Association of home and neighbourhood conditions with anxiety and depression symptoms during the COVID-19 lockdown: Findings from the ALSPAC study

Background The first COVID-19 lockdown in the UK was initially hailed as a great leveller. However, given that people were restricted to their homes and immediate neighbourhoods, there were stark inequalities in how different people experienced lockdown. Nevertheless, evidence on the associations of home and neighbourhood conditions in mental health during lockdown is sparce. Methods Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based cohort, we examined associations of home and neighbourhood conditions with anxiety and depression symptoms at two points during the first UK lockdown in 2020 (23/03/20-15/06/20). Questionnaires were sent to the ALSPAC cohort at two timepoints (T1: April; T2: May/June), including validated measures of mental health, and questions about current home conditions and behaviours, including access to nature, garden access, house type, and household composition. Neighbourhood conditions were obtained via a novel linkage, and included neighbourhood deprivation, population density, social fragmentation, and greenspace. Main associations were examined using linear regression. Potential confounders were identified using a directed acyclic graph and included ethnicity, family psychiatric history, maternal social class, financial difficulties before lockdown, and previous anxiety and depression at age 18. Findings At T1, reduced access to nature (B=1.06, 95% CI=0.68-1.45, p<0.001) and neighbourhood deprivation (B=0.25, 95% CI=0.02-0.48) were associated with anxiety. Furthermore, reduced access to nature (B=0.99, 95% CI=0.57-1.40, p<0.001), no garden access (B=0.62, 95% CI=0.04-1.20, p=0.037), living alone (B=1.53, 95% CI=0.63-2.43, p=0.001), and neighbourhood deprivation (B=0.27, 95% CI=0.02-0.52, p=0.033) were associated with depression. Associations were similar, but often weaker, at T2. For example, there was strong evidence of associations only for access nature with anxiety (B=0.74, 95% CI=0.25-1.23, p=0.004); and for access to nature (B=1.06, 95% CI=0.50-1.61, p=0.001) and living alone (B=1.19, 95% CI=0.25-2.13, p=0.013) with depression. Interpretation Disadvantaged home and neighbourhood conditions, especially reduced access to nature and neighbourhood deprivation, were associated with more anxiety and depression symptoms during the first UK lockdown. In the case of future pandemics, mitigation efforts should be tailored to reduce the burden on mental health for those most vulnerable. However, the causality of these observational findings is uncertain.