During the 2019 novel coronavirus disease (COVID-19) outbreak in northern Spain, people with chronic disease experienced greater anxiety and depression than those without chronic disease, according to findings published in The American Journal of Geriatric Psychiatry. However, levels of anxiety, depression, and stress symptoms were relatively low across the sample.

COVID-19 has disproportionately affected vulnerable populations, including older adults and people with chronic illness. Mental health concerns are also more common in people with chronic illness, and isolation may pose serious problems for older adults.

Maitane P. Gorrochategi, PhD, of the University of Basque Country, Leioa, Spain, and colleagues conducted an exploratory descriptive study with an elderly population over age 60 years (N=290; 62.1% women). Overall, 32.8% had a chronic illness, and 63.4% of the sample were aged ≥66 years. The researchers used the Depression Anxiety and Stress Scale-21 (DASS-21) to assess stress, anxiety and depression on a 5-point scale.

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The majority of older adults in the sample did not report any depression, anxiety, or stress symptoms, and almost no respondents indicated severe or extremely severe symptoms. Older adults with chronic disease experienced greater depression (U, 8271.50; P =.029; r, .08) and anxiety (U, 7770.00; P =.001; r, .13) symptoms than those without chronic illness.

Individuals aged 60 to 65 years with chronic disease had higher levels of depression (U, 31.54; P =.034) and anxiety (U, 4.115; P <.001) than those without chronic disease. However, individuals aged 66 years and older without chronic illness had higher levels of anxiety than those aged 60 to 65 years with chronic illness (U, 39.415; P <.001). Furthermore, the sample aged 66 years and over with chronic illness experienced more anxiety than people in the younger group (age 60-65 years) who also had chronic illness (U, 28.633; P =.03). Men with chronic disease were also found to experience more anxiety than women with chronic disease (U, 29.28; P <.001).

The study was limited by the lack of data on specific chronic diseases and reliance on self-report measures for the analyses.

The researchers concluded, “it is vitally important to safeguard the mental health of older people, particularly those who suffer from chronic diseases. In particular, there is a need to provide these vulnerable members of the population with psychosocial interventions.”


Gorrochategi  MP, Munitis AE, Santamaria MD, Etxebarria NO. Stress, anxiety, and depression in people aged over 60 in the COVID-19 outbreak in a sample collected in Northern Spain. The American Journal of Geriatric Psychiatry 2020