COVID-19, economic downturn, and long-term trajectories of population mental health: Evidence from two nationally representative British birth cohorts at the intersection of gender and socioeconomic position

We examined long-term trajectories of mental (ill-)health in two British generations (‘Baby boomers’ and ‘Generation X’) across the life-course, including the COVID-19 lockdowns and the following cost-of-living increases. We analysed inequalities by generation, gender, socioeconomic position (SEP), and their intersections, and explored the relationship between inflation and mental (ill-)health post-lockdown. We used data from the National Child Development Study (NCDS/1958, n=8,215) and the 1970 British Cohort Study (BCS/1970, n=7,789), with repeated measures of psychological distress (Malaise Inventory) between ages 23-64.5 (NCDS/58) and 26-52.5 (BCS/70). We used multilevel growth curve models to study long-term trajectories, and negative binomial regression models to analyse associations with inflation/cost-of-living in the 2021-2023 period. Distress increased during the pandemic but declined post-lockdown (second quadratic spline: B NCDS/58 =-0.12 -0.17, -0.08, p <0.001; B BCS/70 =-0.16 -0.21, -0.11, p <0.001). Women and individuals from disadvantaged childhood SEPs started their trajectories with significantly ( p <0.001) higher distress levels in both cohorts (women: B NCDS/58 =0.72 0.62, 0.82, B BCS/70 =0.73 0.62, 0.83; manual-class background: B NCDS/58 =0.24 0.14, 0.35, B BCS/70 =0.23 0.12, 0.35; rented housing: B NCDS/58 =0.34 0.22, 0.46, B BCS/70 =0.30 0.15, 0.45). Inequalities were larger for women from disadvantaged SEPs born in 1958, indicating intersectional effects. None of these inequalities significantly reduced in the long term. Inflation/cost-of-living was significantly associated with distress, but effects did not vary by gender, concurrent SEP, or their intersection. Despite post-pandemic improvements, persistent inequalities by gender and childhood SEP remain. Considering the high levels of socioeconomic adversity in the UK, action is needed to reduce these inequalities and prevent their transmission across generations. • This is the longest study of population mental health trajectories (40+ years) • We used an intersectional, cross-generational and life-course approach • Overall, there was a post-lockdown ‘bounce back’ to pre-pandemic levels of distress • Gaps by gender and childhood socioeconomic position persist across the life course • There is quantitative evidence of long-term intersectional effects in Baby Boomers