What was the impact of COVID-19 on health-related behaviors?

By Dr. Priyom Bose, Ph.D.Reviewed by Lily Ramsey, LLMMar 31 2023

A recent study published on the medRxiv* preprint server assessed the impact of the pandemic on health-related behaviors in the United Kingdom. 

During the coronavirus disease 2019 (COVID-19) pandemic, public health and social distancing measures increased unemployment, financial uncertainty, and social isolation. It is imperative to understand the impact of the pandemic on mental health and other health-related behaviors (HRBs).

Study:Exploring the Impact of the Covid-19 Pandemic on Health-Related Behaviours: A Person-Centred Analysis of Two British Longitudinal Cohort Studies. Image Credit: AxelBueckert/Shutterstock.com

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Background

Individuals coping with a negative environment, such as the one during the pandemic, often deploy a range of affective, cognitive, and behavioral strategies. Certain strategies like substance use could temporarily relieve stress but may confer long-term adverse health risks.

In the UK, during the first months of the lockdown, Public Health England observed an increase in the proportion of people with problematic drinking behavior.

Research has also documented how more people attempted to quit smoking during the pandemic, perhaps due to the closure of shops or since smokers were more vulnerable to respiratory viruses. The impact of COVID-19 on exercise is unclear.

The current study

Given the heterogeneity in individual behaviors, the current study adopted a person-centered rather than a variable-centered approach. The data was obtained from two national longitudinal cohort studies, the 1970 British Cohort Study (BCS70) and the Millennium cohort study (MCS). 

Repeated measures latent class analysis (RMLCA) was used to study whether qualitatively different subgroups shared similar trajectories in weight gain, sleep duration, alcohol consumption, binge drinking, and smoking. Specifically, the evolution of these five HRB classes at three different points in time was examined.

The study also analyzed whether risk factors like grief and loneliness predict class membership. 

Key findings

The analysis of patterns of HRBs was conducted during the first nine months of the pandemic. Five subgroups of individuals with similar patterns of HRBs were identified, and it was also shown how the adoption of risky HRBs varied across the different classes.

No relationship was observed between risky HRBs, social support, and mental health. However, the authors concluded that there was an overall increase in the uptake of unhealthy behaviors in the sample over time. 

It was demonstrated that adverse childhood experience (ACE) was predictive of belonging to a class with a greater probability of risky HRBs. A consistent observation across all classes was atypical sleep duration. This finding is in line with those reported in other studies. During the pandemic, individuals spent much time on their phones, making sleeping difficult.

Psychological distress was seen to significantly predict a higher probability of membership in a class likely to adopt unhealthy behaviors.

This was especially true for the Enhancing BMI Continued Frequent Drinking (EBFD) class. Adverse life events, such as unemployment and the death of loved ones, also made people more likely to engage in risky HRBs.

Limitations

The results documented here could be biased due to the elimination of cases with missing data owing to non-response. Non-response was found to have been most likely from males with younger and less educated parents and those with lower socioeconomic backgrounds.

Further, the diversity of the sample could have been limited by the inability to implement clustering. This is important because research has shown that the likelihood of adopting unhealthy HRBs is associated with experiencing more ACEs.

Conclusions and next steps

In sum, the current study sheds light on the heterogeneous manner in which people changed their HRBs during the COVID-19 pandemic. It further highlights the importance of using person-centric methods over variable-centric methods to study behavioral change.

The identification of subgroups more likely to engage in risky HRBs could assist in the development of interventions tailored to help such individuals and inform comprehensive treatments.

More representative and diverse samples should be used with validated measures of adverse childhood experiences in the future. This would help provide further evidence of the role of ACEs in individuals adopting risky HRBs during the lockdowns.

Additionally, future research should also examine whether pre-pandemic HRBs accurately predict membership in a particular subgroup.

As flagged in the last section, eliminating missing values could have biased the results. The statistical software used in the current study could not use multiple imputations to replace missing values.

This shortfall should be addressed in future studies by using more advanced software. This would aid in including more participants from underrepresented groups, making the results more robust. 

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.