September 26, 2023

Depression increased among COPD patients in Canada during pandemic

1 in 6 patients without a history of depression developed it after COVID-19

Increases in new onset or recurring depression were seen among older Canadian adults with chronic obstructive pulmonary disease (COPD) during the early stages of the COVID-19 pandemic, a study shows.

One in six patients without a history of depression before the pandemic developed it early on. For those with a history of depression, about half had a recurrence.

“The COVID-19 pandemic further exacerbated the risk of depression among those with COPD,” Ishnaa Gulati, one of the study’s authors at the University of Toronto’s Dalla Lana School of Public Health, said in a press release. “There was already an established higher risk of depression among individuals with COPD when compared to those without COPD prior to the pandemic. When considering the mental health stressors during the pandemic, such as extended periods of lockdown, economic precarity, and concerns about contracting or spreading COVID-19, it is unsurprising that this group experienced major mental health challenges during this period.”

Aneisha Taunque, the study’s first author and a research assistant at the Institute for Life Course and Aging at the University of Toronto, said “it is evident that the pandemic has had a detrimental impact on the mental health of many individuals,” including people “who were mentally healthy” before the pandemic.

The study, “Breathless and Blue in the Canadian Longitudinal Study on Aging: Incident and Recurrent Depression Among Older Adults with COPD During the COVID-19 Pandemic,” was published in the International Journal of Chronic Obstructive Pulmonary Disease.

What contributed to higher rates of depression?

As the COVID-19 pandemic emerged around the world in early 2020, public health measures to limit its spread, such as shelter-in-place orders and social distancing, led to social isolation and reduced physical activity for many.

Along with other pandemic-related stressors like economic insecurity and caregiving responsibilities, changes in daily life led to a spike in depression among the general population.

For people with chronic diseases like COPD, the effects of a global pandemic could be particularly profound, especially given that mood disorders such as anxiety or depression are common in these populations. Declines in physical activity, lack of access to routine medical care, and a higher risk of severe consequences from COVID-19 infection may also contribute to their declining health and elevated stress levels.

In the study, Gulati, Taunque, and their colleagues in Canada examined the new onset or recurrence of depression during the pandemic among 875 people with COPD included in the Canadian Longitudinal Study on Aging, a national study on older Canadian adults, ages 45-85.

Long-term depression data were collected from these patients via a questionnaire in four waves — baseline, or study’s start (2011-2015); follow-up 1 (2015-2018); Spring 2020 (around the pandemic’s onset); and Autumn 2020. All the participants were diagnosed with COPD before the pandemic, in the baseline, or follow-up 1 assessment waves.

Overall, 506 (57.8%) didn’t have a pre-pandemic history of depression (as assessed at baseline or follow-up 1), while 369 patients (42.2%) did.

Among those without a history of depression, one in six (about 17%) were considered depressed in Autumn 2020, early in the pandemic. In contrast, the rate of new depression between the baseline and follow-up pre-pandemic periods was just 6.5%, meaning the rate more than doubled early on.

Depression grew as the pandemic wore on

Also, 44.4% of patients who had depression at the baseline measurement also had it at the pre-pandemic follow-up 1 measurement, whereas a higher proportion — 52.3% — were depressed in Autumn 2020.

“This sensitivity analysis suggests that there were higher incident and recurrent depression between the follow-up 1 wave and Autumn 2020 than between the Baseline and follow-up 1 wave,” the researchers wrote.

In both patient groups, those with frequent feelings of loneliness in the early months of the pandemic had a three times higher risk of depression than those who rarely or never felt lonely. Those with increased family conflict during the pandemic were at about a twofold higher risk of depression in the pandemic, as were those with functional limitations.

Given the importance of physical activity in maintaining functional status for COPD patients, “increases in time spent sedentary during periods of lockdown may have further ramifications for this population, potentially contributing to increases in depression,” said Ying Jiang, one of the study’s authors at the Public Health Agency of Canada.

For those without a prior history of depression, disruptions to healthcare access were also associated with about a doubled risk of new depression, underscoring “the reverberating consequences when healthcare is inaccessible,” said Andie MacNeil, another of the study’s authors at the University of Toronto.

Improving access to telemedicine — particularly for those with limited access to technology — may help combat these issues in the future, the researchers said.

Also, among those with a prior history of depression, women had nearly double the risk of recurrent depression relative to their male counterparts, a finding the researchers believe could be related to increases in gendered roles like caregiving or household labor during the lockdown.

The findings emphasize the substantial mental health impacts of the COVID-19 pandemic among those with COPD.

“Screening and interventions aimed at individuals with COPD, both with and without a history of depression, are warranted to potentially mitigate the mental health impacts of the COVID-19 pandemic,” the researchers wrote.

Esme Fuller-Thomson, Ph.D., the study’s senior author and a professor at the University of Toronto, said: “future research should continue to examine depression among older adults with COPD to better understand the pandemic’s cascading impact, even in the post-COVID era.”