Investigating inflation, living costs and mental health service utilization in post-COVID-19 England

Following COVID-19, the UK economy began to recover, yet inflation accelerated markedly (e.g., CPIH rising to 8.9% by March 2023 from 1.5% in March 2020), increasing the cost of living. Prior evidence from the 2008 recession and subsequent studies links economic hardship and specific living cost pressures (housing instability, fuel poverty, limited access to essentials) to poorer mental health. However, in the current post-COVID-19 context, it is unclear whether the observed rise in living costs is statistically associated with mental health service use, which specific components of living costs are most relevant, and whether associations differ by age group. The study’s purpose is to quantify associations between CPIH (overall and subindices) and monthly counts of people in contact with mental health services in England, comparing the pre- and post-COVID-19 periods to inform policy responses.

Previous research indicates economic downturns adversely affect mental health in the UK and globally, including increased depressive symptoms and suicidality during and after the Great Recession. Studies have linked rising living costs and material hardship—such as housing instability, fuel poverty, food insecurity, and transport barriers—to worse mental health and limited access to care. Broader mechanisms include financial stress, widening inequality, and prolonged uncertainty increasing anxiety and depression risk. These studies motivate examining which specific cost-of-living components are most associated with mental health service utilization in the current post-pandemic inflationary context.

Study design: Ecological study using aggregated, publicly available monthly data. Measurements and data sources: Price inflation measured by the Consumer Prices Index including owner occupiers’ housing costs (CPIH), which extends CPI by including owner-occupiers’ housing costs (mortgage interest, insurance, transactions, maintenance/repairs). Monthly CPIH values and subindices for England were obtained from ONS. Mental health status was proxied by the number of people in contact with mental health services (open referrals to secondary mental health, learning disabilities, or autism services), reported in thousands and stratified by age groups 0–18, 19–64, and ≥65 years, sourced from NHS Mental Health Services Monthly Statistics. Monthly unemployment rates (ONS) were included as a confounder. Study period and exclusions: August 2016–February 2023. To isolate inflation effects from pandemic restrictions, data from March 2020–March 2022 were excluded (including the phased relaxation period March 2021–March 2022). Thus, pre-COVID-19 period: August 2016–February 2020; post-COVID-19 period: from 1 April 2022 onward. Statistical analysis: For each price index (overall CPIH and subcategories) and each age-stratified outcome, linear regressions were fitted with the monthly number of people in contact with mental health services as the outcome and the price index as the key predictor. Models controlled for month and year (seasonality), unemployment rate, and included a binary indicator for time period (pre- vs post-COVID-19). Potential lagged effects of price indices were evaluated; optimal lag length selected by Akaike Information Criterion. To assess whether associations differed between periods, an interaction term between the (possibly lagged) price index and time period was included; the interaction coefficient captures the change in association post-COVID-19 relative to pre-COVID-19. Gauss–Markov assumptions were tested (Supplementary Table 3). Analyses were conducted in R 4.2.2 using stats, vars, AER, and lmtest packages, with two-sided P<0.05 considered significant.

- Compared with the pre-COVID-19 period, post-COVID-19 increases in specific price indices were significantly associated with higher numbers of adults (19–64 years) in contact with mental health services: - Food and non-alcoholic beverages: per 1% increase associated with +8.89 thousand adults (95% CI 2.67 to 15.11; P=0.005). - Housing, water and fuels: per 1% increase associated with +35.88 thousand adults (95% CI 8.36 to 63.40; P=0.012). - Miscellaneous goods and services: per 1% increase associated with +24.43 thousand adults (95% CI 8.55 to 40.31; P=0.004). - Negative associations for adults were observed post-COVID-19: - Alcoholic beverages, tobacco and narcotics: per 1% increase associated with −41.97 thousand adults (95% CI 14.94 to 69.00; P=0.003) in contact with services. - Hotels, cafes and restaurants: per 1% increase associated with −50.55 thousand adults (95% CI 12.80 to 88.30; P=0.010). A 1-month lagged association was also observed: −41.04 thousand (95% CI 5.52 to 76.56; P=0.025). - For older adults (≥65 years), post-COVID-19 increases in indices were associated with higher service contact counts: - Overall CPIH: per 1% increase associated with +26.12 thousand (95% CI 16.16 to 36.08). - Food and non-alcoholic beverages: +3.58 thousand (95% CI 0.94 to 6.22; P=0.008). - Miscellaneous goods and services: +7.33 thousand (95% CI 1.83 to 12.82; P=0.011). - Associations among children (0–18 years) were generally not statistically significant across indices in the post-COVID-19 period. Overall, rising costs of essential goods and services were linked to increased mental health service utilization among adults and older adults in the post-COVID-19 era, while certain non-essential or harmful consumption categories showed inverse associations.

Findings indicate that post-COVID-19 price inflation—especially in essentials such as food, housing, and miscellaneous goods/services—is associated with increased demand for mental health services among adults and older adults in England. These results extend evidence from the Great Recession by pinpointing which components of living costs relate to service use and by demonstrating age-specific patterns. Potential mechanisms include financial stress, reduced access to essentials (nutrition, housing quality, essential services), heightened inequality and perceived injustice, uncertainty-related anxiety, and increased working hours to cope with expenses. Counterintuitive negative associations for alcohol/tobacco and hospitality prices may reflect reduced consumption due to higher costs, reallocation of spending, alternative coping strategies, or deferred formal care seeking; the observed 1-month lag for hospitality suggests temporal dynamics. Policy implications include targeted financial support (e.g., subsidies for food, housing, essential goods) and scaling up mental health services, with age-tailored approaches to address differing needs.

This study identifies specific living cost components that are significantly associated with mental health service utilization in post-COVID-19 England. By clarifying which price indices relate to service use and how associations vary by age, the findings provide actionable guidance for targeted social and economic policies and for expanding mental health services to mitigate inflation-related mental health burdens.

- Observational design precludes causal inference. - Mental health measured via contacts with services (proxy), which may not capture true prevalence or severity. - Lack of gender-disaggregated outcome data limits assessment of known sex differences. - Regional mismatch: regional mental health data available but no corresponding regional inflation data, limiting analysis of geographic heterogeneity. - Potential unmeasured confounders (e.g., income, debt) not available monthly despite controlling for unemployment. - Possible lingering effects of COVID-19 despite exclusion of March 2020–March 2022 data. - Outcome not available by socioeconomic status or race/ethnicity, precluding analyses of moderation by deprivation or race.