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South Korea's 2018 minimum wage hike was examined for its impact on potential alcohol use disorders among affected individuals, using data from the Korea Welfare Panel Study (2015-2019). The study sample was restricted to workers aged 19-64 employed over the study years. The treatment group was identified as those below minimum wages, and the control group as those earning more than minimum wages in 2016-2017 (n=3,117 control, n=578 treatment). Using outcomes derived from the Alcohol Use Disorders Identification Test, our results from difference-in-differences models showed that the 2018 wage hike was linked to a 1.9% increase in the 'high risk' of alcohol use disorder and a 3.6% rise in hazardous consumption in the treatment group. Notably, the effects were more pronounced among men and those aged 50-64. Additionally, we confirmed that the spillover effects extended to workers earning up to 20% above the minimum wage. This study underscores the unintended substance use risk of minimum wage policies in the East Asian context. As wage policies are implemented, integrated public health campaigns targeting at-risk groups are required.

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BACKGROUNDS: In the context of increasing hate crimes, legislative challenges, and anti-LGBTQ + sentiment, we conducted the first study that comprehensively examined long-term mental health disparities across sexual orientations in the UK from 2010 to 2021. Prior studies predominantly relied on cross-sectional or limited longitudinal designs, thus failing to capture evolving trends over a decade and providing crucial insights into the dynamics of mental health challenges faced by sexual minorities, essential for devising targeted public health interventions and policies. METHODS: Waves 2-12 of the UK Longitudinal Household Survey for adults (n = 52,591) were used. MCS-12 (Mental Health Component Scale of the Short-Form Health Survey) for mental functioning and GHQ (General Health Questionnaire) for psychological distress were included as the main outcomes, along with other measures of well-being. Mixed-effect longitudinal models were used to examine the trends of mental health disparities across sexual orientations. RESULTS: Relative to their heterosexual counterparts, psychological distress (GHQ) increased for gay men, lesbians, and women with "other" orientations. Bisexual women saw the steepest increase from 1.69 higher GHQ vs. their heterosexual counterparts in 2010 (95%CI: 0.81 to 2.57), up to 3.37 in 2021 (95%CI: 2.28 to 4.45). Similar trends were also shown in the other measures. CONCLUSIONS: The study highlights increases in mental health disparities between sexual minorities and heterosexuals. The escalating psychological distress among sexual minorities, particularly bisexual women, calls for an urgent, multi-faceted, and intersectoral response. This approach must address both symptoms and the social structures perpetuating these disparities across sexual orientations.

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Suicide rates among older adults in Korea are one of the highest in the world. Although prior research found that poverty is associated with suicide mortality among older adults in Korea, it is unknown whether being a recipient of social assistance may reduce suicide risk among older adults living in poverty. We examined the impact of the public assistance program on suicide-related behaviour (SRB). Data from a nationwide cohort in the Korean National Health Insurance Database, including demographic and medical treatment information, linked to the vital statistics for 2010-19 was used. The entire Korean population born before 1951 was included (n = 7,889,086). Flexible parametric survival model was performed to assess whether the risk of SRB hospitalisation and death differed across a) different levels of socioeconomic status, and b) social assistance status among the poor, using gender-stratified models. Older age, chronic disease, poverty, and being out of the labour market were associated with higher SRB hospitalisation and death for both genders. Among those living in poverty, social assistance recipients had lower rates for SRB death and hospitalisation, compared to the low-income non-recipients. Men who were non-recipients had 0.21 higher hazards ratio (95%CI 0.20 to 0.22) for SRB deaths compared to recipients, and the difference was 0.11 (95%CI 0.10 to 0.11) in women, with similar patterns for SRB hospitalizations. Poverty was associated with higher SRB death and hospitalisation among older adults in Korea. Social assistance targeting the older population may help reduce SRB.

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OBJECTIVES: Recent research has focused on the effects of legalization on cannabis-related emergency department visits, but the considerable healthcare costs of cannabis-related hospitalizations merit attention. We will examine the association between recreational cannabis legalization and cannabis-related hospitalizations. METHODS: A cohort of 3,493,864 adults from Alberta was examined (October 2015-May 2021) over three periods: pre-legalization, post-legalization of flowers and herbs (phase one), and post-legalization of edibles, extracts, and topicals (phase two). Interrupted time series analyses were used to detect changes. RESULTS: The study found an increase in hospitalization rates among younger adults (18-24) before legalization, yet no increased risk was associated with cannabis legalization, for either younger (18-24) or older adults (25+). CONCLUSIONS: Clinicians should be aware of the increased risk in younger groups and may benefit from early identification and intervention strategies, including screening and brief interventions in primary care settings.

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BACKGROUND: South Korea had the highest suicide rates in the OECD and one of the largest (16.4%) increases in the minimum wage in 2018. Prior studies have provided evidence that increases in minimum wage reduce suicide rates in the population, but no study examined the effects of the policy change on individual-level suicidal behaviour. METHODS: Our study sample was built using the 2015-2019 waves of the Korean Welfare Panel Survey, a population-representative longitudinal survey. The sample consisted of 5146 participants, including those earning above minimum wage (control) and minimum wage earners (treatment) based on their 2018/19 earnings. The outcome of the study was suicidal ideation, which is an important precursor to other suicidal behaviours, and was captured using self-reported measures. We examined the impact of the 2018 minimum wage hike in Korea on suicidal ideation, using a difference-in-differences design. RESULTS: The minimum wage increase was associated with a 1.6% points reduction (95% CI: -2.8% to -0.5%) in self-reported suicidal ideation. Stronger policy effects were shown among women and older age groups. CONCLUSIONS: Our study demonstrates that public policies employing a population-based approach, such as increasing minimum wages, could serve as an effective intervention to mitigate suicidal ideation among low-income workers.

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BACKGROUND: Poverty is associated with intimate partner violence (IPV), but whether exogenous increases in wage could reduce IPV among low-income women is still unclear. We examined whether the 2018 minimum wage hike led to a reduction in IPV risk among women. METHODS: Using the 2015-2019 Korean Welfare Panel Study, we employed a difference-in-differences (DID) approach to assess the effect of the minimum wage hike on IPV. The analysis focused on married women aged 19 or older. We categorised participants into a target group (likely affected by the minimum wage increase) and a comparison group based on their hourly wage. Three IPV outcomes were examined: verbal abuse, physical threat and physical assault. We conducted DID analyses with two-way fixed-effects models. RESULTS: The increase in minimum wage was correlated with a 3.2% decrease in the likelihood of experiencing physical threat among low-income female workers (95% CI: -6.2% to -0.1%). However, the policy change did not significantly influence the risk of verbal abuse, physical assault or a combined IPV outcome. The study also highlights a higher incidence of all IPV outcomes in the target group compared with the comparison group. CONCLUSIONS: The 2018 minimum wage increase in Korea was associated with a modest reduction in physical threat among low-income female workers. While economic empowerment through minimum wage policies may contribute to IPV prevention, additional measures should be explored. Further research is needed to understand the intricate relationship between minimum wage policies and IPV, and evidence-based prevention strategies are crucial to address IPV risk.

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OBJECTIVE: This study aimed to investigate the sociodemographic and clinical factors associated with receiving follow-up mental healthcare within 7 days and 30 days after hospitalization for suicide-related behaviors (SRB) among older adults in South Korea. METHODS: Data from the Korean National Health Information Database were used, including information on sociodemographic variables and healthcare utilization. The study cohort consisted of individuals born in 1950 or before with a prior hospitalization record for suicide attempts or probable suicide attempts. Logistic regression analysis was conducted to predict the odds of receiving follow-up care within 7 days and 30 days, adjusting for covariates. RESULTS: Among the 37,595 older adults discharged from hospitalization for SRB, 29.13 % and 37.86 % received follow-up care within 7 days and 30 days, respectively. Follow-up care was more common among younger individuals, women, those with higher socio-economic status (SES), urban residents, and individuals with comorbidities. CONCLUSION: The provision of mental health follow-up care for older adults after hospitalization for suicide attempts is inadequate in South Korea. Increasing access to follow-up care among those with lower income, residing in rural areas, and older age is crucial. Public awareness campaigns, stigma reduction training for healthcare providers, and system-level changes, such as telemedicine and integrated care pathways, can help bridge the healthcare gap and reduce suicide mortality among older adults.

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BACKGROUND: While there's a growing body of research studying the health effects of minimum wage increases, evidence of its impact on smoking is inconsistent. Using nationally representative statistics, our quasi-experimental study examines the impacts of South Korea's 2018 minimum wage increase on smoking patterns, offering a distinctive context due to the significant wage growth and the country's permissive smoking culture. METHODS: Using the Korean Welfare Panel Study (KOWEPS), we conducted a difference-in-differences analysis using two-way fixed effect (TWFE) and Callaway and Sant'Anna Difference-in-differences (CSDID) methods. The study sample (n = 3494) included individuals aged 19-64 at baseline in 2016, and employed in the entire study period (2016-2019). RESULTS: The model results suggest a roughly 2% increase in the probability of current smoking with an insignificant impact on average daily cigarette consumption following the 2018 minimum wage increase in Korea. These effects were most pronounced among men and age groups (45-64). We also found policy effects on those earning up to 150% of the minimum wage. CONCLUSION: In a culture with widespread acceptance of smoking, an exogenous increase in disposable income due to elevated minimum wage might enhance vulnerability to societal pressure to smoke. Although TWFE and CSDID both suggest the same overall trend, the latter approach allows a more detailed examination by acknowledging heterogeneous treatment effects. These results could guide policymakers to contemplate the potential for increased smoking resulting from minimum wage hikes in societies where tobacco use is common, and accordingly strategize anti-smoking public health initiatives.

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OBJECTIVE: The authors used a population-representative sample and health administrative data to quantify suicide-related behavior leading to acute care or deaths across self-identified heterosexual, gay/lesbian, and bisexual individuals. METHODS: Data from a population-based survey (N=123,995) were linked to health administrative data (2002-2019), and differences in time to suicide-related behavior events across sexual orientations were examined using Cox proportional hazards regression. RESULTS: The crude incidence rates of suicide-related behavior events per 100,000 person-years were 224.7 for heterosexuals, 664.7 for gay/lesbian individuals, and 5,911.9 for bisexual individuals. In fully adjusted (gender-combined) models, bisexual individuals were 2.98 times (95% CI=2.08-4.27) more likely to have an event, and gay men and lesbians 2.10 times (95% CI=1.18-3.71) more likely, compared with heterosexual individuals. CONCLUSIONS: In a large population-based sample of Ontario residents, using clinically relevant outcomes, the study found gay/lesbian and bisexual individuals to be at elevated risk of suicide-related behavior events. Increased education among psychiatric professionals is needed to improve awareness of and sensitivity to the elevated risk of suicide-related behavior among sexual minority individuals, and further research on interventions is needed to reduce such behaviors.

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BACKGROUND: Recreational cannabis policies are being considered in many jurisdictions internationally. Given that cannabis use is more prevalent among people with depression, legalisation may lead to more adverse events in this population. Cannabis legalisation in Canada included the legalisation of flower and herbs (phase 1) in October 2018, and the deregulation of cannabis edibles one year later (phase 2). This study investigated disparities in cannabis-related emergency department (ED) visits in depressed and non-depressed individuals in each phase. METHODS: Using administrative data, we identified all adults diagnosed with depression 60 months prior to legalisation (n = 929 844). A non-depressed comparison group was identified using propensity score matching. We compared the pre-post policy differences in cannabis-related ED-visits in depressed individuals v. matched (and unmatched) non-depressed individuals. RESULTS: In the matched sample (i.e. comparison with non-depressed people similar to the depressed group), people with depression had approximately four times higher risk of cannabis-related ED-visits relative to the non-depressed over the entire period. Phases 1 and 2 were not associated with any changes in the matched depressed and non-depressed groups. In the unmatched sample (i.e. comparison with the non-depressed general population), the disparity between individuals with and without depression is greater. While phase 1 was associated with an immediate increase in ED-visits among the general population, phase 2 was not associated with any changes in the unmatched depressed and non-depressed groups. CONCLUSIONS: Depression is a risk factor for cannabis-related ED-visits. Cannabis legalisation did not further elevate the risk among individuals diagnosed with depression.

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BACKGROUND: Employment conditions may affect individuals' leisure-time physical activity (LTPA). We aimed to examine the relationship between changes in working and employment conditions and LTPA among working-age populations in South Korea from 2009 to 2019. METHODS: A cohort of 6,553 men and 5,124 women aged 19-64 years was analyzed using linear individual-level fixed-effects regressions to examine changes in working and employment conditions with changes in LTPA. RESULTS: Reduced working hours, labor union membership, and part-time work were associated with increased LTPA for both sexes. Manual labor and self-reported precarious work were associated with reduced LTPA. The longitudinal relationship between employment conditions and LTPA was clear in men, but less apparent in women. CONCLUSIONS: Changes in working and employment conditions had longitudinal associations with changes in LTPA among working-age Koreans. Future research should examine changing employment conditions and their effect on LTPA, particularly among women and manual/precarious workers. These results could inform effective planning and interventions to increase LTPA.

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BACKGROUND: While self-reported data shows that lesbian, gay, and bisexual (LBG) individuals have a greater suicide-related behaviours (SRB) risk, little is known about how rurality may amplify SRB risk associated with sexual minority status. Sexual minority individuals in rural areas may experience unique stressors due to stigma and a lack of LGB-specific social and mental health services. Using a population-representative sample linked to clinical SRB outcomes, we examined whether rurality modifies the association between sexual minority status and SRB risk. METHODS: A nationally representative survey linked to administrative health data was used to construct a cohort of individuals (unweighted n = 169,091; weighted n = 8,778,115) in Ontario, Canada, and captured all SRB-related emergency department visits, hospitalizations, and deaths between 2007 and 2017. Sex-stratified discrete-time survival analyses were used to examine interactions between rurality and sexual minority status on SRB risk while controlling for potential confounders. RESULTS: Sexual minority men had 2.18 times higher SRB odds compared to their heterosexual counterparts (95%CI 1.21-3.91), while sexual minority women had 2.07 times higher odds (95%CI 1.48-2.89) after adjusting for the confounders. The Rurality Index of Ontario and the Index of Remoteness were associated with the odds of SRB in a dose-response manner. No significant interactions were observed between rural and sexual minority status. CONCLUSIONS: Our study provides evidence that rural and sexual minority status both independently contribute to an elevated likelihood of SRB; however, rurality did not appear to modify SRB risk by sexual orientation. Implementation and evaluation of interventions to reduce SRB in both rural and sexual minority populations are required.

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BACKGROUND: There have been no studies examining how neighbourhood deprivation modifies the effects of sexual minority status on suicide-related behaviours (SRB). Sexual minority individuals in deprived areas may face unique challenges and stressors that exacerbate their risk of SRB. This study aims to investigate the association between sexual minority status and clinical SRB, and examine whether the effect of neighbourhood deprivation differs across sexual orientation. METHODS: A population-representative survey sample (169,090 respondents weighted to represent 8,778,120 individuals; overall participation rate 75%) was linked to administrative health data in Ontario, Canada to measure SRB-related events (emergency department visits, hospitalizations, and deaths) from 2007 to 2017. Neighbourhood-level deprivation was measured using the Ontario Marginalisation index measure of material deprivation at the dissemination area level. Discrete-time survival analysis models, stratified by sex, tested the effects of neighbourhood deprivation and sexual minority status, while controlling for individual-level covariates. RESULTS: Sexual minority men had 2.79 times higher odds of SRB compared to their heterosexual counterparts (95% CI 1.66 to 4.71), while sexual minority women had 2.14 times higher odds (95% CI 1.54 to 2.98). Additionally, neighbourhood deprivation was associated with higher odds of SRB: men in the most deprived neighbourhoods (Q5) had 2.01 times higher odds (95% CI 1.38 to 2.92) of SRB compared to those in the least deprived (Q1), while women had 1.75 times higher odds (95% CI 1.28 to 2.40). No significant interactions were observed between sexual minority status and neighbourhood deprivation levels. CONCLUSION: In both men and women, sexual minority status and neighbourhood deprivation are independent risk factors for SRB. Despite the lack of effect modification, sexual minorities living in the most deprived neighbourhoods have the highest chances of SRB. Future investigations should evaluate interventions and policies to improve sexual minority mental health and address neighbourhood deprivation.

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PURPOSE: In 2014, the Korean Government passed the Gender Equality Act, which was accompanied by policies to increase women's participation in the labour force and representation in positions of power in the public and private sectors. While Korea has witnessed modest progress in macro-level gender equality, little is known about the effects of these changes on mental health outcomes. Our study investigated the relationship between regional-level gender equality (as measured by women's economic and political power) and women's depressive symptoms from 2013-18, and whether the effects differed across women from different socioeconomic positions. METHODS: To examine how change over time in political and economic power influences the severity of depressive symptoms, we applied a fixed-effect regression, using a nationally representative sample for women aged 19-64 (n = 9,589) from the Korean Longitudinal Survey of Women and Families (2013-2018, wave 4 to 6) residing across the 16 regions of South Korea. RESULTS: Our study found that increases in women's political and economic power led to moderate reductions in depressive symptoms (-0.25 and -0.23 points in CESD respectively). Sensitivity analyses indicate that economic power is more consistently associated with subsequent reductions in CESD. The effect of economic and political power on depressive symptoms did not differ by women's socioeconomic positions. CONCLUSIONS: Our findings suggest that even modest improvements in gender equality were associated with increases in women's mental health. Further progress to ensure gender equality, such as the anti-discrimination legislation, may lead to greater improvements in public mental health.

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Legalization of recreational cannabis in Ontario included the legalization of flower and herbs (Phase 1, October 2018), and was followed by the deregulation of cannabis retailers and sales of edibles (Phase 2, February 2020). Research on the impact of cannabis legalization on acute care utilization is nascet; no research has investigated potential age, gender, and geographically vulnerable subgroup effects. Residents living in Northern Ontario not only have higher levels of substance use problems, but also have inadequate access to primary healthcare. Our study investigated the impact of Ontario's recreational cannabis policy (including Phase 1 and 2) on cannabis-attributable emergency department (ED) visits, and estimated the impact separately for different age and gender groups, with additional analyses focused on Northern Ontarians. We created a cohort of adults (18 and over) eligible for provincial universal health insurance with continuous coverage from 2015-2021 (n = 14,900,820). An interrupted time series was used to examine the immediate impact and month-to-month changes in cannabis-related ED visits associated with Phase 1 & 2 for each subgroup. While Northern Ontario has higher rates of cannabis-related ED visits, both Northern and Southern Ontario show similar patterns of changes. Phase 1 was associated with significant increases in adults 25-64, with the strongest increases seen in women 45-64. Month-to-month trends were flattened in most groups compared to pre-legalization. Phase 2 was associated with significant immediate increases for adults aged 18-44 in both genders, but the increases were larger in women than men. No significant month-to-month changes were detected in this period. While current preventive efforts are largely focused on reducing cannabis-related harms in youths and younger adults, our results show that adults 25-64, particularly women, have been significantly impacted by cannabis policies. Further research on gender-specific cannabis dosage and targeted interventions for adult women should be investigated. Legalization did not appear to have a differential impact on Northern versus Southern Ontario, but higher rates of ED visits in the North should be addressed.

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Objectives. To examine whether the #MeToo movement influenced depressive symptoms among women in South Korea with a history of experiencing sexual violence. Methods. We used data from a nationally representative sample (n = 4429) of women 19 to 50 years of age who participated in the Korean Longitudinal Survey of Women and Families between 2012 and 2019. A difference-in-differences model was used to estimate within-person changes in depressive symptoms attributable to the #MeToo movement across women with and without a history of experiencing sexual violence. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CESD). Results. After adjustment for potential confounders, the #MeToo movement led to a 1.64 decrease in CESD scores among women with a history of experiencing sexual violence relative to women without such a history. Conclusions. Our findings suggest that the #MeToo movement in Korea led to reduced depressive symptoms among women with a history of experiencing sexual violence. Public Health Implications. Despite the progress of the #MeToo movement, there are still judicial and institutional problems that can revictimize sexual violence survivors. Further policy changes will likely improve the mental health of survivors. (Am J Public Health. 2022;112(9):1337-1345. https://doi.org/10.2105/AJPH.2022.306945).

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BACKGROUND: As governments around the world implement austerity measures to reduce national deficits, there is an urgent need to investigate potential health impacts of specific measures to avoid unintended consequences. In 2013, the UK government implemented the underoccupancy penalty (ie, the bedroom tax) to reduce the national housing benefits bill, by cutting social housing subsidies for households deemed to have excess rooms. We investigated the impact of the bedroom tax on self-reported psychological distress. METHODS: Using data from the UK Household Longitudinal Study (2010-2014), the sample included those who received housing subsidies, aged 16-60, living in England. Control and treatment groupings were identified on their household composition and housing situation. We used matching methods to create an exchangeable set of observations. Difference-in-differences analysis was performed to examine changes across the prereform and postreform psychological distress of the treatment and control groups, using the 12-item General Health Questionnaire. RESULTS: The implementation of the reform was associated with a moderate increase in psychological distress (0.88, 95% CI 0.06 to 1.71) among the treatment group, relative to the control group. However, the announcement was not associated with change in psychological distress (0.53, 95% CI 0.21 to 1.27). CONCLUSION: Our study provides evidence that the implementation of housing austerity measures can increase psychological distress among social housing tenants. As the use of austerity measures become more widespread, policy-makers should consider supplementary interventions to ameliorate potential negative health consequences.

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INTRODUCTION: Recent international and national strategies to reduce suicide mortality have suggested that social protection programmes may be an effective multisectoral response given the link between material deprivation and suicides in observational studies. However, there is a lack of evidence on the causal relationship between social protection programmes and suicide, which may hinder substantial national budget reallocations necessary to implement these policies. Social protection programmes are government interventions that ensure adequate income now and in the future, through changes to earned income (eg, minimum wage increase) or social security (via cash transfers or cash equivalents). Our review aims to evaluate the existing evidence on a causal relationship between social protection programmes and suicide mortality by examining all relevant experimental and quasi-experimental studies between January 1980 and November 2021. METHODS AND ANALYSIS: The review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We will search references published between 1 January 1980 and 30 November 2021 in 10 electronic databases, including MEDLINE (PubMed), PsycINFO, EMBASE and Applied Social Sciences Index Abstracts. Seven reviewers will independently participate in screening studies from titles, abstracts and full texts across all the stages. Experimental (ie, randomised controlled trials) and quasi-experimental studies (ie, non-randomised interventional studies) written in English, French, Spanish, German, Chinese, Korean and Japanese examining the impact of income security programmes on suicide mortality were included. Meta-analyses will be conducted if there are at least three studies with similar income security programmes. ETHICS AND DISSEMINATION: Our proposed review does not require ethical approval. In collaboration with our community partners, we will develop a policy brief for stakeholders to support efforts to implement social protection programmes to help prevent suicides. Our findings will be presented at conferences, published in a peer-reviewer journal and promoted on social media platforms. PROSPERO REGISTRATION NUMBER: CRD42021252235.

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Background: National lockdown in the UK during the COVID-19 pandemic severely restricted the mobility of residents and increased time spent in their residential neighbourhoods. This is a unique opportunity to understand how an exogenous factor that reduces mobility may influence the association between neighbourhood social environment and mental health. This study investigates whether the COVID-19 lockdown may modify the effect of neighbourhood disorder on psychological distress. Methods: We tracked changes in psychological distress, using the UK household longitudinal survey across the pre-COVID and lockdown periods in 16,535 adults. Neighbourhood disorder was measured along two subscales: social stressors and property crime. Fixed-effects regression was used to evaluate whether the widespread reduction in mobility modifies the association between the subscales of neighbourhood disorder and psychological distress. Results: The effect of neighbourhood social stressors on psychological distress was stronger in the lockdown period compared to the pre-COVID period. Compared to the pre-COVID period, the effect of being in neighbourhoods with the highest social stressors (compared to the lowest) on psychological distress increased by 20% during the lockdown. Meanwhile, the effect of neighbourhood property crime on mental health did not change during the lockdown. Conclusion: The sudden loss of mobility as a result of COVID-19 lockdown is a unique opportunity to address the endogeneity problem as it relates to mobility and locational preferences in the study of neighbourhood effects on health. Vulnerable groups who have limited mobility are likely more sensitive to neighbourhood social stressors compared to the general population.