Population mental health in England, 2003–2022: Distress, mental illness and activity limitations

Abstract

Mental health trends have become central to public debate in Europe, and there is evidence that distress has increased in recent years. However, limited distinction is made between different mental health measures, although these may capture rising distress, the labelling of distress as mental illness, or experiences of social exclusion. We use data from England to examine how psychological distress, self-declared mental illness, and activity limitations have changed over the past two decades.

Methods

We analyse repeated cross-sectional data for the working-age population (18–64 years) from the Health Survey for England (2003–2022; N = 109,113). Three outcomes were examined: (i) psychological distress using the General Health Questionnaire (GHQ ≥4), (ii) self-reported mental illness using longstanding illness questions, and (iii) mental health-related activity limitations based on effects on day-to-day activities. Survey-weighted regression models were used to estimate trends over time across age groups.

Findings

Preliminary analyses show an increase of individuals experiencing mental distress from 13.6% (95% CI[13.1;14.0]) in 2003-2006 to 19.1% (CI[17.6;20.7]) in 2022, with a major rise starting before the COVID pandemic. The self-identification with mental illness increased more than threefold from 3.7% (CI[3.5;4.0]) in 2003-2006 period to 12.7% (CI[11.3;14.2]). Among the people with high GHQ symptomology, substantively more identify as having a long-term illness in 2022. Daily limitations are also rising, but this is driven by more people reporting “some” rather than severe limitations.

Interpretation

The findings suggest a sustained rise in population psychological distress in England since the early 2010s, alongside an even stronger increase in self-declared mental illness. This indicates that recent mental health change cannot be captured by a single measure alone, as distress, illness identification, and functional limitation follow different trends.

Key messages

• Mental health trends in England depend on the indicator used: distress increased, self-declared mental illness rose more sharply, while severe limitations changed less.

• A single measure can mislead; distress, illness identification, and functional impairment capture distinct dimensions with different policy implications.