Impact of lockdown relaxation and implementation of the face-covering policy on mental health: A United Kingdom COVID-19 study

Table 1 Lockdown relaxations in the United Kingdom

Date	Policy changes
July 4, 2020	2-metre distance rule was dropped
	Members of two different households have been able to drink or dine together
	Households will be able to host visitors, including overnight, and to meet with members of different households, on different occasions – including in a pub, restaurant or hotel, for example
	To reopen pubs, campsites, hairdressers, and churches. All these venues will be expected to collect and keep the contact details of visitors, so they can be traced in the event of a local outbreak of the virus
	Theatres and concert halls will also be able to reopen but they cannot host live performances because of concerns including the risk that singing can transmit the virus
July 24, 2020	Face mask has become compulsory in shops

Table 2 Sampling distribution of mental health outcomes, demographics, lifestyle changes, and pre-existing health conditions by lockdown periods

Time by lockdown easing policy	May 1, 2020-July 3, 2020 (Lockdown phase)		July 4-23, 2020 (Lockdown relaxation phase)		July 24-31, 2020 (Face-covering phase)		Total
Outcome and control variables	No.	%	No.	%	No.	%	No.	%	P value
Total sample	20173	100	4550	100	4145	100	28890	100
Mental health outcomes/scores
GAD-7
Total	15634	100	3379	100	3153	100	22166	100
Missing	4539		1171		992		6711
IES-R
Total	14516	100	3141	100	2961	100	20618	100
Missing	5657		1409		1184		8260
Demographics, lifestyle changes, and pre-existing health conditions
Key worker
No	5400	29.7	1260	31.4	1778	48.8	8438	32.6
Yes (health)	9205	50.6	1961	48.9	1161	31.8	12327	47.7
Yes (non-health)	3595	19.8	793	19.8	708	19.4	5096	19.7
Total	18200	100	4014	100	3647	100	25861	100	< 0.001
Missing	1973		536		498		3014
Gender
Female	15324	84.2	3331	83.4	2701	75.2	21356	82.8
Male	2872	15.8	662	16.6	891	24.8	4425	17.2
Total	18196	100	3993	100	3592	100	25781	100	< 0.001
Missing	1977		557		553		3094
Age category or group
Under 21	332	1.8	90	2.2	81	2.2	503	1.9
21-24	828	4.5	163	4	100	2.7	1091	4.2
25-34	3627	19.8	709	17.5	566	15.4	4902	18.8
35-44	4076	22.2	794	19.5	712	19.4	5582	21.4
45-54	4676	25.5	1008	24.8	851	23.2	6535	25.1
55-64	3462	18.9	882	21.7	795	21.6	5139	19.7
65 and over	1319	7.2	416	10.2	568	15.5	2303	8.8
Total	18320	100	4062	100	3673	100	26055	100	< 0.001
Missing	1853		488		472		2820
Ethnicity
Non-white British	1649	9	362	8.9	351	9.5	2362	9.1
White British	16703	91	3698	91.1	3325	90.5	23726	90.9
Total	18352	100	4060	100	3676	100	26088	100	< 0.001
Missing	1821		490		469		2787
Religion
Non-Christian	9794	54.1	2140	54.3	1905	53.8	13839	54.1
Christian	8306	45.9	1798	45.7	1633	46.2	11737	45.9
Total	18100	100	3938	100	3538	100	25576	100	0.911
Missing	2073		612		607		3300
Age left education
≤ 18 (A-level or less)	5967	33	1557	38.9	1249	34.4	8773	34.1
> 18 (Higher degree)	12118	67	2442	61.1	2381	65.6	16941	65.9
Total	18085	100	3999	100	3630	100	25714	100
Missing	2088		551		515		3161
Accommodation
Rented home	5030	27.5	1163	28.7	847	23	7040	27
Own home	13288	72.5	2891	71.3	2834	77	19013	73
Total	18318	100	4054	100	3681	100	26053	100	< 0.001
Missing	1855		496		464		2822
Vulnerable according to government category
No	13735	80.6	2938	78.5	2610	77.7	19283	79.8
Yes (do not require shielding)	2005	11.8	503	13.4	494	14.7	3002	12.4
Yes (require shielding)	1307	7.7	303	8.1	257	7.6	1867	7.7
Total	17047	100	3744	100	3361	100	24152	100	< 0.001
Missing	3126		806		784		4725
Experienced coronavirus
No	4354	24.9	1016	26.3	971	27.8	6341	25.5
Yes	13152	75.1	2843	73.7	2518	72.2	18513	74.5
Total	17506	100	3859	100	3489	100	24854	100	0.001
Missing	2667		691		656		4022
Pre-existing mental health condition
No	10685	62.6	2288	60.8	2404	70.1	15377	63.3
Yes	6395	37.4	1476	39.2	1026	29.9	8897	36.7
Total	17080	100	3764	100	3430	100	24274	100	< 0.001
Missing	3093		786		715		4604
Drinking alcohol
Never	2611	14.6	540	13.7	492	13.8	3643	14.4
Monthly or less	3954	22.2	944	24	692	19.4	5590	22.1
2-4 times a month	3909	21.9	930	23.6	824	23	5663	22.3
2-3 times a week	4873	27.3	1007	25.6	999	27.9	6879	27.1
4 times or more a week	2479	13.9	520	13.2	569	15.9	3568	14.1
Total	17826	100	3941	100	3576	100	25343	100	< 0.001
Missing	2347		609		569		3532
Taking drug
No	17354	97.9	3810	97.3	3465	97.3	24629	97.7
Yes	369	2.1	107	2.7	95	2.7	571	2.3
Total	17723	100	3917	100	3560	100	25200	100	< 0.001
Missing	2450		633		585		3675
Suicidal thoughts
No	12015	68.3	2591	66.7	2521	71.5	17127	68.5
Yes	5572	31.7	1292	33.3	1005	28.5	7869	31.5
Total	17587	100	3883	100	3526	100	24996	100	< 0.001
Missing	2586		667		619		3879

GAD-7: Generalised anxiety disorder-7; IES-R: Impact of events scale-revised.

Table 3 Means of mental health conditions by lockdown easing periods, demographics, lifestyle changes, and pre-existing health conditions

Control variables	Means of GAD-7 (n = 18948) (95%CI)			Means of IES-R (n = 17739) (95%CI)
	May 1, 2020-July 3, 2020 (Lockdown)	July 4-23, 2020 (Lockdown relax)	July 24-31, 2020 (Face-covering)	May 1, 2020-July 3, 2020 (Lockdown)	July 4-23, 2020 (Lockdown relax)	July 24-31, 2020 (Face-covering)
Total study population	5.6 (5.5-5.7)	5.6 (5.3-5.8)	4.4 (4.2-4.6)	17.3 (16.9-17.6)	16.8 (16.0-17.6)	13.4 (12.7-14.2)
Key worker
Not a key worker	5.8 (5.6-6.0)	6.2 (5.7-6.7)	4.1 (3.8-4.4)	18.5 (17.8-19.2)	19.9 (18.2-21.5)	13.1 (12.1-14.2)
Health	5.1 (5.0-5.3)	5 (4.7-5.3)	4.3 (3.9-4.6)	15.9 (15.4-16.3)	14.4 (13.4-15.4)	12.2 (11.0-13.5)
Not in health	6.3 (6.1-6.6)	6.1 (5.5-6.6)	5.3 (4.8-5.9)	19 (18.2-19.8)	18.5 (16.8-20.3)	16.1 (14.4-17.9)
Gender
Female	5.8 (5.7-5.9)	5.7 (5.5-6.0)	4.8 (4.5-5.1)	18 (17.6-18.4)	17.3 (16.4-18.2)	14.4 (13.5-15.2)
Male	4.3 (4.0-4.5)	4.8 (4.1-5.4)	3.2 (2.8-3.7)	13.3 (12.4-14.1)	14.1 (12.2-16.1)	10.7 (9.4-12.1)
Age group
Under 21	7.7 (6.8-8.5)	9.3 (6.7-11.9)	8.6 (6.4-10.9)	24 (20.9-27.1)	30.8 (20.8-40.8)	28.8 (20.2-37.3)
21-24	7.9 (7.4-8.5)	7.8 (6.3-9.2)	6.7 (5.0-8.4)	22.6 (20.8-24.3)	21.4 (17.0-25.7)	19.2 (13.9-24.5)
25-34	6.8 (6.5-7.0)	7.5 (7.0-8.1)	5.7 (5.1-6.4)	19 (18.2-19.8)	21.3 (19.4-23.2)	15.4 (13.3-17.4)
35-44	6.1 (5.9-6.3)	6.1 (5.6-6.6)	5.2 (4.7-5.7)	18.3 (17.5-19.0)	17.8 (16.1-19.5)	14.4 (12.8-15.9)
45-54	4.9 (4.7-5.1)	4.8 (4.4-5.3)	4.5 (4.0-5.0)	16.2 (15.6-16.9)	14.5 (13.0-16.0)	13.2 (11.8-14.7)
55-64	4.6 (4.4-4.8)	4.8 (4.3-5.3)	3.7 (3.3-4.1)	15.7 (15.0-16.5)	14.8 (13.2-16.4)	12.6 (11.2-14.0)
65 and over	3.1 (2.8-3.4)	3.1 (2.5-3.7)	1.9 (1.4-2.3)	10.8 (9.7-11.8)	12.2 (9.7-14.6)	8.1 (6.5-9.7)
Ethnicity
Non-white	4.9 (4.5-5.2)	5.9 (5.1-6.8)	4.9 (4.1-5.7)	15.9 (14.7-17.1)	19.2 (16.3-22.0)	14.4 (12.0-16.8)
White	5.6 (5.5-5.7)	5.5 (5.3-5.8)	4.4 (4.1-4.6)	17.4 (17.0-17.7)	16.6 (15.7-17.4)	13.3 (12.5-14.1)
Religion
Non-Christian	5.7 (5.6-5.9)	6.0 (5.6-6.3)	4.6 (4.3-4.9)	17.6 (17.2-18.1)	17.6 (16.5-18.7)	13.8 (12.8-14.8)
Christian	5.4 (5.2-5.5)	5.1 (4.8-5.5)	4.2 (3.9-4.5)	16.8 (16.3-17.3)	15.8 (14.6-17.0)	12.9 (11.9-14.0)
Education
A-level or less	6.2 (6.0-6.4)	6.1 (5.7-6.6)	4.5 (4.1-4.9)	19.1 (18.4-19.8)	19.1 (17.6-20.5)	14.3 (12.9-15.7)
Higher degree	5.3 (5.2-5.4)	5.2 (4.9-5.5)	4.4 (4.1-4.6)	16.4 (16.0-16.8)	15.5 (14.6-16.4)	13 (12.2-13.9)
Type of accommodation
Rented	7.1 (6.9-7.3)	7.8 (7.3-8.3)	6.7 (6.1-7.3)	21.6 (20.9-22.3)	23.1 (21.4-24.8)	19.7 (17.8-21.6)
Own	5 (4.9-5.1) 4	4.7 (4.5-5.0)	3.8 (3.5-4.0)	15.7 (15.3-16.0)	14.4 (13.5-15.3)	11.7 (10.9-12.4)
Shielding status (government)
Shielding not required	5.5 (5.4-5.6)	5.5 (5.2-5.8)	4.4 (4.1-4.6)	16.8 (16.5-17.2)	16.2 (15.3-17.1)	12.9 (12.1-13.7)
Shielding required (but not Shielding)	5.5 (5.2-5.9)	5.1 (4.5-5.8)	4 (3.4-4.6)	17.6 (16.5-18.6)	16.6 (14.5-18.8)	13 (11.0-14.9)
Shielding required (shielding)	6.6 (6.2-7.0)	7.4 (6.4-8.5)	5.5 (4.6-6.5)	21.2 (19.8-22.6)	23.9 (20.7-27.2)	19.3 (16.2-22.3)
Experience of COVID-19
No such experience	5.1 (4.9-5.3)	5.1 (4.6-5.6)	3.9 (3.5-4.4)	15.5 (14.8-16.2)	16.3 (14.7-18.0)	12.1 (10.7-13.5)
Yes	5.7 (5.6-5.8)	5.7 (5.4-6.0)	4.6 (4.3-4.9)	17.8 (17.4-18.2)	17 (16.1-17.9) 1	3.9 (13.1-14.8)
Pre-existing mental health
No	4.1 (4.0-4.2)	3.7 (3.5-3.9)	3.2 (2.9-3.4)	13 (12.6-13.3)	11.5 (10.7-12.3)	9.7 (9.0-10.4)
Yes	8.2 (8.0-8.4)	8.7 (8.3-9.2)	7.6 (7.1-8.1)	24.9 (24.3-25.6)	25.9 (24.5-27.4)	23 (21.3-24.7)
Drinking alcohol
Never	6.3 (6.0-6.6)	6.2 (5.5-6.9)	5.7 (4.9-6.4)	19.7 (18.6-20.7)	17.9 (15.6-20.2)	16.2 (13.8-18.6)
Monthly or less	6.2 (6.0-6.5)	6.6 (6.0-7.1)	5 (4.4-5.5)	18.8 (18.0-19.6)	19.5 (17.6-21.3)	15.2 (13.4-17.0)
2-4 times a month	5.4 (5.2-5.6)	5.3 (4.8-5.8)	4.3 (3.8-4.7)	16.7 (15.9-17.4)	17 (15.4-18.5)	13 (11.5-14.5)
2-3 times a week	5 (4.9-5.2) 5	5.2 (4.7-5.6)	3.9 (3.5-4.4)	15.5 (14.9-16.1)	15.2 (13.7-16.7)	12.2 (10.9-13.5)
4 times or more a week	5.1 (4.8-5.3)	4.3 (3.7-5.0)	3.8 (3.2-4.4)	16.9 (16.0-17.9)	13.4 (11.6-15.3)	12 (10.3-13.7)
Drug use
Never	5.5 (5.4-5.6)	5.5 (5.2-5.7)	4.3 (4.1-4.6)	17.1 (16.8-17.5)	16.6 (15.8-17.4)	13.1 (12.4-13.9)
Ever	7.7 (6.8-8.6)	9.6 (7.9-11.4)	7.3 (5.5-9.1)	23.8 (20.9-26.8)	25.5 (19.9-31.1)	24.2 (18.3-30.0)
Suicidal thoughts ever
No	4.5 (4.4-4.6)	4.4 (4.1-4.7)	3.4 (3.2-3.7)	13.9 (13.5-14.3)	13.2 (12.3-14.0)	10.3 (9.6-11.0)
Yes	7.8 (7.6-8.0)	8 (7.6-8.5)	6.9 (6.4-7.4)	24.3 (23.7-25.0)	24.4 (22.8-25.9)	21.6 (19.9-23.3)

CI: Confidence intervals; COVID-19: Coronavirus disease 2019; GAD-7: Generalised anxiety disorder-7; IES-R: Impact of events scale-revised.

Table 4 Changes in mental health indices by cut-off dates, control variables from regression discontinuity design regression models

Policy change dates in 2020	Population sub-groups	GAD-7, changes (95%CI)	P value	IESR, changes (95%CI)	P value
July 4, 2020 (Lockdown relaxation date)	Total sample	-0.513 (-0.913, -0.112)	0.081	-2.620 (-4.279, -0. 961)	0.464
July 24, 2020 (Face-covering start date)	Total sample	-1.148 (-1.800, -0.496)		-3.449 (-5.725, -1.172)
	Key worker
July 4, 2020 (Lockdown relaxation date)	Not a key worker	-0.910 (-1.810, -0.011)	0.062	-3.546 (-6.235, -0.857)	0.708
	Health	0.017 (-0.602, 0.637)		-1.643 (-3.914, 0.628)
	Non-health	-0.756 (-1.877, 0.365)		-1.704 (-5.115, 1.708)
July 24, 2020 (Face-covering start date)	Not a key worker	-1.191 (-2.259, -0.123)	0.064	-3.877 (-7.410, -0.343)	0.843
	Health	-0.986 (-1.584, -0.387)		-1.693 (-4.376, 0.991)
	Non-health	-1.421 (-3.454, 0.613)		-5.458 (-9.144, -1.772)
	Gender
July 4, 2020 (Lockdown relaxation date)	Female	-0.496 (-0.983, -0.010)	0.817	-2.606 (-4.445, -0.767)	0.936
	Male	-0.622 (-1.652, 0.409)		-2.461 (-5.929, 1.007)
July 24, 2020 (Face-covering start date)	Female	-1.013 (-1.778, -0.248)	0.382	-3.369 (-5.789, -0.948)	0.926
	Male	-1.739 (-2.993, -0.485)		-3.112 (-6.985, 0.762)
	Age group
July 4, 2020 (Lockdown relaxation date)	Under 21	-5.482 (-9.526, -1.437)	0.029	-19.319 (-41.541, 2.902)	0.260
	21-24	-0.103 (-1.975, 1.770)		-3.715 (-8.350, 0.920)
	25-34	-0.314 (-1.346, 0.717)		-2.653 (-4.900, -0.406)
	35-44	-0.640 (-1.646, 0.366)		0.545 (-2.309, 3.399)
	45-54	0.179 (-0.663, 1.021)		-1.871 (-4.785, 1.043)
	55-64	-0.911 (-2.117, 0.294)		-5.390 (-9.419, -1.361)
	65 and over	-0.923 (-2.330, 0.484)		-2.633 (-8.466, 3.199)
July 24, 2020 (Face-covering start date)	Under 21	-0.983 (-5.502, 3.536)		-3.941 (-23.634, 15.753)
	21-24	-0.830 (-6.322, 4.661)		-2.354 (-14.469, 9.761)
	25-34	-1.928 (-3.272, -0.584)		-7.306 (-11.582, -3.029)
	35-44	-0.722 (-2.406, 0.962)		-0.469 (-5.717, 4.780)
	45-54	-0.641 (-1.940, 0.658)		-2.386 (-5.752, 0.980)
	55-64	-0.997 (-1.971, -0.023)		-1.930 (-5.331, 1.472)
	65 and over	-1.447 (-2.952, 0.057)	0.995	-4.192 (-9.646, 1.261)	0.795
	Ethnicity
July 4, 2020 (Lockdown relaxation date)	Non-white	1.302 (0.085, 2.518)		3.185 (-2.139, 8.510)
	White	-0.657 (-1.129, -0.185)	0.018	-3.044 (-4.830, -1.259)	0.035
July 24, 2020 (Face-covering start date)	Non-white	-0.104 (-1.715, 1.506)		-0.380 (-6.308, 5.548)
	White	-1.243 (-1.957, -0.529)	0.348	-3.567 (-5.888, -1.246)	0.410
	Religion
July 4, 2020 (Lockdown relaxation date)	Non-Christian	-0.369 (-0.934, 0.195)	0.522	-2.500 (-4.563, -0.437)	0.904
	Christian	-0.652 (-1.298, -0.006)		-2.679 (-4.909, -0.449)
July 24, 2020 (Face-covering start date)	Non-Christian	-1.298 (-2.290, -0.306)	0.578	-3.473 (-6.483, -0.464)	0.957
	Christian	-0.928 (-1.630, -0.226)		-3.354 (-6.289, -0.420)
	Education
July 4, 2020 (Lockdown relaxation date)	A-level or less	-1.363 (-1.929, -0.797)	0.007	-3.958 (-6.641, -1.275)	0.221
	Higher degree	-0.080 (-0.512, 0.352)		-1.955 (-3.408, -0.502)
July 24, 2020 (Face-covering start date)	A-level or less	-1.421 (-2.058, -0.783)	0.460	-4.109 (-6.780, -1.438)	0.561
	Higher degree	-0.876 (-1.712, -0.041)		-2.667 (-5.356, 0.022)
	Accommodation
July 4, 2020 (Lockdown relaxation date)	Rented	-0.369 (-1.449, 0.712)	0.796	-1.933 (-5.935, 2.068)	0.675
	Own	-0.517 (-0.919, -0.114)		-2.719 (-4.784, -0.653)
July 24, 2020 (Face-covering start date)	Rented	-1.837 (-3.056, -0.618)	0.197	-4.387 (-9.165, 0.391)	0.571
	Own	-0.782 (-1.419, -0.144)		-2.820 (-4.892, -0.748)
	Require shielding by government
July 4, 2020 (Lockdown relaxation date)	Not required	-0.322 (-0.750, 0.107)	0.241	-2.212 (-3.717, -0.706)	0.560
	Required shielding, but not shielding	-1.243 (-2.295, -0.191)		-4.136 (-8.303, 0.032)
	Required shielding and shielding	-0.655 (-2.023, 0.713)		-3.447 (-8.512, 1.619)
July 24, 2020 (Face-covering start date)	Not required	-0.978 (-1.721, -0.234)	0.393	-3.175 (-5.683, -0.668)	0.956
	Require shielding, but not shielding	-1.045 (-2.351, 0.261)		-3.730 (-10.106, 2.647)
	Require shielding and shielding	-3.064 (-4.686, -1.442)		-4.742 (-10.111, 0.628)
	Experience of COVID-19
July 4, 2020 (Lockdown relaxation date)	No	-0.559 (-1.279, 0.161)	0.892	-1.999 (-4.771, 0.774)	0.657
	Yes	-0.490 (-0.961, -0.018)		-2.795 (-4.666, -0.924)
July 24, 2020 (Face-covering start date)	No	-1.927 (-2.904, -0.951)	0.156	-6.223 (-10.542, -1.905)	0.131
	Yes	-0.875 (-1.621, -0.129)		-2.462 (-4.509, -0.416)
	Pre-existing mental health condition
July 4, 2020 (Lockdown relaxation date)	No	-0.343 (-0.729, 0.043)	0.551	-2.308 (-3.782, -0.834)	0.788
	Yes	-0.649 (-1.582, 0.284)		-2.772 (-6.246, 0.702)
July 24, 2020 (Face-covering start date)	No	-0.687 (-1.194, -0.181)	0.239	-1.407 (-3.154, 0.340)	0.056
	Yes	-1.576 (-3.163, 0.012)		-6.239 (-10.192, -2.286)
	Drinking alcohol
July 4, 2020 (Lockdown relaxation date)	Never	-1.025 (-2.463, 0.412)		-3.091 (-7.778, 1.596)
	Monthly or less	-0.582 (-1.779, 0.615)		-3.020 (-6.621, 0.581)
	2-4 times a month	-0.243 (-0.901, 0.415)		-2.017 (-4.434, 0.401)
	2-3 times a week	-0.050 (-0.543, 0.443)		-1.782 (-3.882, 0.319)
	4 times or more a week	-1.165 (-2.178, -0.151)	0.401	-3.784 (-7.229, -0.340)	0.828
July 24, 2020 (Face-covering start date)	Never	-1.309 (-3.955, 1.337)	0.835	2.636 (-2.839, 8.111)	0.607
	Monthly or less	-1.240 (-2.787, 0.306)		-2.619 (-5.693, 0.455)
	2-4 times a month	-1.251 (-2.243, -0.259)		-6.981 (-10.394, -3.568)
	2-3 times a week	-1.140 (-1.694, -0.587)		-4.444 (-7.173, -1.715)
	4 times or more a week	-0.601 (-2.269, 1.067)		-1.616 (-6.815, 3.583)
	Taking drugs
July 4, 2020 (Lockdown relaxation date)	No	-0.504 (-0.890, -0.118)	0.542	-2.522 (-4.160, -0.883)	0.955
	Yes	0.631 (-3.023, 4.286)		-2.827 (-12.067, 6.412)
July 24, 2020 (Face-covering start date)	No	-1.114 (-1.669, -0.558)	0.875	-3.571 (-5.538, -1.604)	0.222
	Yes	-1.470 (-6.338, 3.398)		5.805 (-11.429, 23.039)
	Suicidal thoughts ever
July 4, 2020 (Lockdown relaxation date)	No	-0.173 (-0.599, 0.252)	0.039	-0.941 (-2.482, 0.600)	0.003
	Yes	-1.232 (-1.983, -0.481)		-5.938 (-8.759, -3.118)
July 24, 2020 (Face-covering start date)	No	-0.831 (-1.343, -0.319)	0.337	-2.520 (-4.065, -0.975)	0.511
	Yes	-1.588 (-3.487, 0.310)		-4.256 (-9.486, 0.974)

Note: To capture the effects of lockdown easing and compulsory face-covering on different groups, separate OLS regressions were run for all demographics, lifestyle change type, and pre-existing health condition (listed above) using the Regression Discontinuity Design model. Cluster/date/trend adjusted 95% confidence intervals are in parentheses. P values are shown to indicate whether changes in mental health scores are different among those listed groups. CI: Confidence intervals; COVID-19: Coronavirus disease 2019; GAD-7: Generalised anxiety disorder-7; IES-R: Impact of events scale-revised.