CCopeY: A Mixed-Methods Co-Produced Study on the Mental Health Status and Coping Strategies of Young People During COVID-19 Lockdown in the UK

Background: Young people’s mental health during COVID-19 pandemic has been identified as a priority. However, studies to date are largely simple surveys and lacking any meaningful involvement from patients and the public in their design, planning and delivery. The study aim was to examine the mental health status and coping strategies of young people (aged 16-24) during and after COVID-19 lockdown using co-production methodology.  Methods: We utilised a sequential co-produced mixed methods design. Participants were aged 16-24 and lived in the UK. The primary outcome was mental health status, measured using Patient Health Questionnaire (PHQ-9), anxiety coronavirus impact sub-scale (CIS) and reported self-harm. Predictors included sociodemographic variables, coping strategies (Brief COPE), sleep (Sleep Condition Indicator), personality traits (Ten-Item Personality Inventory) and optimism (Life-Orientation Test - Revised). Semi-structured interviews were also conducted with a purposive sample of survey participants. The study was registered with COVID MINDS.  Results: Seven-hundred and ninety-six participants (mean age 19.6 [SD 2.7]) took part in the first survey in April 2020. Survey data showed 26.6% had poor mental health and 10% had self-harmed since lockdown. Young people identifying as Black/Black British ethnicity in our study had the highest increased odds of experiencing poor mental health. Logistic regression showed behavioural disengagement, self-blame and substance misuse coping strategies, negative affect, sleep problems and reduced conscientiousness were all significantly associated with poor mental health. Eighteen participants were followed up and interviewed. There were three main interlinking themes: (1) pre-existing and developed helpful coping strategies employed during lockdown, (2) mental health difficulties worsened during lockdown and (3) the need for mental health and non-mental health support during and after lockdown.  Interpretation: To our knowledge this is the first sequential co-produced mixed methods study to examine mental health status and coping strategies of young people during COVID-19 lockdown. On average, young people’s mental health has significantly worsened since lockdown, and dysfunctional coping strategies are associated with this. However, young people have found innovative and adaptive ways to cope, including distraction and having a good routine. Going forward, appropriate and effective mental health support adapted to lockdown conditions is needed to help young people during and after lockdown. Trial Registration: The study was registered with COVID MINDS. Funding Statement: NIHR Patient Safety Translational Research Centre programme grant (Ref: PSTRC-2016-004) and Institute of Global Health Innovation. We are also grateful for support from the National Institute for Health Research (NIHR) under the Applied Research Collaboration (ARC) programme for North West London. and the Imperial NIHR Biomedical Research Centre. Declaration of Interests: PA received funding from Dr Foster Ltd (a wholly owned subsidiary of Telstra Health). AB received funding from Dr Foster Ltd and Medtronic. All other authors declare no competing interests. Ethics Approval Statement: This study was approved by the Imperial Research Ethics committee (ICREC ref: 20IC914) on 20/04/2020.