How scientists track rising rates of depression

Isolation and fear of infection are two contributing factors to increased anxiety and depression amid the pandemic.Credit: RenataAphotography/Getty

As the COVID-19 pandemic enters its second year, rapidly spreading new variables are causing an increase in the number of infections in many countries, and renewed lockdowns. The devastation wrought by the pandemic – millions of deaths, economic conflicts, and unprecedented restrictions on social interaction – has had a noticeable impact on people’s mental health. Researchers around the world are looking into the causes and effects of this stress, and some fear the decline in mental health may persist long after the pandemic has subsided. Ultimately, the scientists hope they can use the mounds of data collected in studies on mental health to correlate the effect of control measures to changes in people’s well-being, and to inform the management of future epidemics.

The data that emerges from these studies will be huge, says sociologist James Nazru at the University of Manchester, UK. “This is really ambitious science,” he says.

More than 42% of people surveyed by the US Census Bureau in December reported symptoms of anxiety or depression in December, an increase of 11% from the previous year. Data from other surveys suggest that the picture is similar worldwide (see ‘COVID mental stress’). “I don’t think this will return to baseline anytime soon,” says clinical psychologist Luana Marques, at Harvard Medical School in Boston, Massachusetts, who monitors the mental health effects of the crisis on residents in the United States and elsewhere.

The mental stress of COVID.  Data show that the percentage of people with depressive symptoms has risen in the pandemic.

Source: Office for National Statistics (UK data); Centers for Disease Control and Prevention (US data).

Major events that have shaken communities, Marques says, such as the September 11 terrorist attack in New York, have left some people with psychological distress for years. study1 Of the more than 36,000 New Yorkers and rescue workers who revealed that more than 14 years after the attack, 14% still had PTSD and 15% had depression—much higher rates than in comparable populations (5% and 8%, respectively). ).

Fear and isolation

The distress in the pandemic probably stems from people’s limited social interactions, tensions between families closed together and fear of disease, says psychiatrist Marcella Reichl of the Central Institute of Mental Health in Mannheim, Germany.

Studies and surveys conducted thus far in this epidemic consistently show that young people, rather than the elderly, are most vulnerable to increased psychological distress, possibly because their need for social interactions is stronger. The data also suggests that young women are more likely to be affected than young men, and that people who have young children, or who have previously been diagnosed with a psychiatric disorder, are at particular risk of developing mental health problems. Victor Ugo, campaign officer who specializes in mental health policy at United for Global Mental Health, a mental health advocacy group in London.

Scientists conducting large, detailed international studies say they may eventually be able to show how certain measures to control COVID — such as lockdowns or restrictions on social interaction — reduce or exacerbate mental health stresses, and whether certain populations, such as ethnic minorities, disproportionately affected by certain policies. The researchers say this could help guide the response in this pandemic and the future.

“We have a real opportunity, natural experiment, in how policies in different countries affect people’s mental health,” says epidemiologist Kathleen Merikangas at the US National Institutes of Mental Health in Bethesda, Maryland.

mental health monitoring

Addressing the psychological impact of the COVID pandemic in a developing country like India has been particularly challenging, says Mithili Hazarika, a clinical psychologist at Guwahati Medical College in Assam, India. She says public resources are scarce and awareness of mental health problems is low.

When the COVID crisis broke out, Hazarika launched a telephone counseling service with six emergency helplines provided to her by the Assam Police. In a preliminary study of 239 callers last April, she and her colleagues found that 46% had anxiety, 22% had some form of depression, and 5% had suicidal thoughts. That was enough to persuade the government to act, and after months of wrangling with officials, Hazarika and her colleagues launched a statewide telehealth service named Monon in June.

They have developed guidelines for remote counseling during a disaster and trained 400 volunteer counsellors. Anyone who tested positive for COVID-19 in Assam has received a call from the service. Hazarika says this proactive approach is critical, because stigma and a lack of awareness mean few people would consider calling a helpline. “In rural areas, mental illness means you have to go to a shelter and no one can cure you,” she says.

The easing of restrictions means the possibility of in-person counseling again. But by December, the service had contacted more than 43,000 people and had collected preliminary data on the mental health of nearly half. They found that 9% had symptoms of anxiety, 4% had some form of depression, and more than 12% of people experienced stress related to COVID-19.

Ed Gent

International Comparisons

To bring the studies together, Daisy Fancourt, a psychoneuroimmunologist at University College London, launched the Wellcome-funded CovidMinds programme, which has brought together about 140 longitudinal studies in more than 70 countries. These recruit large numbers of participants and collect health information at regular intervals. CovidMinds connects scientists in different countries and encourages the use of standardized questionnaires so that results can be compared directly in international collaborations. “This may allow us to compare the psychological response alongside the political response across countries,” she says.

This set of studies is a combination of current population cohorts and studies established early in the pandemic. Existing cohorts are useful because their compositions tend to reflect those of the general population, so their results can be generalized. And because long-term population groups will have data on participants from before the epidemic, they can accurately pinpoint changes in mental health, says epidemiologist Klaus Berger of the University of Münster in Germany, who heads the German national cohort, one of the largest in the world. health cohorts.

But large, well-established cohorts move relatively slowly and are usually sampled infrequently. Newer collections lack a baseline of data collected before the pandemic, but many can follow the dynamics of the crisis in a smarter way.

Fancourt is leading one of the largest of the new studies, the Sociological Study on COVID-19 in the UK. The study – mostly through social media – recruited more than 72,000 British adults in the first few weeks of the country’s first lockdown, in March. Participants fill out a weekly 10-minute online questionnaire, which includes questions outlining feelings of anxiety or depression.

real time information

“With survey responses coming in at a rate of one every 20 seconds, we get information about how people are psychologically and socially responding to the pandemic in real time, and we see specifically how they have changed in response to things like upcoming new government measures, or the easing of lockdown measures,” Vancourt says. For example, she says, the high levels of anxiety and depression that the study found decreased in its early weeks during the lockdown, rather than increasing as some had expected.

“Together these types of studies will tell us how government policies are being tried across different segments of societies and will help us understand how to manage this epidemic and future epidemics,” says Nazro, who is involved in the EU-wide survey. COVID and mental health.

Another study, called the COVID-19 Health Care Workers Study, aims to determine how health workers, who have faced unprecedented levels of illness and death, are coping. The study collects data in 21 countries, including low-income countries in Latin America and Africa where mental health resources are limited (see ‘Mental Health Monitoring’). “We want to compare countries to see what’s happening differently,” says Olatunde Ayinde, who is researching the Nigerian arm of the study. He believes that geographical differences likely stem from differences in the quality of mental health services, the availability and types of social care offered and poverty levels. Many countries in Africa have only a small percentage of mental health practitioners compared to high-income countries. “We want to know what is responsible for the differences,” Allende says.

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