Study data published in the Journal of Psychiatric Research suggest that the psychiatric effects of the COVID-19 pandemic were more strongly pronounced in individuals with lower economic and personal capital. In a large population-based cohort study, COVID-19-related anxiety and depression were more prevalent in patients with low income, patients with chronic health conditions, and patients with obesity.
This analysis was embedded in the Lifelines cohort, an ongoing prospective study designed to assess the health and health-related behaviors of residents in the Netherlands. Patients with established health records in the Lifelines cohort were invited to complete a series of questionnaires administered weekly or biweekly from March 30, 2020 through August 5, 2020, comprising the first several months of the COVID-19 pandemic.
The questionnaires captured anxiety and depression symptoms using the Mini-International Neuropsychiatric Interview. Participants also provided data on their educational attainment, occupation, income, and current health, including the presence of chronic conditions and obesity. Mental health symptom trajectories were estimated using a 2-part latent class growth analysis; class membership was predicted using economic and personal capital.
The study cohort comprised 65,854 individuals aged mean 50.4±12.0 years at baseline. The majority of respondents were women (60.2%); 39.8% were men; and 22.8% reported being in poor health at baseline. Most participants did not report symptoms of depression (80.6%) or anxiety (75.9%). However, a “stable-high” class was observed for both conditions, with 1.6% and 6.7% of participants reporting an increase in depression and anxiety symptoms, respectively, during the study period.
In multinomial class membership prediction models, less person capital was generally associated with an increase in the risk for depression and anxiety. Specifically, obesity, poor health condition, and self-reported neuroticism were associated with increased likelihood of belonging to the stable-high classes of anxiety and depression. Similarly, low-income respondents were more likely to experience increased anxiety and depression than their counterparts with high income. However, associations were mixed with respect to educational attainment and employment status.
Results from this latent class trajectory analysis identify correlates of COVID-19-related anxiety and depression in a large, population-based cohort. Patients with obesity, poorer health, and lower income were more likely to experience an increase in anxiety and depression during the pandemic. As study limitations, investigators noted the cohort homogeneity as results may not be generalizable to populations outside the Netherlands.
“During the initial stages of the COVID-19 pandemic, a minority of individuals reported an increase in symptoms of depression or anxiety,” authors wrote. “In particular, those individuals with less capital, and especially person capital, experienced more symptoms of depression and anxiety during the follow-up period, which may stress the importance of devoting more resources to prevent further deterioration of mental health for this high-risk group of individuals.”
Qi Y, Lepe A, Almansa J, Ots P, de Kroon MLA. Increases in symptoms of depression and anxiety in adults during the initial phases of the COVID-19 pandemic are limited to those with less resources: results from the Lifelines Cohort Study. J Psychiatr Res. Volume 154, 2022, Pages 151-158. doi:10.1016/j.jpsychires.2022.07.011