Giorgio Di Gessa | University College London (original) (raw)

Papers by Giorgio Di Gessa

European Journal of Ageing, Apr 29, 2024

Although the long-term consequences of informal care provision have been well investigated, few s... more Although the long-term consequences of informal care provision have been well investigated, few studies have examined the trajectories of informal care provision among older people and the socioeconomic, demographic, health, and family characteristics associated with them. We use data from four waves of the English Longitudinal Study of Ageing, with 6561 respondents followed for 6 years (2012/3–2018/9). We used group-based trajectory modelling to group people's provision of care over time into a finite number of distinct trajectories of caregiving. Using multinomial logistic regressions, we then investigated the characteristics associated with these trajectories. Four distinct trajectories of caregiving were identified: “stable intensive”, “increasing intensive”, “decreasing”, and “stable no care”. Results suggest that although there are socioeconomic, demographic, and health differences across the trajectories of caregiving (with younger women in good health and poorer socioeconomic status more likely to care intensively throughout), family characteristics are their main drivers. Respondents who live alone, with no children, and no parents alive are more likely to never provide care, whereas those with older parents and who live with adults in poor health are more likely to provide stable intensive care. Also, changes in family characteristics (e.g. death of parents, widowhood, or deterioration of the partner’s health) are associated with trajectories representing increases or decreases in caregiving over time. Overall, trajectories of informal caregiving undertaken by older people are varied and these patterns are mostly associated with both the availability and health of family members, suggesting that need factors represent the most immediate reason for caregiving commitments.

European Journal of Ageing , 2024

Although the long-term consequences of informal care provision have been well investigated, few s... more Although the long-term consequences of informal care provision have been well investigated, few studies have examined the trajectories of informal care provision among older people and the socioeconomic, demographic, health, and family characteristics associated with them. We use data from four waves of the English Longitudinal Study of Ageing, with 6561 respondents followed for 6 years (2012/3–2018/9). We used group-based trajectory modelling to group people's provision of care over time into a finite number of distinct trajectories of caregiving. Using multinomial logistic regressions, we then investigated the characteristics associated with these trajectories. Four distinct trajectories of caregiving were identified: “stable intensive”, “increasing intensive”, “decreasing”, and “stable no care”. Results suggest that although there are socioeconomic, demographic, and health differences across the trajectories of caregiving (with younger women in good health and poorer socioeconomic status more likely to care intensively throughout), family characteristics are their main drivers. Respondents who live alone, with no children, and no parents alive are more likely to never provide care, whereas those with older parents and who live with adults in poor health are more likely to provide stable intensive care. Also, changes in family characteristics (e.g. death of parents, widowhood, or deterioration of the partner’s health) are associated with trajectories representing increases or decreases in caregiving over time. Overall, trajectories of informal caregiving undertaken by older people are varied and these patterns are mostly associated with both the availability and health of family members, suggesting that need factors represent the most immediate reason for caregiving commitments.

Journal of Adolescent Health, Dec 31, 2023

Purpose -- Providing care in early adulthood may have long-term consequences, given the importanc... more Purpose -- Providing care in early adulthood may have long-term consequences, given the importance of this life stage for life-course transitions. This study aimed to analyze how the transition into caring during young adulthood (17–29 years old) influenced health and life satisfaction in the United Kingdom and Germany. Methods -- Datasets were from 10 annual waves of the UK Household Longitudinal Study and the German Socioeconomic Panel between the years 2009–2018. We used propensity score matching to match young adult carers (YACs) to similar noncarers to address the endogeneity of unpaid care provision. Then we applied piecewise growth curves to observe changes in self-rated health (United Kingdom N = 2,851; Germany N = 454) and life satisfaction (United Kingdom N = 2,263; Germany N = 449) between YAC and noncarers before, during, and after the onset of care. We assessed carer status, weekly hours spent on care, and duration of care. Results -- In the United Kingdom, life satisfaction decreased and the probability of reporting poor health increased after becoming a YAC, particularly for those who reported caring for more weekly hours. However, no such differences were found between YAC and noncarers in Germany. Discussion -- The onset and intensity of caring responsibilities during early adulthood influenced health and life satisfaction in the United Kingdom but not in Germany. One possible interpretation for these differences may be attributed to the different welfare contexts in which YACs are providing informal care. Our results highlight the importance of identifying and supporting the needs of young adults who are providing informal care while making key life-course transitions.

Journal of Social Policy, Oct 18, 2023

Informal care plays an important role in the provision of care. However, previous research has ma... more Informal care plays an important role in the provision of care. However, previous research has mainly focused on middle-or older-aged informal carers and less is known about informal care among young adults, its consequences on educational achievement and employment transitions and whether this varies across country contexts. Using data from the 2009-2018 waves of the UK Household Longitudinal Study (N = 25,856) and the German Socio-Economic Panel (N = 16,666), we investigated the influence of informal care responsibilities of 17-29 year olds on their chances of achieving a university degree using logistic regression and employment transitions using Cox proportional hazard regression models. Our results revealed that young adulthood caring was negatively associated with the likelihood of obtaining a university degree, reduced the likelihood of entering employment and increased the likelihood of unemployment. These associations were more pronounced if people reported caring for more weekly hours (especially in the UK) or caring for longer durations (especially in Germany). The potential negative influence of caring in young adulthood on education was stronger for women than for men in Germany, and the influence of caring on entering unemployment was stronger for women than for men in the UK.

Journal of Adolescent Health, 2024

Purpose -- Providing care in early adulthood may have long-term consequences, given the importanc... more Purpose -- Providing care in early adulthood may have long-term consequences, given the importance of this life stage for life-course transitions. This study aimed to analyze how the transition into caring during young adulthood (17–29 years old) influenced health and life satisfaction in the United Kingdom and Germany.

Methods -- Datasets were from 10 annual waves of the UK Household Longitudinal Study and the German Socioeconomic Panel between the years 2009–2018. We used propensity score matching to match young adult carers (YACs) to similar noncarers to address the endogeneity of unpaid care provision. Then we applied piecewise growth curves to observe changes in self-rated health (United Kingdom N = 2,851; Germany N = 454) and life satisfaction (United Kingdom N = 2,263; Germany N = 449) between YAC and noncarers before, during, and after the onset of care. We assessed carer status, weekly hours spent on care, and duration of care.

Results -- In the United Kingdom, life satisfaction decreased and the probability of reporting poor health increased after becoming a YAC, particularly for those who reported caring for more weekly hours. However, no such differences were found between YAC and noncarers in Germany.

Discussion -- The onset and intensity of caring responsibilities during early adulthood influenced health and life satisfaction in the United Kingdom but not in Germany. One possible interpretation for these differences may be attributed to the different welfare contexts in which YACs are providing informal care. Our results highlight the importance of identifying and supporting the needs of young adults who are providing informal care while making key life-course transitions.

BJPsych Open

Background Although the COVID-19 pandemic has affected depression, evidence of the role of pre-pa... more Background Although the COVID-19 pandemic has affected depression, evidence of the role of pre-pandemic history of depression remains limited. Aims We investigated how long-term trajectories of depressive symptomatology before the COVID-19 pandemic were related to depression during the pandemic, over and above the latest pre-pandemic depression status. Furthermore, we examined whether those experiencing depression closer to the pandemic were at higher risk during the pandemic. Method Employing data from waves 4–9 of the English Longitudinal Study of Ageing (2008–2009 to 2018–2019), we used group-based trajectory modelling on 3925 English older adults aged 50+ years to identify distinctive trajectories of elevated depressive symptoms (EDS). Fully adjusted logistic models were then used to examine the associations between trajectories and depression during the COVID-19 pandemic (June–July and November–December 2020). Results We identified four classes of pre-pandemic trajectories of E...

Background People who live alone experience greater levels of mental illness; however, it is uncl... more Background People who live alone experience greater levels of mental illness; however, it is unclear whether the COVID-19 pandemic had a disproportionately negative impact on this demographic. Objective To describe the mental health gap between those who live alone and with others in the UK prior to and during the COVID-19 pandemic. Methods Self-reported psychological distress and life satisfaction in 10 prospective longitudinal population surveys (LPSs) assessed in the nearest pre-pandemic sweep and three periods during the pandemic. Recorded diagnosis of common and severe mental illnesses between March 2018 and January 2022 in electronic healthcare records (EHRs) within the OpenSAFELY-TPP. Findings In 37 544 LPS participants, pooled models showed greater psychological distress (standardised mean difference (SMD): 0.09 (95% CI: 0.04; 0.14); relative risk: 1.25 (95% CI: 1.12; 1.39)) and lower life satisfaction (SMD: −0.22 (95% CI: −0.30; −0.15)) for those living alone pre-pandemic. This gap did not change during the pandemic. In the EHR analysis of c.16 million records, mental health conditions were more common in those who lived alone (eg, depression 26 (95% CI: 18 to 33) and severe mental illness 58 (95% CI: 54 to 62) more cases more per 100 000). For common mental health disorders, the gap in recorded cases in EHRs narrowed during the pandemic. Conclusions People living alone have poorer mental health and lower life satisfaction. During the pandemic, this gap in self-reported distress remained; however, there was a narrowing of the gap in service use. Clinical implications Greater mental health need and potentially greater barriers to mental healthcare access for those who live alone need to be considered in healthcare planning.

medRxiv (Cold Spring Harbor Laboratory), Jul 31, 2023

Proceedings of the National Academy of Sciences of the United States of America, Mar 20, 2023

The family plays a central role in shaping health behaviors of its members through social control... more The family plays a central role in shaping health behaviors of its members through social control and support mechanisms. We investigate whether and to what extent close kin (i.e., partner and children) matter for older people in taking on precautionary behaviors (e.g., wearing a mask) and vaccination during the COVID-19 pandemic in Europe. Drawing on data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we combine its Corona Surveys (June to September 2020 and June to August 2021) with pre-COVID information (October 2019 to March 2020). We find that having close kin (especially a partner) is associated with a higher probability of both adopting precautionary behaviors and accepting a COVID-19 vaccine. Results are robust to controlling for other potential drivers of precautionary behaviors and vaccine acceptance and to accounting for coresidence with kin. Our findings suggest that policymakers and practitioners may differently address kinless individuals when promoting public policy measures.

Journal of Applied Gerontology, Feb 28, 2023

Stay-at-home and lockdown measures during the COVID-19 pandemic had an impact on health-related b... more Stay-at-home and lockdown measures during the COVID-19 pandemic had an impact on health-related behaviors which in turn posed a risk to mental health, particularly among older people. In this study, we investigated how changes to health behaviors (physical activity, sleeping, eating, and drinking) impacted mental health (depression, quality of life, and life satisfaction) during and beyond the initial phase of the COVID-19 lockdown. Using data from Wave 9 (2018/19) and two COVID-19 sub-studies (June/July 2020; November/December 2020) of the English Longitudinal Study of Ageing (N = 4989), we found that health behaviors changes during lockdown were associated with poorer mental health in June/July 2020. However, in November/ December 2020, higher depression, lower quality of life, and lower life satisfaction were more likely only among respondents who reported less physical activity, eating more, changes in sleep patterns, and drinking more alcohol. Public health programs should support healthy behaviors as we emerge from the pandemic.

Innovation in Aging, Nov 1, 2022

European journal of public health, Sep 23, 2017

Background: Social and policy changes in the last several decades have increased women's options ... more Background: Social and policy changes in the last several decades have increased women's options for combining paid work with family care. We explored whether specific combinations of work and family care over the lifecourse are associated with variations in women's later life health. Methods: We used sequence analysis to group women in the English Longitudinal Study of Ageing according to their work histories and fertility. Using logistic regression, we tested for group differences in later life disability, depressive symptomology and mortality, while controlling for childhood health and socioeconomic position and a range of adult socioeconomic circumstances and health behaviours. Results: Women who transitioned from family care to either part-time work after a short break from the labour force, or to full-time work, reported lower odds of having a disability compared with the reference group of women with children who were mostly employed full-time throughout. Women who shifted from family care to part-time work after a long career break had lower odds of mortality than the reference group. Depressive symptoms were not associated with women's work and family care histories. Conclusion: Women's work histories are predictive of their later life disability and mortality. This relationship may be useful in targeting interventions aimed at improving later life health. Further research is necessary to explore the mechanisms linking certain work histories to poorer later life health and to design interventions for those affected.

medRxiv (Cold Spring Harbor Laboratory), Jun 28, 2023

Edward Elgar Publishing eBooks, Apr 14, 2023

European journal of public health, Feb 24, 2020

Background: Employment histories influence health. However, most studies have so far investigated... more Background: Employment histories influence health. However, most studies have so far investigated crosssectional associations between employment histories and health, failing to recognize health as a dynamic process in later life. Methods: We use Waves 3-8 of the English Longitudinal Study of Ageing, including retrospective information on respondents' employment activities. We used dynamic hamming distances to summarize lifetime employment histories up to state pension age (64 for men and 59 for women). Multilevel growth curve models were then used to estimate the influence of lifetime employment histories on later life health trajectories over a 10-year period using quality of life (QoL), somatic health, and depression. Results: Net of selection effect and a host of contemporaneous material and social resources, men who exited early started off with poorer health than those with continuous attachment to the labour market but had a very similar health profile by the end of the 10year period considered. Among women, better somatic health and higher QoL were observed among those who had employment breaks for family care, and this health advantage was maintained over time. Lifetime employment histories are not related to depression for either men or women. Conclusion: Overall, differences in health by employment histories level off only among men who left earlier and those continuously employed. Flexible arrangements for men in poor health who benefit from leaving the labour market early and supporting women who wish to take breaks for family care may help reduce health inequalities in later life.

Journal of Adolescence, Jun 10, 2023

IntroductionYoung adult caregivers (aged 16–29 years) are an important but underrecognized group ... more IntroductionYoung adult caregivers (aged 16–29 years) are an important but underrecognized group of informal caregivers. There is some evidence suggesting that young adult caregivers have fewer social relationships. However, this research has been largely cross‐sectional in design or restricted to caregivers, providing no comparison with noncaregivers. Further, there is little evidence on whether and to what extent there are inequalities in associations between young adult caregiving and social relationships by gender, age, caregiving intensity, or household income.MethodsUsing five waves of data on 3‐4000 young adults aged 16–29 from the UK Household Longitudinal Study, we investigated associations between becoming a young adult caregiver and subsequent social relationships (number of close friends and participation in organized social activities) in the short‐term (1–2 years after caregiving initiation) and longer‐term (4–5 years later). We also assessed differences by gender, age, household income, and caregiving intensity.ResultsOverall, those who became young adult caregivers, and particularly those providing 5+ h/week, reported fewer friends in the short‐ but not longer‐term. No associations were observed between young adult caregiving and participation in organized social activities. Also, there was no evidence of differences by gender, age, income, or caregiving hours.ConclusionsBecoming a young adult caregiver is associated with a reduction in number of close friends, particularly in the short‐term. Given the importance of practical and emotional support provided by friends, the early identification of young adult caregivers and greater population awareness of caring in young adulthood may help to mitigate the effects on social relationships.

medRxiv (Cold Spring Harbor Laboratory), May 22, 2022

SARS-CoV-2 antibody levels can be used to assess humoral immune responses following SARS-CoV-2 in... more SARS-CoV-2 antibody levels can be used to assess humoral immune responses following SARS-CoV-2 infection or vaccination, and may predict risk of future infection. From cross-sectional antibody testing of 9,361 individuals from TwinsUK and ALSPAC UK population-based longitudinal studies (jointly in April-May 2021, and TwinsUK only in November 2021-January 2022), we tested associations between antibody levels following vaccination and: (1) SARS-CoV-2 infection following vaccination(s); (2) health, socio-demographic, SARS-CoV-2 infection and SARS-CoV-2 vaccination variables.Within TwinsUK, single-vaccinated individuals with the lowest 20% of anti-Spike antibody levels at initial testing had 3-fold greater odds of SARS-CoV-2 infection over the next six to nine months, compared to the top 20%. In TwinsUK and ALSPAC, individuals identified as at increased risk of COVID-19 complication through the UK “Shielded Patient List” had consistently greater odds (2 to 4-fold) of having antibody levels in the lowest 10%. Third vaccination increased absolute antibody levels for almost all individuals, and reduced relative disparities compared with earlier vaccinations.These findings quantify the association between antibody level and risk of subsequent infection, and support a policy of triple vaccination for the generation of protective antibodies.Lay summaryIn this study, we analysed blood samples from 9,361 participants from two studies in the UK: an adult twin registry, TwinsUK (4,739 individuals); and the Avon Longitudinal Study of Parents and Children, ALSPAC (4,622 individuals). We did this work as part of the UK Government National Core Studies initiative researching COVID-19. We measured blood antibodies which are specific to SARS-CoV-2 (which causes COVID-19). Having a third COVID-19 vaccination boosted antibody levels. More than 90% of people from TwinsUK had levels after third vaccination that were greater than the average level after second vaccination. Importantly, this was the case even in individuals on the UK “Shielded Patient List”. We found that people with lower antibody levels after first vaccination were more likely to report having COVID-19 later on, compared to people with higher antibody levels. People on the UK “Shielded Patient List”, and individuals who reported that they had poorer general health, were more likely to have lower antibody levels after vaccination. In contrast, people who had had a previous COVID-19 infection were more likely to have higher antibody levels following vaccination compared to people without infection. People receiving the Oxford/AstraZeneca rather than the Pfizer BioNTech vaccine had lower antibody levels after one or two vaccinations. However, after a third vaccination, there was no difference in antibody levels between those who had Oxford/AstraZeneca and Pfizer BioNTech vaccines for their first two doses. These findings support having a third COVID-19 vaccination to boost antibodies.

European Journal of Ageing, Apr 29, 2024

Although the long-term consequences of informal care provision have been well investigated, few s... more Although the long-term consequences of informal care provision have been well investigated, few studies have examined the trajectories of informal care provision among older people and the socioeconomic, demographic, health, and family characteristics associated with them. We use data from four waves of the English Longitudinal Study of Ageing, with 6561 respondents followed for 6 years (2012/3–2018/9). We used group-based trajectory modelling to group people's provision of care over time into a finite number of distinct trajectories of caregiving. Using multinomial logistic regressions, we then investigated the characteristics associated with these trajectories. Four distinct trajectories of caregiving were identified: “stable intensive”, “increasing intensive”, “decreasing”, and “stable no care”. Results suggest that although there are socioeconomic, demographic, and health differences across the trajectories of caregiving (with younger women in good health and poorer socioeconomic status more likely to care intensively throughout), family characteristics are their main drivers. Respondents who live alone, with no children, and no parents alive are more likely to never provide care, whereas those with older parents and who live with adults in poor health are more likely to provide stable intensive care. Also, changes in family characteristics (e.g. death of parents, widowhood, or deterioration of the partner’s health) are associated with trajectories representing increases or decreases in caregiving over time. Overall, trajectories of informal caregiving undertaken by older people are varied and these patterns are mostly associated with both the availability and health of family members, suggesting that need factors represent the most immediate reason for caregiving commitments.

European Journal of Ageing , 2024

Although the long-term consequences of informal care provision have been well investigated, few s... more Although the long-term consequences of informal care provision have been well investigated, few studies have examined the trajectories of informal care provision among older people and the socioeconomic, demographic, health, and family characteristics associated with them. We use data from four waves of the English Longitudinal Study of Ageing, with 6561 respondents followed for 6 years (2012/3–2018/9). We used group-based trajectory modelling to group people's provision of care over time into a finite number of distinct trajectories of caregiving. Using multinomial logistic regressions, we then investigated the characteristics associated with these trajectories. Four distinct trajectories of caregiving were identified: “stable intensive”, “increasing intensive”, “decreasing”, and “stable no care”. Results suggest that although there are socioeconomic, demographic, and health differences across the trajectories of caregiving (with younger women in good health and poorer socioeconomic status more likely to care intensively throughout), family characteristics are their main drivers. Respondents who live alone, with no children, and no parents alive are more likely to never provide care, whereas those with older parents and who live with adults in poor health are more likely to provide stable intensive care. Also, changes in family characteristics (e.g. death of parents, widowhood, or deterioration of the partner’s health) are associated with trajectories representing increases or decreases in caregiving over time. Overall, trajectories of informal caregiving undertaken by older people are varied and these patterns are mostly associated with both the availability and health of family members, suggesting that need factors represent the most immediate reason for caregiving commitments.

Journal of Adolescent Health, Dec 31, 2023

Purpose -- Providing care in early adulthood may have long-term consequences, given the importanc... more Purpose -- Providing care in early adulthood may have long-term consequences, given the importance of this life stage for life-course transitions. This study aimed to analyze how the transition into caring during young adulthood (17–29 years old) influenced health and life satisfaction in the United Kingdom and Germany. Methods -- Datasets were from 10 annual waves of the UK Household Longitudinal Study and the German Socioeconomic Panel between the years 2009–2018. We used propensity score matching to match young adult carers (YACs) to similar noncarers to address the endogeneity of unpaid care provision. Then we applied piecewise growth curves to observe changes in self-rated health (United Kingdom N = 2,851; Germany N = 454) and life satisfaction (United Kingdom N = 2,263; Germany N = 449) between YAC and noncarers before, during, and after the onset of care. We assessed carer status, weekly hours spent on care, and duration of care. Results -- In the United Kingdom, life satisfaction decreased and the probability of reporting poor health increased after becoming a YAC, particularly for those who reported caring for more weekly hours. However, no such differences were found between YAC and noncarers in Germany. Discussion -- The onset and intensity of caring responsibilities during early adulthood influenced health and life satisfaction in the United Kingdom but not in Germany. One possible interpretation for these differences may be attributed to the different welfare contexts in which YACs are providing informal care. Our results highlight the importance of identifying and supporting the needs of young adults who are providing informal care while making key life-course transitions.

Journal of Social Policy, Oct 18, 2023

Informal care plays an important role in the provision of care. However, previous research has ma... more Informal care plays an important role in the provision of care. However, previous research has mainly focused on middle-or older-aged informal carers and less is known about informal care among young adults, its consequences on educational achievement and employment transitions and whether this varies across country contexts. Using data from the 2009-2018 waves of the UK Household Longitudinal Study (N = 25,856) and the German Socio-Economic Panel (N = 16,666), we investigated the influence of informal care responsibilities of 17-29 year olds on their chances of achieving a university degree using logistic regression and employment transitions using Cox proportional hazard regression models. Our results revealed that young adulthood caring was negatively associated with the likelihood of obtaining a university degree, reduced the likelihood of entering employment and increased the likelihood of unemployment. These associations were more pronounced if people reported caring for more weekly hours (especially in the UK) or caring for longer durations (especially in Germany). The potential negative influence of caring in young adulthood on education was stronger for women than for men in Germany, and the influence of caring on entering unemployment was stronger for women than for men in the UK.

Journal of Adolescent Health, 2024

Purpose -- Providing care in early adulthood may have long-term consequences, given the importanc... more Purpose -- Providing care in early adulthood may have long-term consequences, given the importance of this life stage for life-course transitions. This study aimed to analyze how the transition into caring during young adulthood (17–29 years old) influenced health and life satisfaction in the United Kingdom and Germany.

Methods -- Datasets were from 10 annual waves of the UK Household Longitudinal Study and the German Socioeconomic Panel between the years 2009–2018. We used propensity score matching to match young adult carers (YACs) to similar noncarers to address the endogeneity of unpaid care provision. Then we applied piecewise growth curves to observe changes in self-rated health (United Kingdom N = 2,851; Germany N = 454) and life satisfaction (United Kingdom N = 2,263; Germany N = 449) between YAC and noncarers before, during, and after the onset of care. We assessed carer status, weekly hours spent on care, and duration of care.

Results -- In the United Kingdom, life satisfaction decreased and the probability of reporting poor health increased after becoming a YAC, particularly for those who reported caring for more weekly hours. However, no such differences were found between YAC and noncarers in Germany.

Discussion -- The onset and intensity of caring responsibilities during early adulthood influenced health and life satisfaction in the United Kingdom but not in Germany. One possible interpretation for these differences may be attributed to the different welfare contexts in which YACs are providing informal care. Our results highlight the importance of identifying and supporting the needs of young adults who are providing informal care while making key life-course transitions.

BJPsych Open

Background Although the COVID-19 pandemic has affected depression, evidence of the role of pre-pa... more Background Although the COVID-19 pandemic has affected depression, evidence of the role of pre-pandemic history of depression remains limited. Aims We investigated how long-term trajectories of depressive symptomatology before the COVID-19 pandemic were related to depression during the pandemic, over and above the latest pre-pandemic depression status. Furthermore, we examined whether those experiencing depression closer to the pandemic were at higher risk during the pandemic. Method Employing data from waves 4–9 of the English Longitudinal Study of Ageing (2008–2009 to 2018–2019), we used group-based trajectory modelling on 3925 English older adults aged 50+ years to identify distinctive trajectories of elevated depressive symptoms (EDS). Fully adjusted logistic models were then used to examine the associations between trajectories and depression during the COVID-19 pandemic (June–July and November–December 2020). Results We identified four classes of pre-pandemic trajectories of E...

Background People who live alone experience greater levels of mental illness; however, it is uncl... more Background People who live alone experience greater levels of mental illness; however, it is unclear whether the COVID-19 pandemic had a disproportionately negative impact on this demographic. Objective To describe the mental health gap between those who live alone and with others in the UK prior to and during the COVID-19 pandemic. Methods Self-reported psychological distress and life satisfaction in 10 prospective longitudinal population surveys (LPSs) assessed in the nearest pre-pandemic sweep and three periods during the pandemic. Recorded diagnosis of common and severe mental illnesses between March 2018 and January 2022 in electronic healthcare records (EHRs) within the OpenSAFELY-TPP. Findings In 37 544 LPS participants, pooled models showed greater psychological distress (standardised mean difference (SMD): 0.09 (95% CI: 0.04; 0.14); relative risk: 1.25 (95% CI: 1.12; 1.39)) and lower life satisfaction (SMD: −0.22 (95% CI: −0.30; −0.15)) for those living alone pre-pandemic. This gap did not change during the pandemic. In the EHR analysis of c.16 million records, mental health conditions were more common in those who lived alone (eg, depression 26 (95% CI: 18 to 33) and severe mental illness 58 (95% CI: 54 to 62) more cases more per 100 000). For common mental health disorders, the gap in recorded cases in EHRs narrowed during the pandemic. Conclusions People living alone have poorer mental health and lower life satisfaction. During the pandemic, this gap in self-reported distress remained; however, there was a narrowing of the gap in service use. Clinical implications Greater mental health need and potentially greater barriers to mental healthcare access for those who live alone need to be considered in healthcare planning.

medRxiv (Cold Spring Harbor Laboratory), Jul 31, 2023

Proceedings of the National Academy of Sciences of the United States of America, Mar 20, 2023

The family plays a central role in shaping health behaviors of its members through social control... more The family plays a central role in shaping health behaviors of its members through social control and support mechanisms. We investigate whether and to what extent close kin (i.e., partner and children) matter for older people in taking on precautionary behaviors (e.g., wearing a mask) and vaccination during the COVID-19 pandemic in Europe. Drawing on data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we combine its Corona Surveys (June to September 2020 and June to August 2021) with pre-COVID information (October 2019 to March 2020). We find that having close kin (especially a partner) is associated with a higher probability of both adopting precautionary behaviors and accepting a COVID-19 vaccine. Results are robust to controlling for other potential drivers of precautionary behaviors and vaccine acceptance and to accounting for coresidence with kin. Our findings suggest that policymakers and practitioners may differently address kinless individuals when promoting public policy measures.

Journal of Applied Gerontology, Feb 28, 2023

Stay-at-home and lockdown measures during the COVID-19 pandemic had an impact on health-related b... more Stay-at-home and lockdown measures during the COVID-19 pandemic had an impact on health-related behaviors which in turn posed a risk to mental health, particularly among older people. In this study, we investigated how changes to health behaviors (physical activity, sleeping, eating, and drinking) impacted mental health (depression, quality of life, and life satisfaction) during and beyond the initial phase of the COVID-19 lockdown. Using data from Wave 9 (2018/19) and two COVID-19 sub-studies (June/July 2020; November/December 2020) of the English Longitudinal Study of Ageing (N = 4989), we found that health behaviors changes during lockdown were associated with poorer mental health in June/July 2020. However, in November/ December 2020, higher depression, lower quality of life, and lower life satisfaction were more likely only among respondents who reported less physical activity, eating more, changes in sleep patterns, and drinking more alcohol. Public health programs should support healthy behaviors as we emerge from the pandemic.

Innovation in Aging, Nov 1, 2022

European journal of public health, Sep 23, 2017

Background: Social and policy changes in the last several decades have increased women's options ... more Background: Social and policy changes in the last several decades have increased women's options for combining paid work with family care. We explored whether specific combinations of work and family care over the lifecourse are associated with variations in women's later life health. Methods: We used sequence analysis to group women in the English Longitudinal Study of Ageing according to their work histories and fertility. Using logistic regression, we tested for group differences in later life disability, depressive symptomology and mortality, while controlling for childhood health and socioeconomic position and a range of adult socioeconomic circumstances and health behaviours. Results: Women who transitioned from family care to either part-time work after a short break from the labour force, or to full-time work, reported lower odds of having a disability compared with the reference group of women with children who were mostly employed full-time throughout. Women who shifted from family care to part-time work after a long career break had lower odds of mortality than the reference group. Depressive symptoms were not associated with women's work and family care histories. Conclusion: Women's work histories are predictive of their later life disability and mortality. This relationship may be useful in targeting interventions aimed at improving later life health. Further research is necessary to explore the mechanisms linking certain work histories to poorer later life health and to design interventions for those affected.

medRxiv (Cold Spring Harbor Laboratory), Jun 28, 2023

Edward Elgar Publishing eBooks, Apr 14, 2023

European journal of public health, Feb 24, 2020

Background: Employment histories influence health. However, most studies have so far investigated... more Background: Employment histories influence health. However, most studies have so far investigated crosssectional associations between employment histories and health, failing to recognize health as a dynamic process in later life. Methods: We use Waves 3-8 of the English Longitudinal Study of Ageing, including retrospective information on respondents' employment activities. We used dynamic hamming distances to summarize lifetime employment histories up to state pension age (64 for men and 59 for women). Multilevel growth curve models were then used to estimate the influence of lifetime employment histories on later life health trajectories over a 10-year period using quality of life (QoL), somatic health, and depression. Results: Net of selection effect and a host of contemporaneous material and social resources, men who exited early started off with poorer health than those with continuous attachment to the labour market but had a very similar health profile by the end of the 10year period considered. Among women, better somatic health and higher QoL were observed among those who had employment breaks for family care, and this health advantage was maintained over time. Lifetime employment histories are not related to depression for either men or women. Conclusion: Overall, differences in health by employment histories level off only among men who left earlier and those continuously employed. Flexible arrangements for men in poor health who benefit from leaving the labour market early and supporting women who wish to take breaks for family care may help reduce health inequalities in later life.

Journal of Adolescence, Jun 10, 2023

IntroductionYoung adult caregivers (aged 16–29 years) are an important but underrecognized group ... more IntroductionYoung adult caregivers (aged 16–29 years) are an important but underrecognized group of informal caregivers. There is some evidence suggesting that young adult caregivers have fewer social relationships. However, this research has been largely cross‐sectional in design or restricted to caregivers, providing no comparison with noncaregivers. Further, there is little evidence on whether and to what extent there are inequalities in associations between young adult caregiving and social relationships by gender, age, caregiving intensity, or household income.MethodsUsing five waves of data on 3‐4000 young adults aged 16–29 from the UK Household Longitudinal Study, we investigated associations between becoming a young adult caregiver and subsequent social relationships (number of close friends and participation in organized social activities) in the short‐term (1–2 years after caregiving initiation) and longer‐term (4–5 years later). We also assessed differences by gender, age, household income, and caregiving intensity.ResultsOverall, those who became young adult caregivers, and particularly those providing 5+ h/week, reported fewer friends in the short‐ but not longer‐term. No associations were observed between young adult caregiving and participation in organized social activities. Also, there was no evidence of differences by gender, age, income, or caregiving hours.ConclusionsBecoming a young adult caregiver is associated with a reduction in number of close friends, particularly in the short‐term. Given the importance of practical and emotional support provided by friends, the early identification of young adult caregivers and greater population awareness of caring in young adulthood may help to mitigate the effects on social relationships.

medRxiv (Cold Spring Harbor Laboratory), May 22, 2022

SARS-CoV-2 antibody levels can be used to assess humoral immune responses following SARS-CoV-2 in... more SARS-CoV-2 antibody levels can be used to assess humoral immune responses following SARS-CoV-2 infection or vaccination, and may predict risk of future infection. From cross-sectional antibody testing of 9,361 individuals from TwinsUK and ALSPAC UK population-based longitudinal studies (jointly in April-May 2021, and TwinsUK only in November 2021-January 2022), we tested associations between antibody levels following vaccination and: (1) SARS-CoV-2 infection following vaccination(s); (2) health, socio-demographic, SARS-CoV-2 infection and SARS-CoV-2 vaccination variables.Within TwinsUK, single-vaccinated individuals with the lowest 20% of anti-Spike antibody levels at initial testing had 3-fold greater odds of SARS-CoV-2 infection over the next six to nine months, compared to the top 20%. In TwinsUK and ALSPAC, individuals identified as at increased risk of COVID-19 complication through the UK “Shielded Patient List” had consistently greater odds (2 to 4-fold) of having antibody levels in the lowest 10%. Third vaccination increased absolute antibody levels for almost all individuals, and reduced relative disparities compared with earlier vaccinations.These findings quantify the association between antibody level and risk of subsequent infection, and support a policy of triple vaccination for the generation of protective antibodies.Lay summaryIn this study, we analysed blood samples from 9,361 participants from two studies in the UK: an adult twin registry, TwinsUK (4,739 individuals); and the Avon Longitudinal Study of Parents and Children, ALSPAC (4,622 individuals). We did this work as part of the UK Government National Core Studies initiative researching COVID-19. We measured blood antibodies which are specific to SARS-CoV-2 (which causes COVID-19). Having a third COVID-19 vaccination boosted antibody levels. More than 90% of people from TwinsUK had levels after third vaccination that were greater than the average level after second vaccination. Importantly, this was the case even in individuals on the UK “Shielded Patient List”. We found that people with lower antibody levels after first vaccination were more likely to report having COVID-19 later on, compared to people with higher antibody levels. People on the UK “Shielded Patient List”, and individuals who reported that they had poorer general health, were more likely to have lower antibody levels after vaccination. In contrast, people who had had a previous COVID-19 infection were more likely to have higher antibody levels following vaccination compared to people without infection. People receiving the Oxford/AstraZeneca rather than the Pfizer BioNTech vaccine had lower antibody levels after one or two vaccinations. However, after a third vaccination, there was no difference in antibody levels between those who had Oxford/AstraZeneca and Pfizer BioNTech vaccines for their first two doses. These findings support having a third COVID-19 vaccination to boost antibodies.

The importance of life course influences on health differentials in later life has been increasin... more The importance of life course influences on health differentials in later life has been increasingly recognised. Parenthood represents a major domain of most people’s lives with short and long-term implications. Apart from the physiological and psychological effects of pregnancy and childbirth, the health of both women and men may be influenced by stresses, role changes, and changes in allocation of personal and family resources associated with childrearing and by the emotional and social support benefits of parenthood. The associations of fertility history indicators on health have been rarely studied in familialistic countries such as Italy. In a familialistic country with strong family ties, frequent contact between generations may play a significant role in enhancing the role of parenthood against childlessness, especially for the subjective indicators of health. Additionally it should be stressed that familialistic countries are characterised by the unbalanced division of house and care work: women’s multiple roles may affect (positively for the “role enhancing theory” or negatively for the “role strain model”) the perception of their health status. This study aims to understand how fertility quantum and tempo components may have an effect on different health indicators (self-rated health, presence of limitations, ADL, IADL, and depression score) at ages 50 and above, controlling for a set of demographic and socio-economic indicators. We use data from the Italian Survey on Family and Social Relations 2009, and the pooled baseline interviews of the waves 1 and 2 of the Survey of Health, Ageing and Retirement in Europe (SHARE), for Italian respondents for whom information on their fertility history had been collected. We define individual fertility biographies by parity, early and late fertility, and spacing and explore their effect on both gender. These relations are analysed by taking different socio-economic indicators into consideration in order to control for these confounding factors. Conclusions Our results provide additional insight on how fertility histories may influence health in later life. Concentration of fertility in low parities and a reduction of early pregnancies among younger cohorts of women may have a positive effect on health in the future, while men’s health seems not to be significantly influenced by fertility histories variables.

Background: During the COVID-19 pandemic, older and clinically vulnerable people were instructed ... more Background: During the COVID-19 pandemic, older and clinically vulnerable people were instructed to shield or stay at home to save lives. Policies restricting social contact and human interaction pose a risk to mental health, but we know very little about the impact of shielding and stay at home orders on the mental health of older people.
Aims: Understand the extent to which shielding contributes to poorer mental health.
Method: Exploiting longitudinal data from Wave 9 (2018/19) and two COVID-19 sub-studies (June/July 2020; November/December 2020) of the English Longitudinal Study of Ageing we use logistic and linear regression models to investigate associations between patterns of shielding during the pandemic and mental health, controlling for socio-demographic characteristics, pre-pandemic physical and mental health, and social isolation measures.
Results: By December 2020, 70% of older people were still shielding or staying at home, with 5% shielding throughout the first 9 months of the pandemic. Respondents who shielded experienced worse mental health. Although prior characteristics and lack of social interactions explain some of this association, even controlling for all covariates, those shielding throughout had higher odds of reporting elevated depressive symptoms (OR=1.87, 95%CI=1.22;2.87) and reported lower quality of life (B=-1.28, 95%CI=-2.04;-0.52) than those who neither shielded nor stayed at home. Shielding was also associated with increased anxiety.
Conclusions: Shielding itself seems associated with worse mental health among older people, highlighting the need for policymakers to address the mental health needs of those who shielded, both in emerging from the current pandemic and for the future.