Psychosocial/physical health, socioeconomics tied to depression risk during pandemic

Psychosocial and health-related risk factors, as well as socioeconomic position, were linked to risk for moderate to severe depressive symptoms during the COVID-19 pandemic, according to study results published in JAMA Network Open.

“Previous studies on other epidemics and pandemics (e.g., the severe acute respiratory syndrome epidemic in 2003 or the 2014 Ebola outbreak) suggest a plausible increase in mental health problems across the wider population, including symptoms of posttraumatic stress, confusion, anger and depression,” Eleonora Iob, MSc, of the Research Department of Behavioural Science and Health at University College London, and colleagues wrote. “However, it is unclear how mental health problems are manifesting in more at-risk groups during the current pandemic, such as in people with preexisting physical or mental health conditions, people with experiences of physical and psychological abuse and people of lower socioeconomic position.”

In the current cohort study, the investigators sought to evaluate the severity levels of depressive symptoms among individuals at high risk during the COVID-19 pandemic. They analyzed data of 51,417 adults aged 18 years or older who resided in the U.K. and were part of the COVID-19 Social Study, an ongoing large panel study,. They accounted for several sociodemographic risk factors, such as belonging to the Black, Asian and historically underrepresented racial/ethnic communities (n = 6,145), low socioeconomic position (n = 17,143) and essential worker roles (11,342). Further, pre-existing physical and mental health conditions, low social support and experience of physical or psychological abuse served as health-related and psychosocial risk factors. Iob and colleagues measured depressive symptoms seven times between March 21 and April 2 using the nine-item Patient Health Questionnaire (PHQ-9). They used latent growth mixture modeling to derive group-based depressive symptom trajectories.

The researchers found that 60% of participants had low depressive symptoms, 29% had moderate and 11% had severe. Further, they reported significant associations between severe depressive symptoms and experiences of physical or psychological abuse (OR = 13.16; 95% CI, 12.95-13.37), preexisting mental health conditions (OR = 12.99; 95% CI, 12.87-13.11), preexisting physical health conditions (OR = 3.41; 95% CI, 3.29-3.54), low social support (OR = 12.72; 95% CI, 12.57-12.86) and low socioeconomic position (OR = 5.22; 95% CI, 5.08-5.36) after adjusting for covariates. However, they observed no significant association for race/ethnicity (OR = 1.07; 95% CI, 0.85-1.28). Those classified as essential workers were at decreased risk for experiencing severe depressive symptoms (OR = 0.66; 95% CI, 0.53-0.8). Iob and colleagues found similar association patterns for the group of participants with moderate depressive symptoms. “These differential associations highlight the importance of developing strategies to identify at-risk individuals, reallocate mental health services to those in need and provide evidence-based treatments to alleviate depressive symptoms,” the researchers wrote.