Children and young people risk being ‘disproportionately harmed’ by the COVID-19 pandemic. Whilst an evolving body of literature focuses on the impact of the pandemic on the mental health and wellbeing of children and young people, less attention has been paid to the collection of qualitative, exploratory data. The aim of this study was to examine young people in North East England’s experiences of COVID-19 and associated control measures. Flexible, qualitative diaries were collected with 31 young people aged 13–17 for six weeks between July and October 2020. Diary extracts were curated using Instagram Direct Messaging (DM), email and text messaging. At the end of this study, participants took part in a follow-up interview (conducted by telephone or Zoom), asking them to reflect on their diary entries. Thematic analysis of diaries and interviews yielded three central themes: (1) impacts upon mental health and emotional wellbeing; (2) disruptions and changes to education and school life; and (3) frustration, burden and responsibility. These findings highlight acute mental health impacts (loneliness, isolation, anxiety) as well as longer-term repercussions from disrupted education (missed parts of curriculum, home schooling, cancelled exams, periods of isolation) on young people aged 13–17 as a result of the COVID-19 pandemic.

Background: The welfare state distributes financial resources to its citizens – protecting them in times of adversity. Variations in how such social protection policies are administered have been attributed to important differences in population health. The aim of this systematic review of reviews is to update and appraise the evidence base of the effects of social protection policies on health inequalities. Methods/design: Systematic review methodology was used. Nine databases were searched from 2007 to 2017 for reviews of social policy interventions in high-income countries. Quality was assessed using the Assessment of Multiple Systematic Reviews 2 tool. Results: Six systematic reviews were included in our review, reporting 50 unique primary studies. Two reviews explored income maintenance and poverty relief policies and found some, low quality, evidence that increased unemployment benefit generosity may improve population mental health. Four reviews explored active labour-market policies and found some, low-quality evidence, that return to work initiatives may lead to short-term health improvements, but that in the longer term, they can lead to declines in mental health. The more rigorously conducted reviews found no significant health effects of any of social protection policy under investigation. No reviews of family policies were located. Conclusions: The systematic review evidence base of the effects of social protection policy interventions remains sparse, of low quality, of limited generalizability (as the evidence base is concentrated in the Anglo-Saxon welfare state type), and relatively inconclusive. There is a clear need for evaluations in more diverse welfare state settings and particularly of family policies.

Background: Community empowerment initiatives are receiving increased interest as ways of improving health and reducing health inequalities. Purpose: Longitudinally examine associations between collective control, social-cohesion and mental wellbeing amongst participants in the Big Local community empowerment initiative across 150 disadvantaged areas of England. Methods: As part of the independent Communities in Control study, we analysed nested cohort survey data on mental wellbeing (Short Warwick Edinburgh Mental Wellbeing Scale—SWEMWBS) and perceptions of collective control and social-cohesion. Data were obtained in 2016, 2018 and 2020 for 217 residents involved in the 150 Big Local areas in England. Adjusted linear mixed effect models were utilized to examine changes in SWEMWBS over the three waves. Subgroup analysis by gender and educational level was conducted. Results: There was a significant 1.46 (0.14, 2.77) unit increase in mental wellbeing score at wave 2 (2018) but not in wave 3 (2020) (0.06 [−1.41, 1.53]). Across all waves, collective control was associated with a significantly higher mental wellbeing score (3.36 [1.51, 5.21]) as was social cohesion (1.09 [0.19, 2.00]). Higher educated participants (1.99 [0.14, 3.84]) and men (2.41 [0.55, 4.28]) experienced significant increases in mental wellbeing in 2018, but lower educated participants and women did not. Conclusion: Collective control and social cohesion are associated with better mental wellbeing amongst residents engaged with the Big Local initiative. These health benefits were greater amongst men and participants from higher educational backgrounds. This suggests that additional care must be taken in future interventions to ensure that benefits are distributed equally.

Background: Area-based initiatives that include a focus on community empowerment are increasingly being seen as potentially an important way of improving health and reducing inequalities. However, there is little empirical evidence on the pathways between communities having more control and health outcomes. Purpose: To identify pathways to health improvement in a community-led area-based community empowerment initiative. Methods: Longitudinal data on mental health, community control, area belonging, satisfaction, social cohesion and safety were collected over two time points, 6 months apart from 48 participants engaged in the Big Local programme, England. Qualitative comparative analysis (QCA) was used to explore pathways to health improvement. Results: There was no clear single pathway that led to mental health improvement but positive changes in ‘neighbourhood belonging’ featured in 4/5 health improvement configurations. Further, where respondents experienced no improvement in key social participation/control factors, they experienced no health improvement. Conclusion: This study demonstrates a potential pathway between an improvement in ‘neighbourhood belonging’ and improved mental health outcomes in a community empowerment initiative. Increasing neighbourhood belonging could be a key target for mental health improvement interventions.

Background: Most research on community empowerment provides evidence on engaging communities for health promotion purposes rather than attempts to create empowering conditions. This study addresses this gap.Intervention: Big Local started in 2010 with £271M from the National Lottery. Ending in 2026, it gives 150 relatively disadvantaged communities in England control over £1M to improve their neighbourhoods.Objective: To investigate health and social outcomes, at the population level and among engaged residents, of the community engagement approach adopted in a place-based empowerment initiative.Study design, data sources and outcome variables: This study reports on the third wave of a longitudinal mixed-methods evaluation. Work package 1 used a difference-in-differences design to investigate the impact of Big Local on population outcomes in all 150 Big Local areas compared to matched comparator areas using secondary data. The primary outcome was anxiety; secondary outcomes included a population mental health measure and crime in the neighbourhood. Work package 2 assessed active engagement in Big Local using cross-sectional data and nested cohort data from a biannual survey of Big Local partnership members. The primary outcome was mental well-being and the secondary outcome was self-rated health. Work package 3 conducted qualitative research in 14 Big Local neighbourhoods and nationally to understand pathways to impact. Work package 4 undertook a cost-benefit analysis using the life satisfaction approach to value the benefits of Big Local, which used the work package 1 estimate of Big Local impact on life satisfaction.Results: At a population level, the impacts on ‘reporting high anxiety’ (–0.8 percentage points, 95% confidence interval –2.4 to 0.7) and secondary outcomes were not statistically significant, except burglary (–0.054 change inz-score, 95% confidence interval –0.100 to –0.009). There was some effect on reduced anxiety after 2017. Areas progressing fastest had a statistically significant reduction in population mental health measure (–0.053 change inz-score, 95% confidence interval –0.103 to –0.002).Mixed results were found among engaged residents, including a significant increase in mental well-being in Big Local residents in the nested cohort in 2018, but not by 2020; this is likely to be COVID-19. More highly educated residents, and males, were more likely to report a significant improvement in mental well-being. Qualitative accounts of positive impacts on mental well-being are often related to improved social connectivity and physical/material environments. Qualitative data revealed increasing capabilities for residents’ collective control. Some negative impacts were reported, with local factors sometimes undermining residents’ ability to exercise collective control.Finally, on the most conservative estimate, the cost–benefit calculations generate a net benefit estimate of £64M.Main limitations: COVID-19 impacted fieldwork and interpretation of survey data. There was a short 4-year follow-up (2016/20), no comparators in work package 2 and a lack of power to look at variations across areas.Conclusions: Our findings suggest the need for investment to support community organisations to emerge from and work with communities. Residents should lead the prioritisation of issues and design of solutions but not necessarily lead action; rather, agencies should work as equal partners with communities to deliver change.Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research Programme (16/09/13) and will be published in full inPublic Health Research; Vol. 11, No. 9. See the NIHR Journals Library website for further project information.

Objectives: Fuel poverty, defined in this study as a household’s inability to meet basic energy needs, presents a significant challenge. We aimed to map research on the impact of fuel poverty on mental health.Methods: We searched peer review and grey literature repositories. Studies were considered eligible if they focused on both fuel poverty and mental health.Results: 47 studies were included. 64% were published in the last 3 years. 43% focused on the UK sub-geography, with the next most common being Spain (17%) and China (13%). 55% had a quantitative study design. Conceptualisation and operationalisation of fuel poverty varied across studies and contexts. 58% focused on specific vulnerable populations. 46 studies reported evidence of a detrimental association between fuel poverty and mental health. We broadly summarise the role of fuel poverty on mental health under four headings: economic, social, behavioural and environmental.Conclusion: We highlight a need for clear and explicit conceptualisation of fuel poverty, in conjunction with consideration of pathways connecting fuel poverty to mental health, to advance the field and facilitate research which can improve population health.