), Danggui (Radix Angelicae Sinensis), Chinese angelica (Ramulus Cinnamomi), Liquorice root (Radix Glycyrrhizae), Pangolin scales (Squama Manis) and Moutan cortex (Cortex Moutan Radicis); the 5 most common syndromes of OCs are qi stagnation and blood stasis, phlegm and blood stasis, uterine blood stasis, stagnation of liver qi and retention of phlegm and dampness, nearly to 54.26%; In association rules analysis, 5 sets of two-herbs association rules were obtained, 17 sets of three-herbs association rules were obtained, 22 sets of four-herbs association rules were obtained and 4 sets of five-herbs association rules were obtained; By clustering, 13 sets of core couplet medicinals were obtained. Conclusion Medicinal herbs for promoting blood circulation to remove blood stasis, resolve hard lumps, for strengthening the spleen, eliminating phlegm, and relieving liver qi stagnation were highly used in the treatment of OCs; Herbs attributed to the Liver Meridian, the Spleen Meridian and the Heart Meridian were highly used in OCs; The compatibility of herbs for promoting blood circulation to remove blood stasis and resolve hard lumps were highly used; Guizhi Fuling Wan (GFW) was often used and combined with other herbs in the treatment of OCs.

Rationale There are increasing worries that lockdowns and ‘stay-at-home’ orders due to the COVID-19 pandemic could lead to a rise in loneliness, which is recognised as a major public health concern. But profiles of loneliness during the pandemic and risk factors remain unclear. Objective The current study aimed to examine if and how loneliness levels changed during the strict lockdown and to explore the clustering of loneliness growth trajectories. Methods Data from 38,217 UK adults in the UCL COVID -19 Social Study (a panel study collecting data weekly during the pandemic) were analysed during the strict lockdown period in the UK (23/03/2020–10/05/2020). The sample was well-stratified and weighted to population proportions of gender, age, ethnicity, education and geographical location. Growth mixture modelling was used to identify the latent classes of loneliness growth trajectories and their predictors. Results Analyses revealed four classes, with the baseline loneliness level ranging from low to high. In the first a few weeks of lockdown, loneliness levels increased in the highest loneliness group, decreased in the lowest loneliness group, and stayed relatively constant in the middle two groups. Younger adults (OR = 2.17–6.81), women (OR = 1.59), people with low income (OR = 1.3), the economically inactive (OR = 1.3–2.04) and people with mental health conditions (OR = 5.32) were more likely to be in highest loneliness class relative to the lowest. Further, living with others or in a rural area, and having more close friends or greater social support were protective. Conclusions Perceived levels of loneliness under strict lockdown measures due to COVID-19 were relatively stable in the UK, but for many people these levels were high with no signs of improvement. Results suggest that more efforts are needed to address loneliness., Highlights • Our analyses revealed four distinctive latent classes of loneliness trajectories. • During the seven weeks of strict lockdown, loneliness levels were relatively stable. • There is a slight increase in the highest loneliness class and decrease in the lowest class. • A range of demographic, health, and social factors were related to latent classes.