Mental health and COVID-19 in a general population cohort in Spain (COVICAT study)

Abstract

Purpose Mental health conditions may affect outcome of COVID-19 disease, while exposure to stressors during the pandemic may impact mental health. The purpose of this study was to examine these factors in relation to ocurrence of depression and anxiety after the first outbreak in Spain. Methods We contacted 9515 participants from a population-based cohort study in Catalonia between May and October 2020. We drew blood samples to establish infection to the virus. Pre-pandemic mental health conditions were confirmed through Electronic Health Registries. We used the Hospital Anxiety and Depression Scale to assess severe depression and anxiety post-pandemic. Exposure to proximal, financial and wider environment stressors during the lockdown were collected. We calculated Relative Risks (RR), adjusting for individual- and contextual covariates. Results Pre-pandemic mental health disorders were not associated with SARS-CoV-2 infection , but were associated with severity of COVID-19 disease. People with pre-existing mental health disorders showed higher prevalence of severe depression (25.4%) and anxiety (37.8%) than those without prior mental disorders (4.9% and 10.1%). Living alone was a strong predictor of severe depression among mental health patients (RR = 1.6, 95% CI 1.2–2.2). Among those without prior mental health disorders, post-lockdown depression and anxiety were associated with household interpersonal conflicts (RR = 2.6, 95% CI 2.1–3.1; RR = 2.1, 95% CI 1.9–2.4) and financial instability (RR = 2.2, 95% CI 1.8–2.9; 1.9, 95% CI 1.6–2.2). Conclusions The COVID-19 pandemic and the lockdown were associated with increased post-lockdown depression and anxiety. Patients with pre-existing mental health conditions are a vulnerable group for severe COVID-19 disease.

Changes in Population Health-Related Behaviors During a COVID-19 Surge: A Natural Experiment

“…In this case, it might be possible that the increasing number of tasks assumed at home gave individuals fewer opportunities to be healthier (e.g., less time to practice exercise, less time to cook balanced meals, more stressors triggering tobacco, and alcohol consumption) or that changes in household dynamics given by the extra time spent at home could motivate individuals to assume healthier behaviors (e.g., cooking home meals, practicing physical activity at home with children, reducing smoking and alcohol, and sleeping longer). Finally, being frequently exposed to media news about the pandemic was associated with a higher likelihood of belonging to the "global worsening," "worsening physical activity and weight" and "improvement" patterns, with the idea that elevated exposure to a highly disruptive event such as a pandemic, may become an additional cause of anxiety and stress symptoms [35,48] and may trigger extreme changes in human behavior. Interestingly, and contrary to expected, we did not find a relation between access to outdoor home spaces and changes in health-related behaviors.…”

“…COVID-19 cohort in Catalonia (COVICAT) is a populationbased study aimed at describing the health impact of the COVID-19 pandemic on the adult population of Catalonia, Spain [33][34][35]. COVICAT was built on five pre-existing cohort studies established before the outbreak [33,34].…”

“…Participants were asked to complete a questionnaire and provide blood samples between May and December 2020. Further details on the recruitment for our cohort study have been published elsewhere [34,35]. Briefly, participants (50% of the eligible sample) were younger (mean (SD) 55 (8) vs. 57 (9), p < .01) and had higher education level (45% vs. 29% university studies, p < .01) and lower BMI (27 (5) vs. 28 (5), p < .01) than non-participants [34].…”

Impact of the COVID-19 pandemic on the mental health of the general population and health care workers

“…The first studies published, based on data from previous pandemics, warned about the potential impact of confinement on the increase of symptoms such as irritability, low mood, insomnia or post-traumatic symptoms, highlighting the usefulness of strategies such as altruism to counteract them [12]. Subsequent studies, with data collected during the COVID-19 pandemic, have confirmed the effect of confinement on mental health, with increased der in those with no previous history [19]. These data contrast with primary care data, which document an initial increase in anxiety diagnoses, with a subsequent decrease, and a lower than expected rate of depression diagnoses throughout the pandemic [20].…”

Major depressive disorders and the risk of susceptibility to COVID-19 infection and hospitalization: findings from the Employees’ Health Cohort Study of Iran (EHCSIR)

“…Mental disorders may increase the risk of infection and severity of COVID-19 because of unhealthy lifestyle, low socioeconomic status, lack of awareness, and functional impairment [4,6,[9][10][11]. Major Depressive Disorder (MDD) is reported as the most common mental disorder in the world [12].…”