Understanding the relationship between income and mental health among 16- to 24-year-olds: Analysis of 10 waves (2009-2020) of Understanding Society to enable modelling of income interventions

Long-term trends in mental health disparities across sexual orientations in the UK: a longitudinal analysis (2010-2021)

BACKGROUNDS

In the context of increasing hate crimes, legislative challenges, and anti-LGBTQ + sentiment, we conducted the first study that comprehensively examined long-term mental health disparities across sexual orientations in the UK from 2010 to 2021. Prior studies predominantly relied on cross-sectional or limited longitudinal designs, thus failing to capture evolving trends over a decade and providing crucial insights into the dynamics of mental health challenges faced by sexual minorities, essential for devising targeted public health interventions and policies.

METHODS

Waves 2-12 of the UK Longitudinal Household Survey for adults (n = 52,591) were used. MCS-12 (Mental Health Component Scale of the Short-Form Health Survey) for mental functioning and GHQ (General Health Questionnaire) for psychological distress were included as the main outcomes, along with other measures of well-being. Mixed-effect longitudinal models were used to examine the trends of mental health disparities across sexual orientations.

RESULTS

Relative to their heterosexual counterparts, psychological distress (GHQ) increased for gay men, lesbians, and women with "other" orientations. Bisexual women saw the steepest increase from 1.69 higher GHQ vs. their heterosexual counterparts in 2010 (95%CI: 0.81 to 2.57), up to 3.37 in 2021 (95%CI: 2.28 to 4.45). Similar trends were also shown in the other measures.

CONCLUSIONS

The study highlights increases in mental health disparities between sexual minorities and heterosexuals. The escalating psychological distress among sexual minorities, particularly bisexual women, calls for an urgent, multi-faceted, and intersectoral response. This approach must address both symptoms and the social structures perpetuating these disparities across sexual orientations.

Whose assets? Individual and household income and savings and mental health in a longitudinal cohort

While there is a growing understanding of the link between financial assets and mental health, the literature is lacking in two dimensions. First, although wealth (including savings) may better inform ability to cope with life's stressors than income alone, the role of wealth in shaping health is substantially understudied relative to income. Second, most studies measure income at the household level instead of the individual level. Using five waves of the nationally representative CLIMB survey collected in Spring 2020, 2021, 2022, 2023, and 2024, we estimated the odds of probable depression (Patient Health Questionnaire, PHQ-9≥10) and anxiety (GAD-7≥10) across individual and household level income and savings using generalized estimating equations to account for clustering over time at the individual level and to account for baseline mental health. Our sample included 1,314 participants across the five waves of the CLIMB survey. The average age of participants was 46.5 years [sd: 16.4] in 2020. When controlling for demographic variables, each financial asset was independently associated with mental health. In fully adjusted models where savings and income at the individual and household level were included, for every $10,000 more that an adult reported in individual annual income, they had 0.95 times the odds of probable depression (95%CI: 0.92, 0.99) and 0.95 time the odds of probable anxiety (95%CI: 0.91, 0.99), translating to 5% lower odds. Having $10,000 more in individual savings was associated with 0.95 times the odds of probable anxiety (95%CI: 0.91, 0.99). These findings suggest that 1) financial assets were each independently associated with mental health, 2) having higher individual income was associated with mental health even when adjusting for financial assets at the household and individual level, and 3) higher individual savings were associated with lower probable anxiety. Individual-level financial assets may be associated with mental health differently than household-level financial assets.

Examining the relationship between income and both mental and physical health among adults in the UK: Analysis of 12 waves (2009-2022) of Understanding Society

There is growing evidence of a causal relationship between income and health. At the same time, pressure on reactive health and care services in the UK is increasing. Previous work to quantify the relationship has focused on particular age groups, conditions, or single-item self-rated health. This article reports findings from a study that aimed to provide more comprehensive estimates with an objective of creating an evidential basis for microsimulation modelling of upstream income interventions. We analyse the relationship between income and two health measures - SF-12 Mental Component Summary (MCS-12) and Physical Component Summary (PCS-12) - across 12 waves (2009/11-2020/22) of Understanding Society: The UK Household Longitudinal Study. Using a 'within-between' model (Model 1), we find that increases in income compared with an individual's average and a higher income compared with the sample average is associated with better mental health (higher MCS-12 score) and better functional physical health (higher PCS-12 score). However, for a given increase in household income (say £100 per month), the association with better mental and physical health is smaller at higher incomes. This suggests that redistribution from high-income to lower income households would increase average population physical and mental health, other things being equal. Using a random-effects logistic regression (Model 2), we similarly find that average income quintile is inversely and monotonically associated with the probability of having clinically significant symptoms of depressive disorders (MCS-12 ≤ 45.6) and physical health problems (PCS-12 score ≤ 50.0), with smaller changes in these probabilities from increases in income at higher points in the income distribution. These findings facilitate microsimulation modelling including an estimation of the impact of changes in QALYs, from changes in income, enabling a more detailed and complete understanding of which socioeconomic interventions might begin to address some of the causes of long-term health conditions that are underpinned by socioeconomic determinants.

Exogenous Increases in Basic Income Provisions Increase Preventive Health-Seeking Behavior: A Quasi-Experimental Study

INTRODUCTION

Universal Basic Income (UBI) policies have the potential to promote a wide range of public health objectives by providing those who qualify with direct cash payments. One overlooked mechanism of particular importance to health researchers is the possibility that guaranteed income might increase consultation of primary and preventive care (e.g., annual doctors' visits; regular vaccination against infectious disease) by providing people with both the time and monetary resources to do so, thereby improving general health.

METHODS

This study assesses the effects of an exogenous shock to Alaska's UBI payments to all state residents: a 2022 decision to reclassify dividend "energy relief" provisions as nontaxable (thereby increasing payments by approximately $2,000 inflation-adjusted dollars). It estimates quasi-experimental treatment effects (in 2022 vs. 2021) via mixed linear probability models that compare pre/post policy change in primary care seeking behavior in Alaska vs. the US adult population; controlling for respondent-level fixed effects and state-level random effects. Data were collected in 2021-2022, and analyzed in 2024.

RESULTS

The likelihood that Alaskans sought primary care postreform (relative to beforehand) increased by 6pp, which was significantly greater than the same difference (2pp) observed across all other (non-UBI) US States (∆=4pp, p<0.01). The study provides suggestive evidence that comparatively fewer Alaskans had difficulty affording primary care during this period, with less-consistent evidence of increased flu vaccine uptake.

CONCLUSIONS

Enhanced UBI payments ought to be thought about as a form of health policy, as they have the potential to advance a wide range of health objectives related to preventive care.

Prospective Health Impacts of a Universal Basic Income: Evidence from Community Engagement in South Tyneside, United Kingdom

Studies have suggested that universal basic income (UBI) has the capacity to have substantial health benefits across the population at national level. Multiple impact pathways have recently been theorized and there are calls for trials to explore these pathways empirically. However, very limited research has taken place at local levels to explore potential context-specific effects, or how these effects could play out in economic, social, and behavioral changes. In order to examine these effects and to think through potential issues and unintended consequences, we brought together citizen engagement groups in Jarrow, South Tyneside, in the northeast of England to explore local people's expectations and positions on the development of UBI policies and pilots prior to their implementation. We found that people's expectations regarding the potential beneficial health impacts of UBI on their communities mapped strongly onto academically theorized impact pathways. They also extended understanding of these pathways in meaningful ways. Our findings add to the literature about UBI and health and provide important insights for the future development of empirical, health focused, UBI research.

Trends in youth acute care hospital visits for anxiety and depression in Illinois

PURPOSE

This study analyzes the trajectory of youth emergency department or inpatient hospital visits for depression or anxiety in Illinois before and during the COVID-19 pandemic.

METHODS

We analyze emergency department (ED) outpatient visits, direct admissions, and ED admissions by patients ages 5-19 years coded for depression or anxiety disorders from 2016 through June 2023 with data from the Illinois Hospital Association COMPdata database. We analyze changes in visit rates by patient sociodemographic and clinical characteristics, hospital volume and type, and census zip code measures of poverty and social vulnerability. Interrupted times series analysis was used to test the significance of differences in level and trends between 51 pre-pandemic months and 39 during-pandemic months.

RESULTS

There were 250,648 visits to 232 Illinois hospitals. After large immediate pandemic decreases there was an estimated -12.0 per-month (p = 0.003, 95% CI -19.8-4.1) decrease in male visits and a - 13.1 (p = 0.07, 95% CI -27 -1) per-month decrease in female visits in the during-pandemic relative to the pre-pandemic period. The reduction was greatest for outpatient ED visits, for males, for age 5-9 and 15-19 years patients, for smaller community hospitals, and for patients from the poorest and most vulnerable zip code areas.

CONCLUSIONS

llinois youth depression and anxiety hospital visit rates declined significantly after the pandemic shutdown and remained stable into 2023 at levels below 2016-2019 rates. Further progress will require both clinical innovations and effective prevention grounded in a better understanding of the cultural roots of youth mental health.

A longitudinal study on impact of emergency cash transfer payments during the COVID pandemic on coping among Australian young adults

The coronavirus (COVID-19) pandemic has caused financial hardship and psychological distress among young Australians. This study investigates whether the Australian Government's emergency cash transfer payments-specifically welfare expansion for those unemployed prior to the pandemic (known in Australia as the Coronavirus Supplement) and JobKeeper (cash support for those with reduced or stopped employment due to the pandemic)-were associated with individual's level of coping during the coronavirus pandemic among those with and without mental disorders (including anxiety, depression, ADHD and autism). The sample included 902 young adults who participated in all of the last three waves (8, 9C1, 9C2) of the Longitudinal Study of Australian Children (LSAC), a nationally representative cohort study. Modified Poisson regression models were used to assess the impact of emergency cash transfer payments on 18-22-year-old's self-rated coping level, stratifying the analysis by those with and without mental disorders. All models were adjusted for gender, employment, location, family cohesion, history of smoking, alcohol intake, and COVID-19 test result. Of the 902-person sample analysed, 41.5% (n = 374) reported high levels of coping, 18.9% (n = 171) reported mental disorders, 40.3% (n = 364) received the Coronavirus Supplement and 16.4% (n = 148) received JobKeeper payments. Analysing the total sample demonstrated that participants who received the JobKeeper payment were more likely to have a higher level of coping compared to those who did not receive the JobKeeper payment. Stratified analyses demonstrated that those with pre-existing mental disorder obtained significant benefit from the JobKeeper payment on their level of coping, compared to those who did not receive JobKeeper. In contrast, receipt of the Coronavirus Supplement was not significantly associated with higher level of coping. Among those with no mental health disorder, neither the Coronavirus Supplement nor JobKeeper had a statistically significant impact on level of coping. These findings suggest the positive impacts of cash transfers on level of coping during the pandemic were limited to those with a pre-existing mental disorder who received JobKeeper.

Social media effects on well‐being: The hypothesis of addiction of a new variety

Recent evidence shows that social media use has negative effects on well‐being of children and youths. However, the underlying reasons are unclear, as social media are means that can also serve beneficial purposes. We propose the hypothesis that social media induce users to harmful addiction of a new variety because such use is not toxic per se but becomes toxic by crowding out beneficial activities. We identify, in particular, the key mechanism in the change of time preference: While social media induce users to present‐biassed activities, thus encouraged by how platforms are designed, they crowd out activities that develop skills and are forward‐looking, such as education, volunteering and democratic participation. This triggers a vicious circle leading to a long run deterioration of well‐being and skills that would have acted as an antidote to addiction. As implication, policies should address adequate information and education in general, as well as increased competition in the digital platform market. While the available evidence supports our hypothesis in many respects, more empirical research is needed.

Short-term impacts of Universal Basic Income on population mental health inequalities in the UK: A microsimulation modelling study

BACKGROUND

Population mental health in the United Kingdom (UK) has deteriorated, alongside worsening socioeconomic conditions, over the last decade. Policies such as Universal Basic Income (UBI) have been suggested as an alternative economic approach to improve population mental health and reduce health inequalities. UBI may improve mental health (MH), but to our knowledge, no studies have trialled or modelled UBI in whole populations. We aimed to estimate the short-term effects of introducing UBI on mental health in the UK working-age population.

METHODS AND FINDINGS

Adults aged 25 to 64 years were simulated across a 4-year period from 2022 to 2026 with the SimPaths microsimulation model, which models the effects of UK tax/benefit policies on mental health via income, poverty, and employment transitions. Data from the nationally representative UK Household Longitudinal Study were used to generate the simulated population (n = 25,000) and causal effect estimates. Three counterfactual UBI scenarios were modelled from 2023: "Partial" (value equivalent to existing benefits), "Full" (equivalent to the UK Minimum Income Standard), and "Full+" (retaining means-tested benefits for disability, housing, and childcare). Likely common mental disorder (CMD) was measured using the General Health Questionnaire (GHQ-12, score ≥4). Relative and slope indices of inequality were calculated, and outcomes stratified by gender, age, education, and household structure. Simulations were run 1,000 times to generate 95% uncertainty intervals (UIs). Sensitivity analyses relaxed SimPaths assumptions about reduced employment resulting from Full/Full+ UBI. Partial UBI had little impact on poverty, employment, or mental health. Full UBI scenarios practically eradicated poverty but decreased employment (for Full+ from 78.9% [95% UI 77.9, 79.9] to 74.1% [95% UI 72.6, 75.4]). Full+ UBI increased absolute CMD prevalence by 0.38% (percentage points; 95% UI 0.13, 0.69) in 2023, equivalent to 157,951 additional CMD cases (95% UI 54,036, 286,805); effects were largest for men (0.63% [95% UI 0.31, 1.01]) and those with children (0.64% [95% UI 0.18, 1.14]). In our sensitivity analysis assuming minimal UBI-related employment impacts, CMD prevalence instead fell by 0.27% (95% UI -0.49, -0.05), a reduction of 112,228 cases (95% UI 20,783, 203,673); effects were largest for women (-0.32% [95% UI -0.65, 0.00]), those without children (-0.40% [95% UI -0.68, -0.15]), and those with least education (-0.42% [95% UI -0.97, 0.15]). There was no effect on educational mental health inequalities in any scenario, and effects waned by 2026. The main limitations of our methods are the model's short time horizon and focus on pathways from UBI to mental health solely via income, poverty, and employment, as well as the inability to integrate macroeconomic consequences of UBI; future iterations of the model will address these limitations.

CONCLUSIONS

UBI has potential to improve short-term population mental health by reducing poverty, particularly for women, but impacts are highly dependent on whether individuals choose to remain in employment following its introduction. Future research modelling additional causal pathways between UBI and mental health would be beneficial.

Correlation of event-related potentials N170 with dysfunctional attitudes in patients with major depressive disorder

BACKGROUND

Cognitive impairment frequently accompanies first-episode major depressive disorder (MDD) in patients. Early detection and intervention for cognitive impairment can enhance the quality of life for individuals with depressive disorders. Impaired emotion recognition may serve as an initial manifestation of cognitive impairment in these patients. This study examines the characteristics of event-related potentials N170 and dysfunctional attitudinal questionnaire total scores, as well as each factor and their correlation, revealing characteristic electroencephalogram (EEG) changes associated with cognitive impairment in first-episode MDD patients.

METHOD

A total of 88 patients experiencing first-episode MDD and 29 healthy volunteers from the same period participated in the study. They underwent event-related potential N170 measures to assess mood recognition function, the 17-item Hamilton depression scale (HAMD-17) to evaluate the severity of depressive disorder, and the Dysfunctional Attitudes Scales(DAS) to appraise cognitive function.

RESULT

The dysfunctional attitude questionnaire's total score and each factor score were higher in the MDD group compared to the healthy control (HC) group. The MDD group exhibited lower amplitudes than the HC group at CZ, PZ, POZ, P7, PO7, P8, and PO8 electrode points. A correlation was identified between the P7 and PO7 electrode points of the event-related potential N170 and cognitive function.

LIMITATION

This study solely considered neutral face emotional stimuli and did not account for depressive disorder subtypes.

CONCLUSION

Differences were observed between the MDD and HC groups in cognitive function and N170 amplitude in the central brain region (CZ, PZ, POZ), left posterior temporal region (P7), left occipitotemporal region (PO7), right posterior temporal region (P8), and right occipitotemporal region (PO8). Additionally, a correlation was found between N170 latency in the left posterior temporal region of the brain (P7) and the left occipitotemporal region (PO7) with cognitive function.

Quantifying the mental health and economic impacts of prospective Universal Basic Income schemes among young people in the UK: a microsimulation modelling study

OBJECTIVE

Universal Basic Income (UBI)-a largely unconditional, regular payment to all adults to support basic needs-has been proposed as a policy to increase the size and security of household incomes and promote mental health. We aimed to quantify its long-term impact on mental health among young people in England.

METHODS

We produced a discrete-time dynamic stochastic microsimulation that models a close-to-reality open cohort of synthetic individuals (2010-2030) based on data from Office for National Statistics and Understanding Society. Three UBI scheme scenarios were simulated: Scheme 1-Starter (per week): £41 per child; £63 per adult over 18 and under 65; £190 per adult aged 65+; Scheme 2-Intermediate (per week): £63 per child; £145 per adult under 65; £190 per adult aged 65+; Scheme 3-Minimum Income Standard level (per week): £95 per child; £230 per adult under 65; £230 per adult aged 65+. We reported cases of anxiety and depression prevented or postponed and cost savings. Estimates are rounded to the second significant digit.

RESULTS

Scheme 1 could prevent or postpone 200 000 (95% uncertainty interval: 180 000 to 210 000) cases of anxiety and depression from 2010 to 2030. This would increase to 420 000(400 000 to 440 000) for Scheme 2 and 550 000(520 000 to 570 000) for Scheme 3. Assuming that 50% of the cases are diagnosed and treated, Scheme 1 could save £330 million (£280 million to £390 million) to National Health Service (NHS) and personal social services (PSS), over the same period, with Scheme 2 (£710 million (£640 million to £790 million)) or Scheme 3 (£930 million (£850 million to £1000 million)) producing more considerable savings. Overall, total cost savings (including NHS, PSS and patients' related costs) would range from £1.5 billion (£1.2 billion to £1.8 billion) for Scheme 1 to £4.2 billion (£3.7 billion to £4.6 billion) for Scheme 3.

CONCLUSION

Our modelling suggests that UBI could substantially benefit young people's mental health, producing substantial health-related cost savings.

Identifying Social Determinants and Measuring Socioeconomic Inequalities in the Use of Four Different Mental Health Services by Australian Adolescents Aged 13-17 Years: Results from a Nationwide Study

AIM

In this study, we aimed to identify the determinants of four different forms of mental health service usage (general health services, school counselling, telephone, and online services), and the number of mental health services accessed (single and multiple) by Australian adolescents aged 13-17 years. We also measured socioeconomic inequality in mental health services' usage following the concentration index approach within the same sample.

SUBJECT AND METHODS

The data came from the nationwide cross-sectional survey, Young Minds Matter (YMM): the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Random effect models were used to identify the factors associated with four different mental health services and the number of services accessed. Further, the Erreygers' corrected concentration indices for binary variables were used to quantify the socioeconomic inequality in each mental health service. The four services were the general health service (GP, specialist, psychiatrist, psychologist, hospital including emergency), school services, telephone counselling and online services.

RESULTS

Overall, 31.9% of the total analytical sample (n = 2268) aged 13-17 years old visited at least one service, with 21.9% accessing a single service and 10% accessing multiple services. The highest percentage of adolescents used online services (20.1%), followed by general mental health services (18.3%), while school services (2.4%) were the least used service. Age, gender, family type and family cohesion statistically significantly increased the use of general health and multiple mental health service usage (p < 0.05). Area of residence was also found to be a significant factor for online service use. The concentration indices (CIs) were -0.073 (p < 0.001) and -0.032 (p < 0.001) for health and telephone services, respectively, which implies pro-rich socio-economic inequality.

CONCLUSION

Adolescents from low-income families frequently used general mental health services and telephone services compared to those who belonged to high-income families. The study concluded that if we want to increase adolescents' usage of mental health services, we need to tailor our approaches to their socioeconomic backgrounds. In addition, from a policy standpoint, a multi-sectoral strategy is needed to address the factors related to mental health services to reduce inequity in service utilisation.

What role do young people believe Universal Basic Income can play in supporting their mental health?

The proportion of 16- to 24-year-olds in England reporting a longstanding mental health condition increased almost 10-fold between 1995 and 2014. Studies demonstrate an association between income and anxiety and depression, with bi-directional effects. There is also emerging evidence that cash transfers may mitigate, prevent or delay those conditions. This article presents qualitative data exploring the relationship between income and anxiety and depression and the prospective impact of Universal Basic Income (UBI) as a public health measure. Data was gathered from citizen engagement workshops with 28 young people aged 14-22 from Bradford, England. We present four findings: (i) participants believe that the current work and welfare system has a detrimental impact on their mental health; (ii) most participants believe that UBI would have positive impacts on their mental health by virtue of reducing financial strain; (iii) most participants appear to favour a UBI scheme with larger payments than have traditionally been proposed; (iv) participants believe that there are non-financial benefits of UBI, such as reduction in stigma.

Designing a generic, adaptive protocol resource for the measurement of health impact in cash transfer pilot and feasibility studies and trials in high-income countries

INTRODUCTION

In the context of the COVID-19 pandemic, upstream interventions that tackle social determinants of health inequalities have never been more important. Evaluations of upstream cash transfer trials have failed to capture comprehensively the impacts that such systems might have on population health through inadequate design of the interventions themselves and failure to implement consistent, thorough research measures that can be used in microsimulations to model long-term impact. In this article, we describe the process of developing a generic, adaptive protocol resource to address this issue and the challenges involved in that process. The resource is designed for use in high-income countries (HIC) but draws on examples from a UK context to illustrate means of development and deployment. The resource is capable of further adaptation for use in low- and middle-income countries (LMIC). It has particular application for trials of Universal Basic Income but can be adapted to those covering other kinds of cash transfer and welfare system changes.

METHODS

We outline two types of prospective intervention based on pilots and trials currently under discussion. In developing the remainder of the resource, we establish six key principles, implement a modular approach based on types of measure and their prospective resource intensity, and source (validated where possible) measures and baseline data primarily from routine collection and large, longitudinal cohort studies. Through these measures, we seek to cover all areas of health impact identified in our theoretical model for use in pilot and feasibility studies.

RESULTS

We find that, in general, self-reported measures alongside routinely collected linked respondent data may provide a feasible means of producing data capable of demonstrating comprehensive health impact. However, we also suggest that, where possible, physiological measures should be included to elucidate underlying biological effects that may not be accurately captured through self-reporting alone and can enable modelling of long-term health outcomes. In addition, accurate self-reported objective income data remains a challenge and requires further development and testing. A process of development and implementation of the resource in pilot and feasibility studies will support assessment of whether or not our proposed health outcome measures are acceptable, feasible and can be used with validity and reliability in the target population.

DISCUSSION

We suggest that while Open Access evaluation instruments are available and usable to measure most constructs of interest, there remain some areas for which further development is necessary. This includes self-reported wellbeing measures that require paid licences but are used in a range of nationally important longitudinal studies instead of Open Access alternatives.