M Tindall’s research while affiliated with University of Glasgow and other places

Background Income and social security are fundamental determinants of mental health and wellbeing. Universal Credit (UC) was a large-scale reform to the UK’s welfare system, replacing six existing benefits and tax credits, and is currently paid to over 6 million recipients. UC aimed to simplify the claims process and encourage claimants to move into employment. Previous studies have suggested harms to mental health resulting from the new system, via mechanisms such as decreased benefit income, incurred debt and increased stress. Introduction was phased on a geographical basis from 2013 and was available in all areas by the end of 2018 to all new claimants, existing recipients whose circumstances changed and those who chose to switch to the new benefit. We aimed to identify the effect of UC on mental wellbeing on low-income households by treating the phased rollout as a natural experiment. Methods We analysed repeated yearly cross sections of the nationally-representative Annual Population Surveys 2013–2019. The outcome of wellbeing was measured using ‘life satisfaction’, happiness, anxiety, and life rated as ‘worthwhile’. We examined respondents in low-income households (less than £12,000/year household equivalised income; n=249,078), comparing those living in areas where UC had been introduced to those in areas where it had not, using difference-in-difference analyses. In subgroup analyses, we tested for differential effects on under-25s, disabled people, single people, women, non-white ethnicities, people with caring responsibilities, single parents and full-time students (compared to complementary subgroups). We compared effects between Scotland, Wales and England, to take account of differences in the way UC is administered. All analyses were carried out using R. Results Exposure to UC was associated with lower ‘life satisfaction’ (-0.07; -0.10 to -0.04), happiness (-0.06; -0.10 to -0.03) and ‘life worthwhile’ (-0.04; -0.08 to -0.01), and greater anxiety (0.09; 0.04 to 0.13) amongst low-income households. Effects on anxiety were larger among under-25s, disabled people, single people, women, people with caring responsibilities, single parents and full-time students. There were small, additional harms to ‘life satisfaction’ and ‘life worthwhile’ in Scotland compared to England. Conclusion Consistent with studies of the effect of UC on mental health, we found evidence of harmful effects of UC across four measures of wellbeing. Effects on anxiety were exacerbated across multiple axes of vulnerability. This should inform recommendations for the migration of all remaining eligible households onto UC and future adaptations to the UC system to reduce adverse consequences for mental health and wellbeing.

Background Universal Credit (UC) is the largest reform of the UK welfare system since the Second World War. It streamlines six legacy benefits and tax credits, seeking to simplify claims and encourage employment. Previous research suggests UC harmed mental health pre-pandemic, potentially due to increased conditionality and lower payments. During the COVID-19 pandemic, the UK Government increased UC generosity and reduced conditionality, including by suspending work search requirements and providing a £20 weekly uplift. We investigate if pandemic-related changes to UC modified its effect on mental health. Methods We analysed data from the UK Household Longitudinal Study (Understanding Society), a household-based panel study that follows a representative sample of the UK population annually. Data were from 2018, the end of UC rollout, to 2021, when pandemic-related changes were withdrawn. The study population consisted of working age adults (16-65) who reported claiming legacy benefits or UC pre-pandemic, yielding 13,514 observations. We defined people exposed to UC pre-pandemic and compared trends in this group to people exposed to legacy benefits pre-pandemic. Observations were classed as exposed to pandemic-related reforms if sampled after March 2020 and unexposed otherwise. Mental health was measured using the General Health Questionnaire, a validated measure of psychological distress, producing scores from 0 to 36. A difference-in-difference analysis was conducted using a two-way fixed effects linear model, adjusted for confounders, including age, sex, long-term health and cohabiting status. Analysis was conducted in R. Results Pandemic-related UC changes were associated with reduced psychological distress, -0.97 points (95%CI: -1.73, -0.22), relative to trends among legacy benefit recipients. Subgroup analysis showed no difference in effects for under- versus over -25s or between UK countries. Heterogenous effects were found across household structures. Single adults and coupled parents claiming UC experienced improved mental health relative to trends in legacy benefit claimants: -1.47 (-2.71, -0.24) and -1.75 (-3.25, -0.25) respectively. Lone parents and childless couples on UC experienced harms to mental health, although this is less certain due to smaller sample sizes: 0.32 (-1.36, 1.99) and 1.42 (-0.56, 3.39). Conclusion Reduced conditionality and increased payments of UC during the COVID-19 pandemic are associated with improved mental health. While our analytical approach accounts for time-invariant confounders, residual confounding due to the pandemic affecting legacy benefit recipients differently from UC claimants remains possible. Our findings strengthen evidence to support reducing UC conditionality and increasing generosity as a means of improving mental health among socio-economically disadvantaged people.