Changes in the Prevalence of Symptoms of Depression, Loneliness, and Insomnia in U.S. Older Adults With Type 2 Diabetes During the COVID-19 Pandemic: The Look AHEAD Study

Abstract

OBJECTIVE To evaluate changes in the prevalence of depressive symptoms, loneliness, and insomnia among older adults with type 2 diabetes from 2016 to 2020 and to assess risk factors for these conditions including demographics, multimorbidity, BMI, treatment group, and pre-coronavirus 2019 (COVID-19) measure scores. RESEARCH DESIGN AND METHODS This was a prospective, observational study of participants from the Look AHEAD (Action for Health in Diabetes) cohort study. Data were from two assessments before COVID-19 (visit 1: April 2016–June 2018 and visit 2: February 2018–February 2020) and one assessment during COVID-19 (visit 3: July–December 2020). Surveys were administered to assess depressive symptoms, loneliness, and insomnia. RESULTS The study included 2829 adults (63.2% female, 60.6% White, mean [SD] age 75.6 [6.0] years). The prevalence of mild or greater depressive symptoms did not change significantly between the two prepandemic visits (P = 0.88) but increased significantly from pre- to during COVID-19 (19.3% at V2 to 30.4% at V3; P < 0.001). Higher odds of mild or greater depressive symptoms at V3 were associated with being female (adjusted odds ratio [OR] 1.4 [95% CI 1.1–1.7]), identifying as non-Hispanic White (OR 1.4 [95% CI 1.1–1.7]), having obesity (OR 1.3 [95% CI 1.0–1.5]), and reporting mild or greater depressive symptoms at V1 (OR 4.0 [95% CI 2.9–5.4]), V2 (OR 4.4 [95% CI 3.2–5.9]), or both visits (OR 13.4 [95% CI 9.7–18.4]). The prevalence of loneliness increased from 12.3% at V1 to 22.1% at V3 (P < 0.001), while the prevalence of insomnia remained stable across visits at 31.5–33.3%. CONCLUSIONS The prevalence of mild or greater depressive symptoms in older adults with diabetes was more than 1.6 times higher during COVID-19 than before the pandemic.

Impact of COVID‐19 on life experiences reported by a diverse cohort of older adults with diabetes and obesity

“…Women also had more emotional impacts from the pandemic than men. This is consistent with our previous findings from this cohort that, during the pandemic, women reported higher levels of depressive symptoms, loneliness, and anxiety than men ( 16 ). Differences between men and women in the impact of the pandemic on emotional health and well‐being may be related to gender variations in the way emotions are identified and expressed, genetic or physiological factors, and family caregiving and household responsibilities.…”

“…These observations are consistent with those of the sample of 909 college students in which women, irrespective of race or ethnicity, reported higher disruptions related to COVID‐19 than men and were also more likely to report positive changes than men ( 20 ). In our previous work in the Look AHEAD cohort, we reported that women, relative to men, felt a greater sense of threat from the pandemic ( 16 ). Others have reported that women were more concerned about the pandemic and, therefore, reported more compliance with public health and social distancing measures ( 23 ).…”

“…A group of Look AHEAD investigators further adapted the 94‐item EPII‐G questionnaire by selecting a total of 47 items for inclusion and adding 4 questions, resulting in a total of 51 items (Supporting Information Table S1 ). This adaptation allowed us to reduce participant burden and to minimize redundancy with other questionnaires in the packet ( 16 ). Questions were added to capture the impact of the pandemic on diabetes, a condition common to all Look AHEAD participants.…”

Factors Associated with Depression among Type 2 Diabetes Mellitus Patients at a Tertiary Hospital during the COVID-19 Pandemic

“…Record of diabetic foot ulcer (DFU) obtained from physical examination and medical records looking for unresolved foot ulcer or records of amputation related to diabetic foot and then classified into two groups: patient with a record of DFU and without a record of DFU. Total scores from the individual BDI-II questionnaire were classified into four groups: minimal (0-13), mild (14)(15)(16)(17)(18)(19), moderate (20)(21)(22)(23)(24)(25)(26)(27)(28), and severe (29-63). 12,13 Categorical data describing participants' characteris-…”

Diabetes Distress and Depression during COVID-19: Response to Breznoscakova et al. Uncovering the Untold Emotional Toll of Living with Diabetes in the COVID-19 Era

“…People with preexisting diseases, such as diabetes and its complications, are at particular risk of a severe course of COVID-19, posing additional burdens on PWD specifically. We suppose that mental health risks may have risen in this group particularly, and findings of substantially increased depression and anxiety symptoms and sleep problems during the pandemic seem to support this [ 7 ].…”