Is there any evidence examining levels of severity of depressive symptoms amongst high-risk patients with Corona Virus Disease 2019 (COVID-19)?

Comment by InpharmD Researcher

People with psychosocial and health-related risk factors, as well as those with low socioeconomic positions, are at the most risk of experiencing moderate or severe depressive symptoms during the COVID-19 pandemic.
Background

A review article assessing the psychosocial impact of COVID-19 stated that quarantined individuals and positive COVID-19 patients tend to suffer from loneliness, anxiety, panic, post-traumatic stress disorder, and depression. Researchers concluded that setting up mental health organizations specific for future pandemics for research and arranging awareness programs is desperately needed. [1]

A review article assessing the impact of COVID-19 on mental health found that fear of the unknown leads to higher anxiety level in both healthy people and those with pre-existing mental health problems, and that unjustified public fear may lead to discrimination and stigmatization of the illness.
These mental health concerns may evolve into long-lasting health problems, isolation and stigma. Researchers concluded that global health measures should be employed to address psychosocial stressors, particularly related to the use of isolation/quarantine, fear and vulnerability among the general population. [2]

A meta-analyses including studies assessing the prevalence of stress, anxiety and depression in the general population during the COVID-19 pandemic found that people with higher levels of education had greater levels of anxiety, depression, and stress. Previous medical conditions may contribute to increased anxiety levels. Researchers found that the prevalences of stress, anxiety, and depression, as a result of the pandemic in the general population, are 29.6%, 31.9% and 33.7% respectively. [3]

References:

1. Dubey S, Biswas P, Ghosh R, et al. Psychosocial impact of COVID-19. Diabetes Metab Syndr. 2020;14(5):779-788. doi:10.1016/j.dsx.2020.05.035



2. Torales J, O'Higgins M, Castaldelli-Maia JM, Ventriglio A. The outbreak of COVID-19 coronavirus and its impact on global mental health. Int J Soc Psychiatry. 2020 Jun;66(4):317-320. doi: 10.1177/0020764020915212. Epub 2020 Mar 31. PMID: 32233719.



3. Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, Rasoulpoor S, Khaledi-Paveh B. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Global Health. 2020 Jul 6;16(1):57. doi: 10.1186/s12992-020-00589-w. PMID: 32631403; PMCID: PMC7338126.

Literature Review

A search of the published medical literature revealed 1 study investigating the researchable question:

Is there any evidence examining levels of severity of depressive symptoms amongst high-risk patients with Corona Virus Disease 2019 (COVID-19)?

Please see Table 1 for your response.

Levels of Severity of Depressive Symptoms Among At-Risk Groups in the UK During the COVID-19 Pandemic

Design

Cohort study

N= 51,417

Objective

To examine levels of severity of depressive symptoms over time among individuals with high risk in the UK during the COVID-19 pandemic

Methods

This cohort study was a part of an ongoing study of adults aged 18 years and older residing in the UK, and used online weekly data collection to explore the psychological and social experiences of adults during the COVID-19 pandemic.

Targeted recruitment focused on individuals from a low-income background, individuals with no or few educational qualifications, and individuals who were unemployed.

The study was promoted via partnerships with third sector organizations to at-risk groups, including adults with preexisting mental health conditions, older adults, caretakers, and people experiencing domestic violence or abuse. 

Depressive symptoms were measured using the 9-item Patient Health Questionnaire (PHQ-9), a validated screening tool for diagnosing depression in primary care. The questionnaire involved nine questions about the frequency of experiencing common symptoms of major depressive disorder during the past week.

Patients were asked to identify social and physical risk factors. Sociodemographic risk factors included belonging to minority racial communities, low socioeconomic position (SEP), and essential worker roles. Health-related and psychosocial risk factors included preexisting physical and mental health conditions, experience of psychological or physical abuse, and low social support.

Group-based depressive symptom trajectories were derived using latent growth mixture modeling

Outcome Measures

Associations of sociodemographic, psychosocial, and health-related risk factors with depressive symptom trajectories

Results

Weighted Characteristics of Study Participants at First Assessment:

Depressive Symptoms:

No. (%) (N= 51,417)

Minimal or mild

35, 715 (69.5)

Moderate

12,451 (24.2)

Severe

3,251(6.3)

Psychiatric Medications - Yes

7726 (18.0)

 

Analysis resulted in three distinct trajectories of depressive symptoms:

Class 1

Low depressive symptoms

30,850

participants (60.0%)

 

Class 2

Moderate depressive symptoms

14,911 participants

(29.0%)

 

Class 3

Severe depressive symptoms

5,656 participants (11.0%)

 

Associations of sociodemographic, health-related, and psychosocial risk factors with depressive symptom trajectories:

Moderate depressive symptom trajectory:

Risk Factor

Odds Ratio (95% Confidence Interval)

P value

Low SEP

1.97 (1.87-2.08)

<0.001

Black, Asian, and minority racial/ethnic groups

1.21 (1.03-1.40)

=0.04

Essential worker

0.97 (0.87-1.07)

=0.55

Physical condition

1.89 (1.79-1.98)

<0.001

Mental condition

4.24 (4.24-4.24)

<0.01

Abuse

5.34 (5.15-5.54)

<0.001

Low Social Support

4.71 (4.60-4.82)

<0.001

 

Severe depressive symptom trajectory:

Risk Factor

Odds Ratio (95% Confidence Interval)

P value

Low SEP

5.22 (5.08-5.36)

<0.001

Black, Asian, and minority racial/ethnic groups

1.07(0.95-1.28)

=0.56

Essential worker

0.66 (0.53-0.80)

<0.001

Physical condition

3.41 (3.29-3.54)

<0.001

Mental condition

12.99 (12.87-13.10)

<0.001

Abuse

13.16(12.95-13.37)

<0.001

Low Social Support

12.72 (12.58-12.86)

<0.001

Study Author Conclusions

People with psychosocial and health-related risk factors, as well as those with low SEP, were at the most risk of experiencing moderate or severe depressive symptoms during the COVID-19 pandemic.

InpharmD Researcher Critique

This study has a large sample size allowing for more accurate mean values and providing a smaller margin of error. However, the sample is not randomized and thus allows for a higher margin of bias and cannot accurately be applied as a national representation.

Furthermore, the data used is based off of self-reported measures; thus self-report bias could be present. 

Lastly, this study is strictly observational; thus, causality between risk factor and depressive symptom cannot be concluded.

 

References:

Iob E, Frank P, Steptoe A, Fancourt D. Levels of Severity of Depressive Symptoms Among At-Risk Groups in the UK During the COVID-19 Pandemic. JAMA Netw Open. 2020;3(10):e2026064. doi:10.1001/jamanetworkopen.2020.26064