Effects of COVID-19-related worry and rumination on mental health and loneliness during the pandemic: longitudinal analyses of adults in the UK COVID-19 mental health & wellbeing study

Figures & data

Figure 1. Overview of the waves of the UK COVID-19 Mental Health & Wellbeing study and key events during the COVID-19 pandemic in the UK in 2020.

Figure 2. Mean COVID-related worry and rumination, mental health, and loneliness across the six waves (error bars represent standard errors).

Table 1. Mean perseverative cognition and mental health outcomes across the six study waves (31 March 2020 to 4^th November 2020).

	Wave 1	Wave 2	Wave 3	Wave 4	Wave 5	Wave 6
	31 Mar-9 Apr	10 Apr-27 Apr	28 Apr-11 May	27 May-15 Jun	17 Jul-7 Aug	1 Oct-4 Nov
Mean (SD)
Worry^a	3.64 (1.85)	3.55 (1.77)	3.32 (1.77)	3.01 (1.72)	2.86 (1.73)	3.08 (1.77)
Rumination^b	2.87 (1.83)	2.89 (1.79)	2.75 (1.78)	2.56 (1.70)	2.48 (1.68)	2.64 (1.76)
Depression	5.6 (6.25)	5.49 (6.11)	5.54 (6.28)	5.25 (6.04)	5.24 (6.23)	5.38 (6.32)
Anxiety	4.9 (5.21)	4.71 (5.18)	4.55 (5.24)	4.37 (5.20)	4.28 (5.55)	4.42 (5.22)
Wellbeing	22.78 (6.13)	23.01 (6.23)	23.15 (6.23)	23.54 (6.38)	23.53 (6.45)	23.34 (6.41)
Loneliness	5.11 (1.92)	5.10 (1.92)	5.08 (1.92)	5.06 (1.94)	5.03 (1.93)	5.01 (1.95)

^aCOVID-related worry over the past 2 weeks; ^bCOVID-related rumination over the past 2 weeks. N = 1943 across all six waves.

Table 2a. Effects of COVID-related worry and rumination on depression, anxiety, wellbeing and loneliness across the six waves.

	Unadjusted					Adjusted for covariates
		Coeff	SE	d.f.	p value		Coeff	SE	d.f.	p value
Depression
Intercept	β00	5.42	0.125	1942	<0.001	β00	8.899	0.719	1937	<0.001
Gender	β01	–	–	–	–	β01	−1.359	0.224	1937	<0.001
SEG	β02	–	–	–	–	β02	0.358	0.218	1937	0.102
Age	β03	–	–	–	–	β03	−1.993	0.322	1937	<0.001
Mental health status	β04	–	–	–	–	β04	5.459	0.218	1937	<0.001
Physical health status	β05	–	–	–	–	β05	0.591	0.234	1937	0.012
Level 1 slope
Worry – depression	β10	0.554	0.034	1942	<0.001	β10	0.355	0.036	1942	<0.001
Level 1 slope
Rumination – depression	β20	0.555	0.036	1942	<0.001	β20	0.364	0.037	1942	<0.001
Level 1 slope
Wave – depression	β30	−0.060	0.020	1942	0.003	β30	0.020	0.019	1942	0.270
Anxiety
Intercept	β00	4.540	0.106	1942	<0.001	β00	8.140	0.585	1937	<0.001
Gender	β01	–	–	–	–	β01	−1.416	0.187	1937	<0.001
SEG	β02	–	–	–	–	β02	0.060	0.185	1937	0.744
Age	β03	–	–	–	–	β03	−1.528	0.266	1937	<0.001
Mental health status	β04	–	–	–	–	β04	4.531	0.250	1937	<0.001
Physical health status	β05	–	–	–	–	β05	0.319	0.200	1937	0.110
Level 1 slope
Worry – anxiety	β10	0.342	0.183	1937	<0.001	β10	0.398	0.029	1942	<0.001
Level 1 slope
Rumination – anxiety	β20	0.584	0.028	1937	<0.001	β20	0.351	0.028	1942	<0.001
Level 1 slope
Wave – anxiety	β30	−0.110	0.016	1942	<0.001	β30	−0.016	0.014	1942	0.263
Wellbeing
Intercept	β00	23.221	0.127	1942	<0.001	β00	19.941	0.706	1937	<0.001
Gender	β01	–	–	–	–	β01	0.552	0.243	1937	0.024
SEG	β02	–	–	–	–	β02	−0.323	0.237	1937	0.174
Age	β03	–	–	–	–	β03	2.060	0.318	1937	<0.001
Mental health status	β04	–	–	–	–	β04	−4.878	0.264	1937	<0.001
Physical health status	β05	–	–	–	–	β05	0.585	0.245	1937	0.017
Level 1 slope
Worry – wellbeing	β10	−0.507	0.033	1942	<0.001	β10	−0.321	0.034	1942	<0.001
Level 1 slope
Rumination – wellbeing	β20	−0.499	0.034	1942	<0.001	β20	−0.292	0.034	1942	<0.001
Level 1 slope
Wave – wellbeing	β30	0.137	0.019	1942	<0.001	β30	0.064	0.019	1942	<0.001
Loneliness
Intercept	β00	5.064	0.039	1942	<0.001	β00	6.169	0.218	1937	<0.001
Gender	β01	–	–	–	–	β01	−0.456	0.075	1937	<0.001
SEG	β02	–	–	–	–	β02	0.133	0.075	1937	0.076
Age	β03	–	–	–	–	β03	−0.496	0.097	1937	<0.001
Mental health status	β04	–	–	–	–	β04	1.201	0.086	1937	<0.001
Physical health status	β05	–	–	–	–	β05	−0.064	0.080	1937	0.427
Level 1 slope
Worry – loneliness	β10	0.051	0.010	1942	<0.001	β10	0.052	0.010	1942	<0.001
Level 1 slope
Rumination – loneliness	β20	0.066	0.010	1942	<0.001	β20	0.067	0.011	1942	<0.001
Level 1 slope
Wave – loneliness	β30	−0.009	0.006	1942	0.107	β30	−0.009	0.006	1942	0.113

Table 2b. Effects of COVID-related worry and rumination on depression, anxiety, wellbeing and loneliness across the six waves including moderating effects on mental and physical health status.

	Unadjusted					Adjusted for covariates
		Coeff	SE	d.f.	p value		Coeff	SE	d.f.	p value
Depression
Intercept	β00	5.42	0.125	1942	<0.001	β00	8.856	0.719	1937	<0.001
Gender	β01	–	–	–	–	β01	−1.351	0.224	1937	<0.001
SEG	β02	–	–	–	–	β02	0.364	0.218	1937	0.096
Age	β03	–	–	–	–	β03	−1.991	0.322	1937	<0.001
Mental Health	β04	–	–	–	–	β04	5.572	0.296	1937	<0.001
Physical Health	β05	–	–	–	–	β05	0.556	0.234	1937	0.018
Level 1 slope
Worry - depression	β10	0.554	0.034	1942	<0.001	β10	0.281	0.047	1940	<0.001
MH * worry – depression	β14	–	–	–	–	β14	0.357	0.093	1940	<0.001
PH * worry – depression	β15	–	–	–	–	β15	−0.056	0.071	1940	0.429
Level 1 slope
Rumination – depression	β20	0.555	0.036	1942	<0.001	β20	0.352	0.053	1940	<0.001
MH * rumination – depression	β21	–	–	–	–	β21	0.113	0.086	1940	0.188
PH * rumination – depression	β22	–	–	–	–	β22	−0.092	0.074	1940	0.213
Level 1 slope
Wave – depression	β30	−0.060	0.020	1942	0.003	β30	0.021	0.018	1942	0.263
Anxiety
Intercept	β00	4.540	0.106	1942	<0.001	β00	8.103	0.586	1937	<0.001
Gender	β01	–	–	–	–	β01	−1.407	0.187	1937	<0.001
SEG	β02	–	–	–	–	β02	0.062	0.185	1937	0.737
Age	β03	–	–	–	–	β03	−1.407	0.187	1937	<0.001
Mental Health	β04	–	–	–	–	β04	4.654	0.251	1937	<0.001
Physical Health	β05	–	–	–	–	β05	0.290	0.200	1937	0.147
Level 1 slope
Worry – anxiety	β10	0.342	0.183	1937	<0.001	β10	0.323	0.035	1940	<0.001
MH * worry – anxiety	β11	–	–	–	–	β11	0.293	0.074	1940	<0.001
PH * worry – anxiety	β12	–	–	–	–	β12	−0.000	0.061	1940	0.991
Level 1 slope
Rumination – anxiety	β20	0.584	0.028	1937	<0.001	β20	0.343	0.037	1940	<0.001
MH * rumination – anxiety	β21	–	–	–	–	β21	0.110	0.065	1940	0.091
PH * rumination – anxiety	β22	–	–	–	–	β22	−0.098	0.058	1940	0.090
Level 1 slope
Wave – anxiety	β30	−0.110	0.016	1942	<0.001	β30	−0.016	0.014	1942	0.267
Wellbeing
Intercept	β00	23.221	0.127	1942	<0.001	β00	19.94	0.706	1937	<0.001
Gender	β01	–	–	–	–	β01	0.550	0.245	1937	0.025
SEG	β02	–	–	–	–	β02	−0.322	0.237	1937	0.024
Age	β03	–	–	–	–	β03	2.060	0.319	1937	<0.001
Mental Health	β04	–	–	–	–	β04	−4.847	0.264	1937	<0.001
Physical Health	β05	–	–	–	–	Β05	0.551	0.245	1937	0.025
Level 1 slope
Worry – wellbeing	β10	−0.507	0.033	1942	<0.001	β10	−0.339	0.044	1940	<0.001
MH * worry – wellbeing	β11	–	–	–	–	β11	−0.171	0.081	1940	0.036
PH * worry – wellbeing	β12	–	–	–	–	β12	0.189	0.071	1940	0.008
Level 1 slope
Rumination – wellbeing	β20	−0.499	0.034	1942	<0.001	β20	−0.270	0.048	1940	<0.001
MH * rumination – wellbeing	β21	–	–	–	–	β21	0.011	0.071	1940	0.872
PH * rumination – wellbeing	β22	–	–	–	–	β22	−0.060	0.070	1940	0.390
Level 1 slope
Wave – wellbeing	β30	0.137	0.019	1942	<0.001	β30	0.065	0.019	1942	<0.001
Loneliness
Intercept	β00	5.064	0.039	1942	<0.001	β00	6.169	0.218	1937	<0.001
Gender	β01	–	–	–	–	β01	−0.455	0.075	1937	<0.001
SEG	β02	–	–	–	–	β02	0.133	0.075	1937	0.076
Age	β03	–	–	–	–	β03	−0.496	0.097	1937	<0.001
Mental Health	β04	–	–	–	–	β04	1.203	0.086	1937	<0.001
Physical Health	β05	–	–	–	–	β05	−0.067	0.080	1937	0.406
Level 1 slope
Worry – loneliness	β10	0.051	0.010	1942	<0.001	β10	0.054	0.014	1940	<0.001
MH * worry – loneliness	β11	–	–	–	–	β11	0.037	0.023	1940	0.111
PH * worry – wellbeing	β12	–	–	–	–	β12	−0.034	0.022	1940	0.113
Level 1 slope
Rumination – loneliness	β20	0.066	0.010	1942	<0.001	β20	0.055	0.015	1940	<0.001
MH * rumination – loneliness	β21	–	–	–	–	β21	0.026	0.023	1940	0.267
PH * rumination – loneliness	β22	–	–	–	–	β22	0.005	0.023	1940	0.807
Level 1 slope
Wave – loneliness	β30	−0.009	0.006	1942	0.107	β30	−0.009	0.006	1942	<0.115

Note: MH is mental health status; PH is physical health status.

Figure 3. The proportion of participants with high and low Covid-related worry/rumination that meet the threshold for poor mental health. *Poor mental health as indicated by a score of >10 on the PHQ-9 and GAD, a score of <19.3 on the SWEMWBS, and a score of ≥7 on the UCLA-3.

Figure 4. The proportion of participants with high and low Covid-related worry/rumination reporting clinically meaningful levels of anxiety and depression by mental health condition (upper panel) and poor wellbeing by physical health condition (lower panel). Note: Clinically meaningful levels were indicated by a score of >10 on the PHQ-9 and GAD, and a score of <19.3 on the SWEMWBS.