Elevated symptoms of depression and anxiety among family members and friends of critically ill COVID-19 patients - an observational study of five cohorts across four countries

Anikó Lovik; Juan González-Hijón; Asle Hoffart; Chloe Fawns-Ritchie; Ingibjörg Magnúsdóttir; Li Lu; Anna Bára Unnarsdóttir; Anna K Kähler; Archie Campbell; Arna Hauksdóttir; Charilaos Chourpiliadis; Daniel L McCartney; Edda Björk Thordardóttir; Emily E Joyce; Emma M Frans; Jóhanna Jakobsdóttir; Lill Trogstad; Ole A Andreassen; Per Magnus; Sverre Urnes Johnson; Patrick F Sullivan; Thor Aspelund; David J Porteous; Helga Ask; Omid V Ebrahimi; Unnur Anna Valdimarsdóttir; Fang Fang

doi:10.1016/j.lanepe.2023.100733

Elevated symptoms of depression and anxiety among family members and friends of critically ill COVID-19 patients - an observational study of five cohorts across four countries

Lancet Reg Health Eur. 2023 Sep 4:33:100733. doi: 10.1016/j.lanepe.2023.100733. eCollection 2023 Oct.

Authors

Anikó Lovik^{1

2}, Juan González-Hijón¹, Asle Hoffart^{3

4}, Chloe Fawns-Ritchie^{5

6}, Ingibjörg Magnúsdóttir⁷, Li Lu^{8

9

10}, Anna Bára Unnarsdóttir⁷, Anna K Kähler¹¹, Archie Campbell⁵, Arna Hauksdóttir⁷, Charilaos Chourpiliadis¹, Daniel L McCartney⁵, Edda Björk Thordardóttir^{7

12}, Emily E Joyce¹, Emma M Frans¹¹, Jóhanna Jakobsdóttir⁷, Lill Trogstad¹³, Ole A Andreassen^{9

14}, Per Magnus¹⁵, Sverre Urnes Johnson^{3

4}, Patrick F Sullivan^{11

16}, Thor Aspelund^{7

17}, David J Porteous⁵, Helga Ask^{3

10}, Omid V Ebrahimi^{3

4}, Unnur Anna Valdimarsdóttir^{1

7

18}, Fang Fang¹

Affiliations

¹ Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
² Methodology and Statistics Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands.
³ Department of Psychology, University of Oslo, Oslo, Norway.
⁴ Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway.
⁵ Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland.
⁶ Division of Psychology, University of Dundee, Dundee, Scotland.
⁷ Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
⁸ Health Management and Policy Institute, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
⁹ NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
¹⁰ Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.
¹¹ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
¹² Mental Health Services, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland.
¹³ Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway.
¹⁴ NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
¹⁵ Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
¹⁶ Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill, NC, USA.
¹⁷ The Icelandic Heart Association, Kopavogur, Iceland.
¹⁸ Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.

Abstract

Background: Little is known regarding the mental health impact of having a significant person (family member and/or close friend) with COVID-19 of different severity.

Methods: The study included five prospective cohorts from four countries (Iceland, Norway, Sweden, and the UK) with self-reported data on COVID-19 and symptoms of depression and anxiety during March 2020-March 2022. We calculated prevalence ratios (PR) of depression and anxiety in relation to having a significant person with COVID-19 and performed a longitudinal analysis in the Swedish cohort to describe temporal patterns.

Findings: 162,237 and 168,783 individuals were included in the analysis of depression and anxiety, respectively, of whom 24,718 and 27,003 reported a significant person with COVID-19. Overall, the PR was 1.07 (95% CI: 1.05-1.10) for depression and 1.08 (95% CI: 1.03-1.13) for anxiety in relation to having a significant person with COVID-19. The respective PRs for depression and anxiety were 1.15 (95% CI: 1.08-1.23) and 1.24 (95% CI: 1.14-1.34) if the patient was hospitalized, 1.42 (95% CI: 1.27-1.57) and 1.45 (95% CI: 1.31-1.60) if the patient was ICU-admitted, and 1.34 (95% CI: 1.22-1.46) and 1.36 (95% CI: 1.22-1.51) if the patient died. Individuals with a significant person with hospitalized, ICU-admitted, or fatal COVID-19 showed elevated prevalence of depression and anxiety during the entire year after the COVID-19 diagnosis.

Interpretation: Family members and close friends of critically ill COVID-19 patients show persistently elevated prevalence of depressive and anxiety symptoms.

Funding: This study was primarily supported by NordForsk (COVIDMENT, 105668) and Horizon 2020 (CoMorMent, 847776).

Keywords: Anxiety; COVID-19; Cross-country study; Depression; Significant person.