Longitudinal dynamics of depression in risk groups of older individuals during the COVID-19 pandemic

Theresa Dankowski; Lydia Kastner; Ulrike Suenkel; Anna-Katharina von Thaler; Christian Mychajliw; Michael Krawczak; Walter Maetzler; Daniela Berg; Kathrin Brockmann; Ansgar Thiel; Gerhard W Eschweiler; Sebastian Heinzel

doi:10.3389/fepid.2023.1093780

Longitudinal dynamics of depression in risk groups of older individuals during the COVID-19 pandemic

Front Epidemiol. 2023 Feb 13:3:1093780. doi: 10.3389/fepid.2023.1093780. eCollection 2023.

Authors

Theresa Dankowski^{1

2}, Lydia Kastner^{3

4

5}, Ulrike Suenkel⁴, Anna-Katharina von Thaler^{1

6}, Christian Mychajliw⁴, Michael Krawczak², Walter Maetzler¹, Daniela Berg¹, Kathrin Brockmann^{6

7}, Ansgar Thiel³, Gerhard W Eschweiler^{4

8}, Sebastian Heinzel^{1

2}

Affiliations

¹ Department of Neurology, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany.
² Institute of Medical Informatics and Statistics, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany.
³ Institute of Sport Science, Eberhard Karls University of Tübingen, Tübingen, Germany.
⁴ Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany.
⁵ Lead Graduate School and Research Network, University of Tübingen, Tübingen, Germany.
⁶ Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
⁷ German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany.
⁸ Geriatric Center, Tübingen University Hospital, Tübingen, Germany.

Abstract

Background: Older individuals are most at risk of severe COVID-19 and particularly require protection causing (self)restriction of psychosocial interaction in daily living. So far, the impact of psychosocial withdrawal on mental health seems less pronounced in community-dwelling older individuals compared to younger individuals. However, dynamics and adverse long-term effects of the pandemic, such as increases in depression, are still mostly unclear, especially for vulnerable subgroups.

Methods: Pre-pandemic and 3-, 8-, 14-, 20-month peri-pandemic data were analyzed in 877 older participants (age at 3-month peri-pandemic: mean ± SD: 72.3 ± 6.3, range: 58-91 years) of the observational prospective TREND study in Germany. Severity of depression (Beck's Depression Inventory-II scores) and key factors of (mental) health were investigated for cross-sectional associations using path modeling. Risk groups defined by resilience, loneliness, history of depression, stress, health status and fear of COVID-19 were investigated for differences in depression between timepoints.

Findings: The early pandemic (3-month) severity of depression was most strongly associated with history of depression, stress and resilience. Overall increases in clinically relevant depression (mild-severe) from pre- to 3-month peri-pandemic were small (% with depression at pre-/3-month peri-pandemic: 8.3%/11.5%). Changes were most pronounced in risk groups with low resilience (27.2%/41.8%), loneliness (19.0%/28.9%), fear of COVID-19 (17.6%/31.4%), high stress (24.4%/34.2%), a history of depression (27.7%/36.9%), and low health status (21.8%/31.4%). Changes in depression were largely observed from pre- to 3-month and were sustained to the 20-month peri-pandemic timepoint, overall and in stratified risk groups defined by single and cumulative risk factors. Changes between timepoints were heterogenous as indicated by alluvial diagrams.

Conclusion: Only specific risk groups of older individuals showed a large increase in depression during the COVID-19 pandemic. Since these increases occurred early in the pandemic and were sustained over 20 months, these vulnerable risk groups need to be prioritized for counselling and risk mitigation of depression.

Keywords: COVID-19; corona; depression; older population; pandemic; psychosocial factors; resilience; stress.

Grants and funding

The TREND study is being conducted at the University Hospital Tübingen and has been supported by the Hertie Institute for Clinical Brain Research, the DZNE, the Geriatric Center of Tübingen, the Center for Integrative Neuroscience, Teva Pharmaceutical Industries, Union Chimique Belge, Janssen Pharmaceuticals, the International Parkinson Foundation and the German Research Society. Specifically, the CORO-TREND project of the TREND study was funded by the German Research Society (DFG, grant number: AOBJ: 675915).