Healthy Communities Publications

The relationship between financial disruption during the COVID-19 pandemic and mental health: A systematic review and meta-analysis

Richardson T, Ashworth S, Sood M, McKell E, Maguire N, Alwan NA, Smith D

The World Health Organisation (WHO) declared that the coronavirus (COVID-19) outbreak reached global pandemic status on 11 March 2020. Over 3 years later, on 5 March 2023, the WHO announced that COVID-19 no longer constituted a public health emergency of international concern (PHEIC). This pandemic drastically altered people’s lives and has had profound consequences on society in terms of physical health, mental health, and the economy. From research regarding previous pandemics, such as that of the severe acute respiratory syndrome (SARS, 2002–2003), it is understood that the diverse and far-reaching effects of pandemics are likely to endure beyond the period of the pandemic. The effects of the COVID-19 pandemic on mental health have been suggested to follow three main routes, namely: the disease itself, the associated imposed quarantine and social measures, and the economic consequences of the pandemic.

An established and expanding body of research has focussed on the relationship between mental health and economic concepts such as socioeconomic status (SES) and unemployment. While research has focussed broadly on SES and mental health, recent research has focussed on specific socioeconomic variables. For example, studies show that financial hardship (difficulty meeting financial obligations) is a stronger predictor of depression than other socioeconomic variables such as educational attainment and household income while controlling for differences in household demographic composition, size, and subsequent financial requirements. Research has also distinguished objective and subjective financial impact, with the former describing measurable financial impact (e.g. income loss, debt amount) and the latter describing perceived financial impact (e.g. financial stress/worry). Research shows that subjective financial worries have a greater impact on mental health than objective economic impact.

A recent systematic review assessed the impact of the COVID-19 pandemic, previous pandemics, previous epidemics, and the 2008 economic crisis on mental health. The review showed that socioeconomic factors and unemployment resulting from the 2008 economic crisis had negative effects on mental health, including an increase in affective disorders. The main risk factors mediating the effects of the economic crisis on poor mental health included unemployment, indebtedness, precarious working conditions, inequalities, housing instability and lack of social connectedness. Another review examining the impact of economic decline on mental health found that while the effects of economic crises most negatively impacted individuals who were considered poor, less educated, or unemployed, these also affected the general population and individuals in employment, indicating that the negative impact on mental health is experienced widely by diverse groups.

While several systematic reviews have examined the psychological impact of the COVID-19 pandemic, to our knowledge, no systematic review and meta-analysis has investigated the relationship between COVID-19 related financial changes and mental health. A recent review looks at the association between socioeconomic condition indicators (e.g. education, economic factors) and anxiety and depression; the present review offers a more focussed and detailed examination of how financial change during the pandemic relates to mental health. As COVID-19 has caused significant detrimental economic consequences on individual, community, and wider societal levels, and given the established association between financial hardship and mental health difficulties, it is imperative that this area is examined and understood to inform local and national policy and intervention, resource, and support planning.

The objective of this review is to synthesise the existing evidence from cross-sectional and longitudinal quantitative studies that examine the relationship between COVID-19 related financial change and mental health.

https://doi.org/10.1177/22799036251395263

January 2026

The Food (Promotion and Placement) regulations are beginning to shift the onus for healthier choices from individuals to businesses: in-depth perspectives from health experts

Dhuria   P, Muir S, Bird A, Lawrence W, Roe E, Baird J, Vogel C

Retail food environments in the UK use intense marketing strategies to promote the purchase and consumption of less-healthy foods that are associated with ill-health. To help address this issue, the Food (Promotion and Placement) regulations were introduced in England from October 2022, banning the placement of foods high in fat, salt, or sugar (HFSS) at checkouts, aisle-ends, and entrances in qualifying retail settings. Ahead of their introduction, this study examined health experts' (i) perspectives on the likely effectiveness of these regulations and (ii) recommendations to enhance their impact.

https://doi.org/10.1186/s12916-025-04484-2

December 2025

Safety implications of remote assessments for suspected COVID-19: qualitative study in UK primary care

Wieringa S, Neves AL, Rushforth A, Ladds E, Husain L, Finlay T, Pope C, Greenhalgh T

The introduction of remote triage and assessment early in the pandemic raised questions about patient safety. We sought to capture patients and clinicians' experiences of the management of suspected acute COVID-19 and generate wider lessons to inform safer care.

https://doi.org/10.1136/bmjqs-2021-013305

December 2023

Exploring the use of social network interventions for adults with mental health difficulties: a systematic review and narrative synthesis

Brooks H, Devereux-Fitzgerald A, Richmond L, Caton N, Cherry MG, Bee P, Lovell K, Downs J, Edwards BM, Vassilev I, Bush L, Rogers A

People with mental health difficulties often experience social isolation. The importance of interventions to enhance social networks and reduce this isolation is increasingly being recognised. However, the literature has not yet been systematically reviewed with regards to how these are best used. This narrative synthesis aimed to investigate the role of social network interventions for people with mental health difficulties and identify barriers and facilitators to effective delivery. This was undertaken with a view to understanding how social network interventions might work best in the mental health field.

https://doi.org/10.1186/s12888-023-04881-y

July 2023

Normalisation of alcohol misuse and alcohol-related harms: a mixed methods analysis exploring alcohol misuse, morbidity and healthcare engagement in people experiencing homelessness

Wells   C, Dewar-Haggart R, Glyn-Owen K, Stevens H, Parkes J, Kim Y, Buchanan RM

The aim of this study is to understand the views and experiences of homeless adults who drink hazardously around alcohol use, alcohol harms and access to liver healthcare, and to quantify the prevalence of alcohol-related morbidity in this population.

https://doi.org/10.1093/alcalc/agaf071

November 2025

"Am I normal? Is this normal?": Supporting a community approach to grief.

Myall M,   Lund S, Campling N

The grief literacy movement promotes normalizing and regaining conversations about death, dying and grief within communities and networks. Enhancing grief literacy enables the public to identify grief, seek relevant information and adopt appropriate support. 

Historically families have been the primary provider of such support, but recently in the Global North these skills and knowledge have been lost. Families and communities need to be supported to regain ownership and relearn these skills. An online resource was developed and evaluated to explore its value in supporting the knowledge, skills and values required to embed grief literacy in family and friends-based networks. This paper presents findings from qualitative and group interviews. 

These rich datasets confirmed the resource to be an effective mechanism by increasing knowledge and skills to enhance grief literacy and supporting collective grief, where loss transcends the individual and becomes a social or cultural experience for the majority who deal with their grief with the support of family and friends rather than bereavement professionals.

https://doi.org/10.1080/07481187.2025.2598312

December 2025

Early environmental risks and the developmental dynamics of internalizing and externalizing problems from birth to adolescence

Wu K,   Zecchinato F, Guan C, Sun H

Internalizing and externalizing problems often co-exist throughout an individual’s development, shaped by a shared set of early environmental risks. However, most existing studies focused on discrete developmental periods, limiting understanding of how the negative impact of early-life adversity on mental health varies with age. Using data from 7,377 participants across seven waves of the UK Millennium Cohort Study (MCS), the current study investigated the bidirectional associations between internalizing and externalizing problems from ages 5 to 17, as well as the long-term impact of early environmental risks (i.e., prenatal influences, neonatal factors, maternal mental health, harsh parenting, and socioeconomic status) on the two symptom domains across time.

 Analyses indicated that individuals with higher internalizing symptoms tended to report higher externalizing symptoms, with both symptom domains showing high stability over time. A significant positive bidirectional relationship between internalizing and externalizing problems was found from childhood to early adolescence. However, this pattern diverged in late adolescence: internalizing problems at age 14 no longer predict externalizing problems at age 17, whereas externalizing problems negatively predict subsequent internalizing symptoms. Early environmental risk factors significantly predicted both internalizing and externalizing problems from ages 5 to 14, with the effects generally decreasing with age, except for an increase at age 11. Gender differences were also observed in both the bidirectional relationships between the symptom domains and the long-term impact of early environmental risks. 

Findings underscore the enduring impact of early adversity on adolescent mental health and highlight the complex, evolving interaction between internalizing and externalizing problems. The study offers critical insights for early, sustained interventions that address multiple risks and adapt to adolescents’ changing mental health needs over time.

https://doi.org/10.1007/s00787-025-02887-3

November 2025

 "It will sort of drive us to rethink our approach to high fat salt sugar products"- a qualitative analysis of businesses' reactions to the landmark Food (Promotion and Placement) Regulations in England

Dhuria P, Muir S, Shaw S, Lawrence W, Roe E, Baird J, Vogel C

Retail food environments have largely become settings which promote less healthy foods to their customers. In an effort to prompt healthier choices, the UK Government introduced regulations in October 2022 restricting most retailers in England from promoting products high in fat, sugar, or salt (HFSS) at store entrances, aisle-ends, and checkouts, and their online equivalents. Evidence is needed on how businesses approach compliance and adapt to these regulations. This study used in-depth interviews to examine business responses and generate insights to support effective implementation.

https://doi.org/10.1186/s12916-025-04384-5

October 2025

Process evaluation of a randomised controlled trial aimed at improving health behaviours and vitamin D status during pregnancy: Implementation of the SPRING trial

Proebstl S, Vogel C, Lawrence W, Strömmer S, Inskip H, Hammond J, Hart K, McGill K, Harvey NC, Barker M, Baird J

The Southampton PRegnancy Intervention for the Next Generation (SPRING) aimed to assess the efficacy of vitamin D supplementation and the behaviour change intervention 'Healthy Conversation Skills' (HCS) in improving the nutritional status of pregnant women. This paper describes the implementation of these interventions. Efficacy of HCS in improving diet quality and physical activity was evaluated in subgroups of women who discussed ways to improve these behaviours.

https://doi.org/10.1371/journal.pone.0319224

September 2025

The association between adolescents' independent food purchasing and dietary quality differs by socioeconomic status: Findings from a pilot study.

Shaw S, Crozier S, Cooper C, Smith D, Barker M, Vogel C

During adolescence, many young people start to make more independent food purchases. Subsequently, these independent food choices will increasingly contribute to their overall diet quality; little is known, however, about this relationship. This pilot study aimed to examine the role adolescents' independent food purchases play in their diet quality and assess if these relationships vary according to socio-economic status. A convenience sample of adolescents aged 11-18 years and attending secondary school or college in Hampshire, England, were recruited to participate in a one-week cross-sectional observational study

https://doi.org/10.1371/journal.pone.0312903

September 2025

Accountability for tackling childhood obesity: insights from local councillors in England

Taheem R, Woods-Townsend K, Lawrence W, Baird J, Godfrey KM, Hanson MA

Tackling the complex drivers of childhood obesity requires action across sectors and at all levels of government. Elected officials in local government can influence policies targeting communities to prevent childhood obesity, but little is known about their views on local government accountability for tackling the issue. Accountability is the obligation to justify actions on a topic and it could strengthen policy implementation. 

A qualitative study was conducted involving semi-structured interviews with sixteen Southampton City Council local government councillors. Factors limiting accountability included low citizen engagement, the lack of a national mandate to support local action and unachievable targets. Factors that improved accountability included setting a local mandate, public health officers proactively keeping the issue on the agenda and oversight from other system leaders. The findings from this study inform how public health officers and other stakeholders can work within the local system to progress childhood obesity prevention policies.

https://doi.org/10.1057/s41271-025-00573-x

July 2025

Maternal Dietary Inflammatory Status and Serum Neopterin During Pregnancy: Influence on Infantile Atopic Eczema in the Offspring

El-Heis S, Crozier SR, Loo EX, Tham EH, Harvey NC, Inskip HM; Southampton Women's Survey Study Group; Godfrey KM

Atopic eczema is a common inflammatory skin condition, globally affecting 1 in 5 children. It often runs a chronic relapsing and remitting course and can have a significant impact on sleep, growth and development. It can also have a bearing on the families of affected infants as well as the healthcare system.

There is increasing evidence for the importance of early life influences on infantile atopic eczema. Maternal diet before and during pregnancy and specific micronutrient status have been previously examined for their potential to modify the developing immune system risk of offspring atopic eczema. Reports of this have been largely inconsistent but evidence for healthy eating in pregnancy for allergy prevention has been well documented.

A lower risk of allergic conditions has been reported in infants whose mothers had higher serum levels of the pro-inflammatory Th1 markers MCP-1 and neopterin (produced through stimulation of M1 macrophages and monocytes by interferon-gamma) during pregnancy. It has therefore been hypothesized that a Th1 pro-inflammatory intrauterine environment may lower the risk of offspring atopic eczema by diminishing offspring Th2 responses, but supportive evidence is sparse.

Dietary inflammatory indices have been used to characterize the inflammatory potential of dietary patterns and can provide insights beyond those from individual nutrients. The Dietary Inflammatory Index (DII) is derived based on 45 dietary parameters linked to circulating levels of 6 inflammatory markers (IL-1b, IL-4, IL-6, IL-10, TNF-a, C-reactive protein).  The energy-adjusted DII (E-DII) was subsequently designed. It additionally accounts for potential impacts of energy intake on inflammatory potential and has been shown to correlate with DII. The E-DII allows more precise comparison of inflammatory potential of diets that vary in caloric intake.

Within a mother-offspring cohort, we aimed to examine the roles of an inflammatory maternal dietary pattern and serum neopterin in modifying the infant's risk of atopic eczema.

https://doi.org/10.1002/clt2.70080

July 2025