CovidLife: a resource to understand mental health, well-being and behaviour during the COVID-19 pandemic in the UK

CovidLife is a longitudinal observational study designed to investigate the impact of the COVID-19 pandemic on mental health, well-being and behaviour in adults living in the UK. In total, 18,518 participants (mean age = 56.43, SD = 14.35) completed the first CovidLife questionnaire (CovidLife1) between April and June 2020. To date, participants have completed two follow-up assessments. CovidLife2 took place between July and August 2020 (n = 11,319), and CovidLife3 took place in February 2021 (n = 10,386). A range of social and psychological measures were administered at each wave including assessments of anxiety, depression, well-being, loneliness and isolation. Information on sociodemographic, health, and economic circumstances was also collected. Questions also assessed information on COVID-19 infections and symptoms, compliance to COVID-19 restrictions, and opinions on the UK and Scottish Governments’ handling of the pandemic. CovidLife includes a subsample of 4,847 participants from the Generation Scotland cohort (N~24,000, collected 2006–2011); a well-characterised cohort of families in Scotland with pre-pandemic data on mental health, physical health, lifestyle, and socioeconomic factors, along with biochemical and genomic data derived from biological samples. These participants also consented to their study data being linked to Scottish health records. CovidLife and Generation Scotland data can be accessed and used by external researchers following approval from the Generation Scotland Access Committee. CovidLife can be used to investigate mental health, well-being and behaviour during COVID-19; how these vary according to sociodemographic, health and economic circumstances; and how these change over time. The Generation Scotland subsample with pre-pandemic data and linkage to health records can be used to investigate the predictors of health and well-being during COVID-19 and the future health consequences of the COVID-19 pandemic.


Introduction
The COVID-19 pandemic and the mitigation measures to reduce its spread resulted in substantial changes to everyday life in the UK and globally.Early 2020 saw rising COVID-19 infection rates and deaths in the UK and a national lockdown was announced on 23 rd March 2020, requiring everyone to stay at home at all times, with very limited exceptions.
Throughout 2020 and 2021, COVID-19 mitigation measures have eased and tightened as the number of cases, hospitalisations and deaths have reduced and increased.However, some form of restrictions have remained in place since the first stay at home order was announced on 23 rd March 2020.While mitigation measures successfully reduce the number of COVID-19 infections, hospitalisations, and deaths 1,2 , they may negatively impact mental health and well-being.Concerns about the impact of COVID-19 on mental health led leading health journals to call for research into the effect of COVID-19 on mental health 3,4 .
The psychological impact of the COVID-19 mitigation measures may not affect everyone equally.Female participants and younger adults have consistently shown higher rates of psychological distress and loneliness during the COVID-19 pandemic, and show larger increases in psychological distress compared to pre-pandemic levels 5,6,8,10 .Different sociodemographic characteristics have been associated with higher rates of psychological distress during COVID-19, including people from Asian minority ethnic groups 6,8 , people with pre-existing health conditions 6,11 , caregivers 12 , people who are unemployed or economically inactive 8 , those who report experiencing abuse or low social support 11 , those with children under five years 8 , and parents doing 20+ hours of childcare or home schooling a week 13 .
The degree to which COVID-19 and its mitigation measures affect the daily lives of people in the UK may change over time.CovidLife is a longitudinal study that uses online questionnaires to assess the psychological impact of COVID-19 during the first lockdown and how this changes over time as the pandemic progresses.Sociodemographic, economic and health indicators were measured to determine the cross-sectional and longitudinal correlates of mental health, well-being and behaviour during COVID-19.We also measured the degree of adherence and attitudes towards the mitigation measures to understand their associations with mental health and behaviour.
CovidLife consists of 18,518 adults aged 18 years and older resident in the UK who completed the first (baseline) online questionnaire between April and June 2020.In addition to recruiting anyone resident in the UK, invitations were sent to members of the Generation Scotland cohort 14 , a well characterised cohort of Scottish families with data on health and lifestyle collected between 9 and 14 years before the onset of the COVID-19 pandemic.Biological samples were also collected from Generation Scotland participants and consent for linkage to Scottish health records was obtained 14,15 .This subsample can therefore be used to investigate the health, lifestyle and biological predictors of mental health, well-being and behaviour during the COVID-19 pandemic.
CovidLife was designed to be a resource for researchers investigating the impact of the COVID-19 pandemic on health and well-being.Researchers can apply to access the CovidLife data.This paper describes the development of the CovidLife questionnaires, characterises the cohort, and describes the data collected in the first three waves.

Development of the CovidLife questionnaire
The CovidLife questionnaires were developed by the Generation Scotland Team using Qualtrics survey software, a survey development tool 16 .Data collection was limited to remote online assessment due to the COVID-19 restrictions.Online data collection also enabled quick data capture during the COVID-19 pandemic.The questionnaires were designed to be suitable for completion on various devices, including desktop computers, tablets and smartphones.

Questionnaire content
The questionnaire was developed primarily to understand how participants were feeling and behaving during the COVID-19 pandemic.The topics assessed in the first three CovidLife questionnaires are shown in Table 1.All three CovidLife questionnaires administered to date are available in the Extended data 17 (also available at www.ed.ac.uk/generation-scotland/forresearchers/covidlife).
Validated scales were used to assess a range of psychological variables including anxiety and depressive symptoms, well-being, personality, stress and resilience (Table 2).Selected items from other COVID-19 questionnaires were also used (Table 2).To assess COVID-19 knowledge and attitudes, questions from the Chicago COVID-19 Comorbidities survey 18 were adapted for use with UK participants.The second CovidLife questionnaire included a section on childcare during COVID-19, using questions adapted from the Gender Division of Childcare during the COVID-19 Pandemic survey 19 .Where possible, questions aligned with those administered in other longitudinal population studies.Many of the questions used in CovidLife also form part of the Wellcome Trust's COVID-19 questionnaire.The Wellcome Trust's COVID-19 questionnaire was co-developed by Generation Scotland as part of the Wellcome Trust Given the sensitivity of some of the questions, and possible reservations about providing personal and sensitive information in an online study, no question required an answer.Many sensitive questions had a "prefer not to answer" option.Following feedback during the piloting phase, options to skip certain sensitive sections were added.Skip options were added to the social support, mood, and employment sections.These were introduced to enable participants to provide as much information as they felt comfortable sharing while also encouraging them to continue.

Sample and recruitment
CovidLife1.Anyone aged 18 years and over and resident in the UK could take part in CovidLife.Adults who were resident in the UK but were temporarily elsewhere in the world were also eligible.Due to the online nature of the study, individuals without access to the internet were not able to take part..
Generation Scotland participants with a known email address (n = 9,030) were invited to take part in CovidLife.The email included a link to the CovidLife1 questionnaire.Postal invites were sent to Generation Scotland participants for whom no email address was known (n = 13,766).
General public: Traditional media (television and radio news programs), organic social media (Facebook, Twitter, and Instagram), and targeted social media (Facebook and Instagram) were used to advertise the study to the general public.In addition to general targeting, Facebook and Instagram were also used to specifically target recruitment of male participants, those who did not have at least a bachelor degree level qualification, and those aged 18-30 years.Specific targeting of these groups was used to try and make the sample more representative of the general population.
Other research groups: Researchers from the Aberdeen Children of the 1950s (ACONF) study 30,31 shared the CovidLife1 questionnaire link with a subsample of their volunteers via social media and email.ACONF consists of 12,150 individuals born in Aberdeen between 1950 and 1956 who completed the Aberdeen Child Development Survey when in primary school and who have been followed up in adulthood.
Two health research registers were also used to recruit participants.The Scottish Health Research Register (SHARE) includes people aged 11 and over who are interested in taking part in health research in Scotland 32 .SHARE emailed a total of 80,000 members of the register with information about the CovidLife study and a link to take part.We also used the North West London Health Research Register 33 to advertise CovidLife.This register consists of adults aged 18 years and older living in North West London who consented to being contacted about health research opportunities.A total of 6,000 members of the North West London Health Research Register were sent emails inviting them to take part in CovidLife with two reminder emails sent in the following two weeks.
To start CovidLife1 potential participants use the questionnaire web link in either the email, letter, website, or social media post.
Participants read through the Volunteer Information Sheet (VIS), and they gave their consent to taking part by ticking their agreement to each of the 8 consent statements (the VIS and consent are available in the Extended Data 17 ).Participants consented to be re-contacted to take part in future studies.Only after consenting were participants able to start the CovidLife1 questionnaire.
Data collection for CovidLife1 commenced on Friday 17 th April 2020 and closed to new responses on Sunday 7 th June 2020.Participants had 72 hours to complete CovidLife1 after starting it.For most of the time that CovidLife1 was open to participants, the four nations of the UK were under strict "stay at home" orders.The "stay at home" order was lifted in May (ranging from 10 th May in England to 29 th May in Scotland); however, restrictions remained in place, including limits on the number of people who could meet up outdoors, a ban on meeting people indoors, and the continued closure of non-essential businesses.A timeline of the COVID-19 restrictions during the each wave of CovidLife is available in the Extended data 17 .
CovidLife2.Email addresses were available for 15,256 CovidLife1 participants.These participants were emailed an invite containing a personalised link to CovidLife2.The CovidLife2 questionnaire consisted of two sections: 1) a core section, containing many of the same questions asked in CovidLife1; and 2) an optional section, consisting of new topics.These new topics incorporated some suggested by participants in the free-text question at the end of CovidLife1.They included cancelled or postponed healthcare during COVID-19, cancelled events, changes to childcare responsibilities and home-schooling during COVID-19.
Data collection for CovidLife2 began on 21 st July 2020 and closed on 16 th August 2020.Participants had 7 days to complete CovidLife2 after starting.More time was given to completing CovidLife2 because participants were sent a personalised link which allowed them to partially complete the questionnaire, stop, and return later to their saved responses by clicking back on their personalised link.Participants who had not completed CovidLife2 were sent up to two reminder emails on 31 st July 2020 (n = 7,483) and on 14 th August 2020 (n = 5,063 Participants read through the VIS and they gave their consent to taking part by ticking their agreement to each of eight consent statements (VIS and consent are available in the Extended data 17 ).Participants consented to be re-contacted to take part in future studies.

Indicators of health
A range of general health and COVID-19-related health questions were included in CovidLife, and descriptive statistics for some of these reported at baseline are shown in Table 4.Most of the CovidLife sample reported very good (n = 7,435, 40.4%) or excellent (n = 3,053, 16.6%) general health.In total, 7.8% (n = 1,432) reported that they had been instructed to shield because they were at risk of serious illness from COVID-19.Participants self-reported whether they had a range of different physical and mental health conditions (Table 4).One-fifth (n = 3,681, 20.2%) of participants reported having hypertension, 12.6% (n = 2,300) reported asthma, and 6.3% (n = 1,156) reported having type 2 diabetes.Nearly one-quarter (n = 4,293, 23.6%) reported having depression and 16.2% (n = 2,955) reported having anxiety.

Social and psychological measures
A range of social and psychological measures were included in CovidLife.Current anxiety and depressive symptoms were assessed in all three questionnaires using the Generalised Anxiety Disorder 7-item scale 20 (score range = 0-21) and Patient Health Questionnaire 9-item scale 21 (score range = 0-27), respectively.Subjective well-being, which was assessed using the 7-item Short Warwick-Edinburgh Mental Well-being Scale 22,23 (score range = 7-35), was also measured in all questionnaires.Current life satisfaction, isolation and loneliness   were each assessed using a single item in all questionnaires.
Participants were asked to rate how satisfied with life they were using an 11-point scale from (0) "not at all satisfied" to (10) "extremely satisfied".To measure isolation, participants were asked to indicate how much they felt isolated from others on an 11-point scale from (0) "not at all" to (10) "a lot".Loneliness was assessed by asking participants how lonely they felt during the past week.Participants selected one of four options, ranging from "none or almost none of the time" to "all, or almost all of the time".To estimate pre-pandemic life satisfaction, loneliness and isolation, CovidLife1 also asked participants to report how satisfied with life, how lonely and how isolated they felt "before COVID-19 measures were introduced (i.e., January 2020)".In each questionnaire, a four-option question was used to assess how often participants had felt nervous or stressed because of COVID-19 in the last two weeks 18 (ranging from none to all of the time).Perceived stress was measured in CovidLife2 and CovidLife3 using the 4-item version of the Perceived Stress Scale 25,26 (score range = 0-16).Health literacy, resilience, and the personality traits extraversion, conscientiousness, and emotional stability were measured once.Health literacy -the ability to understand and process health information 35 -was measured using a 10-item self-report scale 18 (score range = 10-40).The 6-item Brief Resilience Scale 27 (score range = 1-6) was administered in CovidLife2 to measure a participant's ability to bounce back after an adverse event.Thirty questions from the 50-item IPIP were used to measure personality 24,36 .Ten-items each were used to assess extraversion, consciousness, and emotional stability (score range for each personality trait = 10-50).
Summary statistics for these social and psychological variables measured in CovidLife1, CovidLife2 and CovidLife3 are reported in Table 5 and Table 6.

Generation Scotland subsample
Of the 18,518 participants who make up the CovidLife sample, 4,847 (26.2%) were members of the Generation Scotland cohort.The demographic and socioeconomic characteristics of the Generation Scotland subsample are reported in Table 7, and health characteristics are reported in Table 4.The age distribution grouped by sex is shown in Figure 3.The age distribution for the Generation Scotland subsample was slightly older than for the CovidLife sample owing to the fact that Generation Scotland participants were all aged over 18 at recruitment (2006-2011).For this subsample, researchers can link CovidLife responses with a wealth of data collected in Generation Scotland.The number and percentage of the CovidLife sample with different types of linkable Generation Scotland data is reported in Table 8.
The Generation Scotland baseline assessment (2006-2011) consisted of a pre-clinical questionnaire and a clinic visit 14 .
The pre-clinical questionnaire collected information on sociodemographic characteristics, medical history, family history, mood, and health behaviours.During the clinic visit, physical measurements including height, weight, blood pressure, and ankle-brachial pressure index were taken.Psychological measurements included tests of cognitive function, personality, psychological distress, and screening for emotional and psychiatric problems using the structured clinical interview for the Diagnostic and Statistical Manual IV disorders.Biological samples were also collected.A total of 4,739 (25.6%)CovidLife participants had data collected as part of the Generation Scotland baseline clinical assessment.
Samples collected during the Generation Scotland baseline have been used to derive genotype and DNA methylation data.A total of 4,359 (23.5%)CovidLife participants have genotype data and 2,701 (14.6%) currently have DNA methylation data available.At the time of writing, DNA methylation data is being processed for approximately 10,000 additional Generation Scotland participants, and proteomic data will also be available on a sub-sample of Generation Scotland participants in the future.
Most Generation Scotland participants consented to their study data being linked with Scottish medical records, using their Community Health Index numbers.Generation Scotland study   More detailed information on the measures collected in Generation Scotland and STRADL are available elsewhere 14,28,29 .

Strengths and limitations
CovidLife has a number of strengths, one being the size of the cohort, which stands at over 18,000 participants.The cohort is well characterised, including the collection of demographic, health, social, psychological, and economic information.COVID-19 specific information on infections, symptoms, compliance and opinions of the handling of COVID-19 in the UK was also collected.In particular, this study included many psychological measures, most of which have been assessed on three occasions throughout the COVID-19 pandemic.This means that CovidLife can be used to understand how people were feeling and behaving early in the COVID-19 pandemic, and how this has changed over time.To conclude, the CovidLife study allows us to understand: 1) the mental health, well-being and behaviour of people living in the UK during the COVID-19 pandemic; 2) how these vary according to demographic, health and economic circumstances; and 3) how mental health, well-being and behaviour change over time as the COVID-19 pandemic progresses and as mitigation measures ease and tighten.The subsample of Generation Scotland participants in CovidLife enables the investigation of both pre-pandemic predictors of health and well-being during COVID-19 and the long-term health consequences of the pandemic.Researchers can apply to access the CovidLife and Generation Scotland data to investigate the determinants, correlates, and consequences of health and well-being during COVID-19.

Data availability
Underlying data CovidLife and Generation Scotland data are available to researchers through managed access.Non-identifiable data will be made available to approved researchers in the UK and internationally.
Researchers wanting to access the CovidLife data can apply using the CovidLife Access Request Form, available in the Extended data 17 .Once completed, this form should be emailed to access@generationscotland.org.
Researchers wanting to link CovidLife data with Generation Scotland data can apply for access to the Generation Scotland data using the standard Generation Scotland Access Request Form, available in the Extended data 17 .Once completed, this form should be emailed to access@generationscotland.org.
Up to date information about how to apply to access CovidLife and Generation Scotland data is available on the Generation Scotland website: http://www.generationscotland.org/for-researchers/access Generation Scotland's withdrawal policy allows participants to request that their data no longer be available for research.Therefore when data is released, the sample size for CovidLife and Generation Scotland may vary slightly than that reported here.
The project contains the following extended data: - Many of the respondents resided in Scotland.Is it possible to weight the data of the subsample residing in Scotland using known population values for Scotland?Perhaps the representativeness of the sample could be improved in this manner.
When interpreting the findings of future reports, is there anything about Scottish culture that researchers should know?
Is there a bibliography of studies published (or planned) using the CovidLife dataset?
Is it possible to calculate a response rate for the respondents from the Generation Scotland study?
The CovidLife is understandably linked to the Covid-19 pandemic.The enthusiasm of some researchers and journal reviewers may wane as that global infectious disease pandemic recedes into history.That is a sentiment I do not share because the COVID-19 pandemic was just one example of a shared stressor.There will be outbreaks of diseases in the future, and understanding how people cope, respond, and are affected should help us prepare.

Is the rationale for creating the dataset(s) clearly described? Yes
Are the protocols appropriate and is the work technically sound?Yes

Are sufficient details of methods and materials provided to allow replication by others? Yes
Are the datasets clearly presented in a useable and accessible format?Yes Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Clinical Health Psychology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.
CovidLife1.A total of 23,118 individuals clicked on the CovidLife1 questionnaire link and were recorded as a response in Qualtrics.The following responses were removed: 1. Responses collected before the official launch time of 11:45pm on 17 th April 2020 (n = 160) 2. Responses who completed <8% of the questionnaire.Qualtrics saves responses on a given page only after the participant presses "Next", therefore anyone who did not press "Next" on the first page of the questionnaire did not have any saved data (n = 4,006) 3. Participants who completed the questionnaire more than once were identified based on matching name and email address.Where there was >1 response per participant, the most complete or first response was retained and all others were removed (n = 380) 4. Participants aged under 18 years (n = 3) 5. Participants who did not answer any questions (n = 51).Therefore, 18,518 participants make up the CovidLife sample.A flow chart of how we derived the CovidLife analytic sample is shown in Figure 1.

Figure 2
Figure2shows the number of participants who completed CovidLife on any given day during recruitment.The large

Figure 3 .
Figure 3. Age distribution of (a) CovidLife participants, and (b) Generation Scotland participants who took part in CovidLife, grouped by sex.
34r participants living in Scotland who provided a postcode, Scottish Index of Multiple Deprivation deciles were derived, which rank levels of deprivation based on the amount of employment, income, health, education, housing, access, and crime in the area where the participant lives34.Scottish participants tended to live in less deprived locations, with 22.7% (n = 3,834) living in the least deprived decile.Most Scottish participants lived in urban areas (large urban n = 7,474, 44.2%; other urban n = 3,903, 23.1%).4% of those invited to CovidLife3.In total, 9,116 participants completed all three CovidLife questionnaires (49.2% of the CovidLife sample).The demographic and socioeconomic characteristics of participants who completed CovidLife3 are reported in Table3.

Table 3 . Demographic and socioeconomic characteristics reported at baseline for participants in CovidLife1, CovidLife2 and CovidLife3.
1 Question added to questionnaire on 21 st April 2020.2Onlyavailable for participants providing Scottish postcode SIMD, Scottish Index of Multiple Deprivation.

Table 8 . Number and percentage of CovidLife participants with different types of linkable Generation Scotland data.
77ree waves of CovidLife have been carried out, and these waves coincide with important milestones in the COVID-19 pandemic in the UK (see the CovidLife timeline in Extended data17).CovidLife1 was carried out during the first UK "stay at home" order shortly after COVID-19 cases had peaked (in wave 1) in the UK.CovidLife2 took place when the rates of COVID-19 infections and deaths were relatively low and restrictions had eased considerably.During this time, most people living in the UK were able to meet up with family and friends both outdoors and indoors, though some places were under tighter local restrictions.Many people had returned to work, cafés, restaurants and retail were open, and schools were planning to fully reopen after the summer holidays.COVID-19 cases and deaths began to rise in autumn and winter 2020, and another stay at home order was implemented in all four UK nations by 4 th January, 2021.COVID-19 cases peaked in early January 2021.CovidLife3 data collection took place in February 2021 during this stay at home order.COVID-19 cases and deaths were higher in this period of lockdown compared to the first.However, the UK mass COVID-19 vaccination programme began on 8 th December 2020 and was well underway during the second lockdown37.By collecting data during these important milestones in the COVID-19 pandemic, CovidLife can be used to understand the health, well-being and behaviour of people in the UK, and how these change as the restrictions have eased and tightened, and as individual circumstances have changed throughout the pandemic.The ability to link responses with data collected in Generation Scotland for 4,847 participants is one of the key advantages of CovidLife.Responses can be linked with a wide range of demographic, health, and lifestyle information, collected many years before the pandemic.Genetic and biological sample data can also be linked with responses.Importantly, CovidLife responses can be linked with medical records.Regular releases of NHS Scotland health record data make it possible to examine both retrospective and prospective associations with health outcomes.The CovidLife questionnaires were designed to harmonise with other research studies in the UK and around the world.Many of the measures included in the CovidLife study align with those used in other longitudinal population health studies.Subsequently, it has been possible to collaborate with other research groups to investigate the mental health impact of COVID-19.Using data from CovidLife and the Avon Longitudinal Study of Parents and Children7, anxiety and depression during the early stages of the pandemic were found to be Therefore the sample was not fully representative of those living in the UK, and consisted mostly of participants who were relatively highly educated, white, and from less deprived areas.Although there was a large number of Scottish participants, the other three nations of the UK were less well represented.Like all longitudinal studies, CovidLife suffers from attrition.In total, 49.2% of those in CovidLife1 completed all three CovidLife questionnaires.Due to these limitations, any conclusions drawn from CovidLife data may not generalise to all groups in society.