Pre-existing depressive disorder and food insecurity were linked to increased levels of depression and anxiety during the COVID-19 pandemic among Hispanic psychiatric outpatients of the East Harlem Health Outreach Partnership (EHHOP), a free medical clinic in New York City that provides care for patients who lack residency documentation or are otherwise ineligible for health insurance. This research was published in Psychiatry Research.
The researchers administered staggered surveys in April and May 2020 to a group of 45 patients who transitioned from in-person to telephone psychiatry between February and March 2020.
They used the Kessler Psychological Distress Scale (K10+), Patient Health Questionnaire (PHQ-2) and Generalized Anxiety Disorder (GAD-2) inventory, and a modified migrant-focused telepsychiatry feedback survey, along with a COVID-19-specific survey and a survey on access to necessities during the pandemic. Scores on the PHQ-2 and GAD-2 needed to be at least 3 to be considered positive.
PHQ-2 scores (available for 28 participants) increased by an average of 0.81 points per patient from March to April (95% CI, 0.057-1.05, t=7.01, df=27; P <.0001). GAD-2 scores (30 participants) increased by an average of 0.63 points per patient from March to April (95% CI, 0.40-0.85, df=29, t=5.79; P <.0001).
Patients with positive scores on the PHQ-2 increased from 2 to 8 from March to April (McNemar with continuity correction, χ2 =8.5, P =.004), which also occurred with GAD-2 scores (8 patients in March to 10 patients in April (χ2 =3.78, P =.05).
To assess causality, the researchers conducted COVID-19-specific and telepsychiatry feedback surveys. The COVID-19 mental health survey (35 participants) identified pandemic-related changes in anxiety and depression levels, acquaintance with individuals who tested positive for COVID-19, belief that an acquaintance is infected without having had viral testing, fear of contracting COVID-19, and perceived access to health care resources in case of infection.
Pandemic-related changes in anxiety and depression were linked , as participants who reported a much higher level of anxiety due to COVID-19 were more likely to report that their level of depression was much higher (χ2 =94.40, P =.0005). Not knowing someone who was infected with coronavirus was associated with reporting about the same level of depression (χ2 =67.66, P =.0005).
Thirty of 32 participants agreed or strongly agreed that telephone psychiatry helped them manage their health. Safety levels and the extent to which participants felt they could express themselves compared with on-site visits were significantly related (χ2 =49.9, P =.001).
Using multivariable linear regression analysis, the researchers found that a combination of a pre-existing depressive disorder, food insecurity, and level of expression during telepsychiatry visits together explained 40.11% of the variance in total psychological distress scores (F(6,19)=3.79, adjusted R2 =0.4011, P =.012).
Examining the regression coefficients, the study authors found that a diagnosis of a depressive disorder (P =.017) and food insecurity (P =.020) increased predicted psychological distress, while a patient report of expressing the same amount in their telepsychiatry sessions as they do in on-site sessions decreased predicted psychological distress (P =.023).
Limitations of the study included staggering data acquisition from participants.
Serafini RA, Powell SK, Frere JJ, et al. Psychological distress in the face of a pandemic: An observational study characterizing the impact of COVID-19 on immigrant outpatient mental health. Psychiatry Res. 2021;295:113595. doi:10.1016/j.psychres.2020.113595