Up to a fifth of adults have mental health problems in midlife

21 January 2021

Baby Boomers and Generation X are at the greatest risk of mental ill-health in middle age, finds new research by UCL.

The study, published today in Psychological Medicine, reveals that 20% of those born in 1970 – part of Generation X – 19% of Baby Boomers born in 1946, and 15% of Baby Boomers born in 1958, experienced their highest ever levels of psychological distress in adulthood when they were in their 40s and 50s, including symptoms of depression and anxiety.

The researchers based at the Centre for Longitudinal Studies at the UCL Social Research Institute analysed data collected over the past four decades on more than 28,000 adults who are participating in three of Britain’s birth cohort studies. They examined participants’ reports of their mental health between the ages of 23 and 69 to investigate rates of psychological distress during adulthood, and how they differed across generations.

Among those born in 1958 and 1970, rates of mental ill-health decreased from their early 20s to their early 30s, then for all three cohorts, the prevalence of psychological distress  increased from their early 30s to reach its highest levels in midlife – when participants were aged between 46-53.

The 1970 cohort consistently had the highest rates of mental ill-health during adulthood. At age 26, 16% reported psychological distress, before rates fell to 14% at age 30. Prevalence of mental ill-health increased to 16% at age 34, then to 19% at age 42, before reaching 20% at age 46.

For those born in 1958, prevalence decreased from 10% at age 23 to 8% at age 33, before rising to 13% at age 42, then increased again, to 15% at age 50. For those born in 1946, rates of psychological distress increased steadily during adulthood, from 6% at age 36, to 12% at age 43 and then 19% at age 53.

Among those born in 1946, rates of psychological distress were observed to decline as they reached their 60s. Prevalence of mental ill-health decreased from 18% at age 60-64 to 15% at age 69.

Across all three cohorts, at all ages, rates of psychological distress were higher among women than men. For example, in midlife, 23% of women born in 1970 had mental health problems compared to 17% of men. Among the Baby Boomers in middle age, 19% of women born in 1958 had psychological distress compared to 11% of men, and of women born in 1946, 24% had mental ill-health, compared to 14% of men.

Co-author, Professor George Ploubidis (UCL Centre for Longitudinal Studies) said: “Thanks to longitudinal data collected from almost 30,000 adults over the past four decades we can examine the trajectory of mental ill-health across two generations since the early 1980s.

“Midlife tends to involve a ‘peak’ in career, with middle-aged adults acquiring increasing responsibility as the ‘decision-makers’ in society, which is accompanied by reduced leisure time, and elevated job-related stress. Middle age is also often associated with changes to family structure, which may be linked with mental health, such as empty nest syndrome and rising rates of divorce. As people approach their 50s, they are also more likely to be parents and simultaneously care for ageing parents. The added pressures of the COVID-19 pandemic may therefore have a more pronounced detrimental effect on the mental health of middle-aged adults as many have increased responsibilities, such as homeschooling their children and caring for older and vulnerable relatives.

“Generation X were more likely to have psychological distress than the Baby Boomers across their lives. They entered the job market in the late 1980s and early 1990s during a period of recession and high unemployment, and also found it more difficult than earlier generations to get on the housing ladder. As a result, these particular circumstances may have had a lasting effect on the mental health of this generation throughout adulthood.”

Co-author, Dr Dawid Gondek (UCL Centre for Longitudinal Studies) added: “Mental health in adolescence and older age tends to gain much more attention than psychological distress in middle age, despite adults being particularly vulnerable to mental ill-health at this stage of life. Our study suggests that increased attention should be paid to the detection and management of mental health in middle age, for instance in primary care. It also implies the need for increased public awareness of psychological problems during midlife.”

The study was funded by the Economic and Social Research Council (ESRC).

Media coverage of this research

The Telegraph (£) – Middle age is worst period for mental ill health, study finds

The Telegraph (£) – Six signs you could be suffering from a midlife mental health crisis

The Telegraph (£) – Midlife stress is bad at the best of times, but the Sandwich Generation is at breaking point

Further information

For more information or to speak to the researchers involved, please contact:

Ryan Bradshaw, UCL Centre for Longitudinal Studies. T: +44 (0)207 612 6516 (diverts to mobile phone) E: r.bradshaw@ucl.ac.uk

Kath Butler, UCL Centre for Longitudinal Studies. T: +44 (0)20 7911 5389 (diverts to mobile phone) E: k.butler@ucl.ac.uk

Psychological distress from early adulthood to early old age: Evidence from the 1946, 1958 and 1970 British birth cohorts by Dawid Gondek, David Bann, Praveetha Patalay, Alissa Goodman, Eoin McElroy, Marcus Richards and George Ploubidis is available on the Psychological Medicine journal website.

Study methodology notes

Measures of mental ill-health

Psychological distress: Cohort members taking part in the 1946 study completed a range of questionnaires to measure psychological distress across adulthood. These included a clinical interview for the frequency and severity of psychiatric symptoms in the preceding month at age 36 (the Present State Examination; PSE); an interviewer-administered 18-item instrument derived from the PSE, focusing on symptoms of anxiety and depression during the preceding year at age 43 (the Psychiatric Symptom Frequency; PSF) and a self-administered questionnaire assessing symptoms of anxiety and depression in the preceding four weeks at ages 53, 60-64 and 69 (the 28-item General Health Questionnaire; GHQ).

At all ages during adulthood, 1958 and 1970 study members completed the Malaise Inventory, a measure of psychological distress, or depression and anxiety symptoms.

 Harmonisation of mental health measures

The main aim of the study was to investigate the profile of psychological distress within the same individuals in each birth cohort. As the questionnaires used across the 1946 study differed, it was necessary for the researchers to select common measures of psychological distress from each survey to ensure that the results were comparable across all ages. This was not an issue for NCDS and BCS70, since the same measure – the Malaise Inventory – was used for both birth cohorts. Nonetheless, to facilitate comparisons between the cohorts, the researchers found comparable measures of psychological distress within and across all three birth cohorts. This is thought to be the first attempt to correct for measurement error due to different measures of mental health in the British birth cohorts. Read more about this data harmonisation project: https://www.closer.ac.uk/research-fund-2/data-harmonisation/harmonisation-mental-health-measures-british-birth-cohorts/

The Medical Research Council (MRC) National Survey of Health and Development (NSHD) is the oldest and longest running of the British birth cohort studies; it is a nationally representative sample (N=5,362) of men and women born in England, Scotland or Wales in March 1946. The NSHD is managed by the MRC Unit for Lifelong Health and Ageing at UCL. http://www.nshd.mrc.ac.uk/

The National Child Development Study (NCDS) follows the lives of over 17,000 people born in England, Scotland and Wales in a single week of 1958. Since the initial birth sweep, they have taken part in ten surveys, at ages 7, 11, 16, 23, 33, 42, 46, 50, 55 and 60. Over the course of cohort members’ lives, NCDS has collected information on health, physical, educational and social development, and economic circumstances, among other factors. The study is funded by the Economic and Social Research Council and managed by the Centre for Longitudinal Studies at UCL Social Research Institute. https://cls.ucl.ac.uk/cls-studies/1958-national-child-development-study/

The 1970 British Cohort Study (BCS70) is following the lives of more than 17,000 people born in England, Scotland and Wales in a single week of 1970. Since the birth survey in 1970, there have been nine further surveys of all cohort members at ages 5, 10, 16, 26, 30, 34, 38, 42 and 46. Over the course of cohort members’ lives, BCS70 has collected information on health, physical, educational and social development, and economic circumstances, among other factors. The study is funded by the Economic and Social Research Council and managed by the Centre for Longitudinal Studies at UCL Social Research Institute. https://cls.ucl.ac.uk/cls-studies/1970-british-cohort-study/

The UCL Centre for Longitudinal Studies (CLS) is a resource centre based at the UCL Social Research Institute. CLS is home to four national longitudinal cohort studies, which follow the lives of tens of thousands of people. The Centre is funded by the Economic and Social Research Council (ESRC). www.cls.ucl.ac.uk

The UCL Social Research Institute (SRI) is one of the leading centres in the UK for multidisciplinary teaching and research in the social sciences. Based at the UCL Institute of Education, and with more than 180 academic, research and professional staff, it works to advance knowledge and to inform policy in areas including gender, families, education, employment, migration, inequalities, health and child/adult wellbeing. https://www.ucl.ac.uk/ioe/departments-and-centres/departments/ucl-social-research-institute.

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