Depression common among older adults with COPD during COVID-19 pandemic

Key takeaways:

• A high proportion of older adults with COPD experienced depressive symptoms during autumn 2020.
• Patients with loneliness, functional limitations and family conflict had an increased likelihood for depression.

More than 50% of older adults with COPD and a history of depression screened positive for depression in autumn 2020 of the COVID-19 pandemic, according to results published in International Journal of Chronic Obstructive Pulmonary Disease.

Further, 17% of patients without a history of depression also had a positive screening result for depression during this time, according to researchers.

Esme Fuller-Thomson

“We are hoping that these findings will encourage physicians and other health professionals treating those with COPD to screen for depression,” Esme Fuller-Thomson, PhD, director of the Institute for Life Course and Aging at the University of Toronto and professor in the Factor-Inwentash Faculty of Social Work, told Healio. “If their patients have depression, we hope that they refer them to effective interventions. For example, there is strong evidence that a form of talk therapy called cognitive behavioral therapy, or CBT, is very helpful for older adults with depression.”

Using data from the Canadian Longitudinal Study on Aging, Fuller-Thomson and colleagues assessed 875 older adults (mean age, 71 years; 56.2% women) with COPD to determine the prevalence of depression during the COVID-19 pandemic (autumn 2020) and what factors heightened the risk for depression at this time through bivariate and multivariate logistic regression analyses.

Depression incidence

Within the cohort of adults with no history of depression prior to the pandemic (n = 506; mean age, 72.17 years; 48.8% women), researchers found that approximately 1 in 6 (17%) screened positive for depression according to the Center for Epidemiologic Studies Short Scale of Depression (CES-D-10) in the beginning of the pandemic.

Notably, depression in the early days of COVID-19 was more prevalent among adults with a history of this disorder (n = 369; mean age, 69.7 years; 66.4% women). A little more than half (52%) of this cohort screened positive for depression during this time, according to researchers.

Researchers also considered CES-D-10 scores taken before the pandemic at two time points — between 2011 and 2015 and between 2015 and 2018. A greater proportion of individuals with scores indicative of depression at both time points were again depressed during the pandemic in 2020 (78.7%) than those with symptoms only between 2015 and 2018 (58.3%) and those with symptoms only between 2011 and 2015 (44.6%).

Risk factors

Several factors raised the odds for incident depression during autumn 2020, with loneliness posing the greatest risk (OR = 3.38; 95% CI, 1.7-6.72). Additional factors linked to elevated odds for first-time depression included family conflict (OR = 2.68; 95% CI, 1.17-6.14), a household income between $50,000 to $99,999 vs. income below $50,000 (OR = 2.44; 95% CI, 1.1-5.41), functional limitations (OR = 2.24; 95% CI, 1.22-4.1) and struggling to access health care resources (OR = 2.14; 95% CI, 1.17-3.89).

“We had expected that those with COPD who had functional limitations such as trouble walking or climbing stairs would be slightly more likely to develop depression,” Fuller-Thomson told Healio. “What surprised us was how much more vulnerable they were. Older adults with COPD and functional limitations had double the likelihood of developing depression during the pandemic compared to their peers with COPD who could walk and climb stairs without problems.”

When evaluating factors that heightened the risk for recurrent depression, researchers again observed increased odds linked to loneliness (OR = 3.26; 95% CI, 1.83-5.83), family conflict (OR = 2.52; 95% CI, 1.23-5.19) and functional limitations (OR = 1.93; 95% CI, 1.12-3.33).

Additional risk factors included attainment of post-secondary education vs. less than this level (OR = 3; 95% CI, 1.12-8.05), female sex (OR = 1.88; 95% CI, 1.06-3.34), and having more adverse experiences during childhood, such as physical abuse, sexual abuse, exposure to intimate partner violence or neglect (OR = 1.44; 95% CI, 1.03-2.02).

“Older adults with COPD were at greater risk of developing serious outcomes from COVID-19,” Fuller-Thomson told Healio. “Regular access to health care providers was severely disrupted.

“[For future research,] we are interested in exploring how those with other chronic conditions fared during the pandemic,” Fuller-Thomson added.

Reference:

• Canadian older adults with COPD faced high levels of depression during the COVID pandemic. https://www.eurekalert.org/news-releases/1002027. Published Sept. 20, 2023. Accessed Sept. 20, 2023.

For more information:

Esme Fuller-Thomson, PhD, can be reached at esme.fuller.thomson@utoronto.ca.