{'fraction_non_alphanumeric': 0.036677201607553944, 'fraction_numerical': 0.017831362909204417, 'mean_word_length': 5.13304618329744, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 12, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Mental and social wellbeing and the UK coronavirus job retention scheme: Evidence from nine longitudinal studies

Background The COVID-19 pandemic has led to major economic disruptions. In March 2020, the UK implemented the Coronavirus Job Retention Scheme – known as furlough – to minimize the impact of job losses. We investigate associations between change in employment status and mental and social wellbeing during the early stages of the pandemic. Methods Data were from 25,670 respondents, aged 17–66, across nine UK longitudinal studies. Furlough and other employment changes were defined using employment status pre-pandemic and during the first lockdown (April–June 2020). Mental and social wellbeing outcomes included psychological distress, life satisfaction, self-rated health, social contact, and loneliness. Study-specific modified Poisson regression estimates, adjusting for socio-demographic characteristics and pre-pandemic mental and social wellbeing, were pooled using meta-analysis. Associations were also stratified by sex, age, education, and household composition. Results Compared to those who remained working, furloughed workers were at greater risk of psychological distress (adjusted risk ratio, ARR = 1.12; 95%CI: 0.97, 1.29), low life satisfaction (ARR = 1.14; 95%CI: 1.07, 1.22), loneliness (ARR = 1.12; 95%CI: 1.01, 1.23), and poor self-rated health (ARR = 1.26; 95%CI: 1.05, 1.50). Nevertheless, compared to furloughed workers, those who became unemployed had greater risk of psychological distress (ARR = 1.30; 95%CI: 1.12, 1.52), low life satisfaction (ARR = 1.16; 95%CI: 0.98, 1.38), and loneliness (ARR = 1.67; 95%CI: 1.08, 2.59). Effects were not uniform across all sub-groups. Conclusions During the early stages of the pandemic, those furloughed had increased risk of poor mental and social wellbeing, but furloughed workers fared better than those who became unemployed, suggesting that furlough may have partly mitigated poorer outcomes.


Introduction
COVID-19 and a series of associated 'lockdown' mitigation measures, which included closure of non-essential retail, leisure facilities and schools, have had an adverse impact on the economy in the United Kingdom (UK) and worldwide (Koltai et al., 2020;Office for National Statistics, 2020). There is a well-established relationship between individual employment status and mental health and wellbeing, with most studies suggesting that economic recessions and unemployment are generally associated with poorer mental health (Flint et al., 2013;Frasquilho et al., 2016;Steele et al., 2013), although these associations are complex, might be context-specific, and vary across generations and demographic and socioeconomic groups (Catalano et al., 2011;Copeland et al., 2015;Valkonen et al., 2000).
Overall, it has been estimated that the prevalence of mental distress in the UK increased from 19.1% pre-pandemic to 30.6% in early lockdown (April 2020), with greater deteriorations observed in young adults and women (Banks & Xu, 2020;Niedzwiedz et al., 2021). More recent longitudinal research has found that raised levels of psychological distress were sustained across subsequent stages of the pandemic, particularly for women and younger adults (Anonymized). However, it is unclear how employment status change is related to mental and social wellbeing in this unique context.

Background
Employment is generally considered to be associated with good health (Benach et al., 2010;Graetz, 1993) and job loss or unemployment with deleterious physical and mental health (Puig- Barrachina et al., 2011), including lower psychological wellbeing (Murphy & Athanasou, 1999) and increased mortality (Roelfs et al., 2011). Most studies confirm the negative relationship between unemployment and mental health and wellbeing (McKee-Ryan et al., 2005) but with differences by sex. Men and those in their early and middle career stage can be J o u r n a l P r e -p r o o f 2 especially affected by unemployment (Roelfs et al., 2011), although some studies have found greater effects of unemployment for women (Drivakis, 2015). Unemployment is also sometimes associated with social isolation (Lobo, 2018), which can lead to loneliness (Anonymized). The relationship between unemployment and mental health is bi-directional: mental health is associated with unemployment, and reciprocally, poor mental health makes it difficult to move into employment (Harris et al., 1998;Kraut et al., 2000;Maier et al., 2006).
There is also evidence that the relationship between unemployment and mental health varies by age and education level (van Zon et al., 2017), so studies of this relationship need to be sensitive to differences between sociodemographic groups and to respondents' prior mental health (before changes in employment status).
In March 2020in the early stages of the Covid-19 pandemic -, the UK government launched the Coronavirus Job Retention Scheme (CJRS, widely referred to as 'furlough'), providing employees who were unable to work due to the pandemic with 80% of pay (capped at £2,500 per month) (Adams-Prassl et al., 2020). Furlough occupies an intermediary status between employment and unemployment that is relatively new, particularly in the UK (Bell & Blanchflower, 2020), because the cessation of work is intended to be, in principle, temporary and a substantial portion of income is maintained. Nevertheless, while furlough helps maintain some of the advantages of employment, benefits such as time structure, collective purpose, social contact, and physical activity are likely diminished for furloughed workers (Paul & Batinic, 2010), so it is unclear how this may impact on their mental and social wellbeing.
Existing studies on short-term unemployment schemes during the Covid-19 pandemic are sparse and more evidence is needed. One study has shown that remaining in part-time employment before and during the early stage of pandemic or being furloughed is associated with similar levels of mental health compared with continuous full-time employment (Burchell et al., 2020), indicating that a continuous connection to employment is associated with better J o u r n a l P r e -p r o o f mental health outcomes. However, these findings may need some qualification. It has been observed that people with pre-existing mental health problems were more likely to experience employment disruption during the pandemic (Breslau et al., 2021;Anonymized). It remains unclear how policies introduced to mitigate economic disruption might have affected mental health and controlling for pre-pandemic mental health is critical to addressing this question.
Furthermore, other individual background characteristics may partly explain the propensities to be unemployed or furlough during the pandemic. Younger workers and women were more likely to work in disrupted sectors, and therefore become unemployed or furloughed (Burchell et al., 2020). Similarly, people in lower skilled jobs, living in more deprived areas, or struggling financially were also more likely to be furloughed (Gray et al., 2021). Women with young children were more likely to be furloughed (Anonymized) and previous studies found that, during the school closure period, women took on a bigger share of housework and childcare responsibilities (Zamarro & Prados, 2021;Zhou et al., 2020), and may therefore have been more affected by disruptions such as furlough.
Thus, our study contributes to a key knowledge gap in this area by leveraging data from nine UK population cohort studies and investigating how furlough and other employment changes were associated with a range of outcomes including psychological distress, life satisfaction, self-rated health, social contact, and loneliness. We draw on data from the early stages of the pandemic, when furlough was at its peak (between 25 and 30 percent of the UK population were furloughed between April and July 2020 and only 10 to 20 percent in the following months (ONS, 2021)). Employing 9 studies and statistically pooling results with meta-analysis, allows us to present more robust and nuanced evidence on associations within the UK working age population than would be possible with any single study alone. Given that employment disruption and furlough may have affected socio-demographic groups differently, inclusion of J o u r n a l P r e -p r o o f age, education, and household composition.

Method Participants and design
Participants were 25,670 respondents from nine UK population-based longitudinal studies, who completed surveys both before and during the COVID-19 pandemic. Pandemic data were collected between April-June 2020 and pre-pandemic data constituted the most recent data available for each study prior to the pandemic (median was ~3 years earlier, with a range from 1-14 years). Further details of the design, sampling frame, age range, timing of the prepandemic and COVID-19 surveys, response rates, and sample size are in Supplementary File 1. Analytical samples were restricted to working age participants, defined as those aged 16 to 66 (the current state pension age in the UK), who had at least one wellbeing outcome in the J o u r n a l P r e -p r o o f COVID-19 survey and relevant pre-pandemic measures for confounder adjustment. Studies were weighted to be representative of their target population, accounting for sampling design and differential non-response (see, for instance, Anonymized). Weights were not available for GS.

Measures
Please, see Supplementary File 2 for full details on the measures and variable coding in each study.

Exposure: Employment status change
Employment change (or stability) was operationalised by comparing respondents' self-reported employment status during the initial stages of the pandemic and retrospectively in the months preceding the start of the pandemic. Participants in paid work or in self-employment were both classed as 'employed' for all the studies. Based on this information, we created six employment change (or stability) categories: stable employed (either as self-employed or an employee, which served as the reference group); furloughed (i.e., from employed to furlough); no longer employed (i.e., from employed to not working, such as job loss or retirement); stable unemployed (i.e., unemployed at both points); became employed (i.e., from not working to employed); and stable non-employed (i.e., not available for employment at either point, including in education, early retirement, caring responsibilities, sick or disabled).

Outcomes: Mental health and social wellbeing
We investigated six different mental and social wellbeing outcomes. For each outcome, we created a binary variable using pre-validated cut-off scores where possible. Psychological distress was measured using the Kessler-6 (MCS) (Kessler et al., 2002), General Health Questionnaire-12 (NS, USOC) (Goldberg, 1978), Malaise Inventory (BCS, NCDS) (Rutter, 1970), Centre for Epidemiological Studies Depression Scale (ELSA) (Radloff, 1977), Short J o u r n a l P r e -p r o o f Questionnaire (GS) (Kroenke & Spitzer, 2002), and Hospital Anxiety and Depression Scale (Twins UK) (Zigmond & Snaith, 1983). Life satisfaction was assessed using the Office for National Statistics (ONS) wellbeing scale that asks participants to rate how satisfied they are with their lives (most studies used a 0-10 scale; USOC used 1-7): those who answered less than 7 (or less than 5 in USOC) were classified as reporting low life satisfaction. Self-rated health was measured using responses to a generic question asking participants to rate their health on a five-point ordinal scale (excellent; very good; good; fair; poor): the five items were dichotomised into poor (fair or poor) versus good (excellent, very good or good). Social contact (either face-to-face, by telephone, or text message) with family and friends outside the household was coded to distinguish between those reporting daily versus less than daily social contact. Loneliness was assessed (MCS, NS, BCS, NCDS, ELSA, TwinsUK) using the short version of the Revised UCLA loneliness scale, with scores of 6 and higher indicating high loneliness (Russell et al., 1980). Additionally, we also considered the direct question "How often do you feel lonely?" rated on a three-point ordinal scale (hardly ever; some of the time; often), as this was asked in two further studies (USOC, GS): we compared those reported often feeling lonely versus less frequent or no feelings of loneliness.

Confounders and moderators
Two levels of confounder adjustment were applied. The first level reflected a basic adjustment, accounting for sociodemographic characteristics: age (for age heterogeneous studies), sex, ethnicity (White vs. non-White ethnic minority -not available in NCDS and BCS), education (degree vs. no degreeparent education used for MCS), UK nation (England; Scotland; Wales; Northern Ireland), and household composition (living alone; with partner including possible children or others; with others e.g., housemates or other family members but no partner). The second level reflected full adjustment, additionally including all available pre-pandemic mental J o u r n a l P r e -p r o o f and social wellbeing measures, in order to determine whether differences in outcomes could be attributed to changes taking place during the pandemic. Caption: Without control for pre-pandemic wellbeing, the risk ratios from the basic adjustment may represent both incident and established (pre-pandemic) outcomes. The risk ratios from the full adjustment block effects via pre-pandemic characteristics and are therefore interpreted as representing differential change in outcomes independent of prepandemic status.
Both stages of adjustment are relevant because our exposure, employment change, incorporates pre-pandemic employment status, which may have exerted effects via pre-pandemic mental and social wellbeing (see figure 1). By not controlling for pre-pandemic states, the basic adjusted risk ratios may represent differences in both incident and established (pre-pandemic) outcomes. In contrast, the full adjustment risk ratios block effects via pre-pandemic mental and social wellbeing and can therefore be interpreted as representing differential change in mental and social wellbeing between exposure groups, independent of pre-pandemic status.

Analysis
We conducted analysis in each dataset using a co-ordinated approach. This allowed us to operationalise measures as closely as possible across datasets using a common framework, while ensuring the best approach for characterising variables and measures within each dataset.
As a second step, meta-analysis of dataset-specific estimates was performed which maximises statistical power and generalisability, whilecruciallyallowing us to quantify heterogeneity across studies and take this into account.

J o u r n a l P r e -p r o o f
Within each study, each of the mental and social wellbeing outcomes were regressed on employment status change, using a modified Poisson model with robust standard errors that returns risk ratios for ease of interpretation and to avoid issues related to non-collapsibility of odds ratios (Zou, 2004;Zou & Donner, 2013). A sensitivity analysis was conducted with the continuous version of psychological distress (standardised within studies), using linear regression. We focus on reporting risk ratios comparing stable employment to furlough, no longer employed, and stable unemployment, as the main exposure categories of interest.
Results from each study were statistically pooled using a random effects meta-analysis with restricted maximum likelihood (maximum likelihood was used for models that failed to

Descriptive statistics
Descriptive statistics for mental and social wellbeing outcomes across nine studies are presented in Table 1

Insert Table 1
Employment change Descriptive statistics for employment status change (and stability) across nine studies are displayed in Table 2. The proportion of participants in stable employment ranged from 10.9% (MCS) to 71.5% (ALSPAC G1). The proportion of participants who were furloughed ranged from 5.8% (TwinsUK) to 23.2% (BCS). The proportion of participants no longer employed ranged from 1.7% (BCS) to 7.1% (ALSPAC G0). The proportion of participants who were stable unemployed ranged from 0.5% (BCS, GS) to 8.6% (ALSPAC G0).

Insert Table 2
Main results

J o u r n a l P r e -p r o o f
The pooled results suggest a largely common pattern in the way employment change was associated with mental and social wellbeing outcomes (see Figure 2). Compared to those in stable employment, those furloughed, no longer employed, and stable unemployed tended to show excess risk for poor mental and social wellbeing, with magnitude of excess risk being largest for the stable unemployed, followed by those no longer employed, and then those furloughed. Caption: Error bars show 95% confidence intervals; Stable employment is the reference category; Basic adjustment includes: age, sex, ethnicity, education, household composition; Full adjustment includes: pre-pandemic psychological distress, life satisfaction, self-rated health, social contact, and loneliness.

Less than daily social contact
We observed no differences in the risk of less than daily social contact across employment groups in all models. Sub-group analyses revealed no differences by sex, education, age, or household composition.

Discussion
Across nine UK longitudinal studies drawn from the UK working age population, we found that furlough was associated with a slight decline in mental and social wellbeing compared to stable employment during the early stages of the COVID-19 pandemic. While raised risks of psychological distress, low life satisfaction, poor self-rated health, and loneliness were seen J o u r n a l P r e -p r o o f among furloughed people, the excess risk was generally smaller than that associated with no longer being employed or being in stable unemployment. There was little association between employment status and having daily social contact. Moreover, we observed when adjusting for pre-pandemic characteristics, that the excess risk associated with stable unemployment was more strongly attenuated than that for furlough or no longer being employed. This indicates that the large magnitude risks associated with stable unemployment may have had more to do with characteristics that were already established before the pandemic.
As with most observational studies, unobserved confounding could have affected our estimates. Despite being embedded within long standing cohorts, survey responses during the pandemic were lower than typically achieved, and while weighting was employed to correct for this, bias due to selective non-response could not be ruled out (Fernández-Sanlés et al., 2021;Anonymized)). There are other limitations that should also be considered. First, we were not able to achieve full harmonisation of measures across studies, for example, a range of different psychological distress scales were used and questions on social contact differed considerably (which may explain some of the between study differences in prevalence).
Second, all cohorts and studies could not contribute to every analysis as the number of cases and available data varied between studies. Third, participation in the furlough scheme was more common during the initial stages of the pandemic than being no longer employed or in stable unemployment, which meant that estimates for the latter groups were based on small numbers with considerable heterogeneity, especially in sub-group analyses. Additionally, due to lack of consistently detailed data, we were unable to examine the specific effect of similar schemes for self-employed participants. Finally, it is important to recognise that the experience of stable employment itself may have changed during the pandemic with childcare conflicts during school closures and changes in working practices such as home-working potentially affecting mental health and wellbeing, which is an important area for future research.
Nevertheless, our findings concur with those of Burchell et al. (2020) that continued connection to employment is better for mental health. We demonstrate further that furlough occupies an intermediary position between employment and unemployment and that the mental health of furloughed workers was somewhat worse than those who remained in employment. This finding was consistent after comparing formally job loss and furlough as the reference group.
Our study emphasises that these findings generalize across several measures of mental health and wellbeing (except social contacts), are relatively consistent across nine datasets, and are robust to adjustment for pre-pandemic mental health and wellbeing. Sub-group analyses show that furlough was associated with poorer self-rated health for females and among those aged 30-49 years, pointing out the role of gender and age in assessing the effect of furlough. This is in line with several studies that have recently shown that mental health, furlough, as well as the pandemic experiences were generally gendered Wang et al., 2022).
Interestingly, other studies have shown that furlough was not associated with substantial changes in health behaviours (Anonymized; Anonymized) indicating an effect of furlough that is not mediated by health behaviours.
Understanding the impacts of furlough is important because it was a key policy measure implemented to mitigate the economic disruption of the pandemic. Due to the UK CJRS furlough scheme, unemployment only rose moderately (Küçük et al., 2021), which is confirmed in our studies, as the number of furloughed workers was more than three times higher than the number of employees who lost their job. Furlough schemes and temporary layoff policies were implemented to mitigate employment losses in many European countries, Asia, and the United States (ILO, 2022) but with variations across countries. (Müller et al., 2022). Some countries, such as Portugal or Austria, have implemented short-time work schemes through financial support to companies to compensate the hours not worked by their employees. Some other countries have implemented wage subsidy schemes to subsidy J o u r n a l P r e -p r o o f companies independently of working time reduction such as in the Netherlands or Ireland.
Furlough schemes are about paying employees for hours not worked through temporary or partial layoff and have been implemented in Belgium, Denmark, and Finland as well as the UK but the content, financial modalities and length of these policies have varied from one country to another (Danielli et al., 2021). Unlike traditional forms of unemployment, the relationship between specific labour market policy interventions, such as furlough, and health is less wellunderstoodn (Escudero-Castillo et al., 2021;Ikeda et al., 2021;Anonymized). This is partly because job retention schemes, which focus on buffering the impact of economic downturns, were uncommon in Western countries, and particularly in the UK, prior to the COVID-19 outbreak (Puig-Barrachina et al., 2020).
The UK CJRS furlough scheme officially ended on the 30 th of September 2021. It might be expected that the economic downturn caused by the COVID-19 pandemic will last beyond the end of the furlough scheme, and potentially beyond the end of the pandemic (Whitehead et al., 2021). With potentially damaging effects on mental health and wellbeing for those who stopped working (via furlough or otherwise), one pertinent question is whether the mental health and wellbeing of those who were furloughed will recover when they move back to their previous employment status. In line with this, another important question is whether those who benefited from the CJRS scheme will be more likely to experience further economic disruptions such as job or income loss in the post-furlough period, as this could exacerbate detrimental effects on health and wellbeing. A final point to consider is whether furlough schemes could help mitigate negative impacts of other economic disruptions (besides COVID-19) on mental and social wellbeing. Whilst temporary forms of unemployment existed prior to the start of the pandemic in countries such as Belgium (Hendrickx et al., 2020) or Germany (Chung & Thewissen, 2011), schemes allowing employers to furlough employees in cases of acute economic difficulty could be investigated further.

Conclusion
During the initial stages of the COVID-19 pandemic, many people experienced employment disruption, which we found to be associated with change in mental and social wellbeing.
Compared to those who remained working, furloughed workers showed a decline with respect to their mental and social wellbeing. However, those who had left employment or remained unemployed fared worse than furloughed workers. This suggests that furlough may have helped to mitigate some of the detrimental impacts of employment disruption on mental health, but nevertheless, furloughed workers still experienced a modest deterioration in their mental and social wellbeing and may need additional support to recover from pandemic-related disruptions.
J o u r n a l P r e -p r o o f Note: Data were collected during the early stages of the COVID-19 pandemic (April-June 2020); Pre-pandemic data were collected at different times ranging from 2006-2019 (see Supplementary File 1 for more information); Missing items reflect that no consistent measure was available for that particular study.
J o u r n a l P r e -p r o o f