Physical activity, low-grade inflammation, and psychological responses to the COVID-19 pandemic among older adults in England (preprint)

Mental health responses to the COVID-19 pandemic have been widely studied, but less is known about the potentially protective role of physical activity (PA) and the impact of low-grade inflammation. Using a sample of older adults from England, this study tested (1) if pre-pandemic PA and its changes during the pandemic were associated with mental health responses; (2) if older adults with low-grade inflammation experienced greater increases in depression and anxiety, compared to pre-pandemic levels; (3) if PA attenuated the association between inflammation and depression/anxiety. The study used data from the English Longitudinal Study of Ageing, a cohort study following a national sample aged 50+. Information on mental health and PA were collected before the pandemic (2016/17 and 2018/19) and during November and December 2020. Inflammation was ascertained using pre-pandemic C-reactive protein (CRP). Analyses were adjusted for sociodemographic and health-related factors and pre-pandemic mental health. Increasing PA from before to during the pandemic was linked to reduced odds of depression (OR = 0.955, 95%CI [0.937, 0.974]) and anxiety (OR = 0.954, 95%CI [0.927; 0.982]). Higher pre-pandemic PA was associated with reduced odds of depression (OR = 0.964, 95%CI [0.948, 0.981]) and anxiety (OR = 0.976, 95%CI [0.953, 1.000]), whereas elevated CRP was associated with 1.343 times higher odds of depression (95%CI [1.100, 1.641]). PA did not attenuate the inflammation-depression association. The findings suggest that PA may contribute to psychological resilience among older adults, independently of inflammation. Further research is needed to explore the psychobiological pathways underlying this protective mechanism.

The Immediate and Longer-Term Impact of the COVID-19 Pandemic on the Mental Health and Wellbeing of Older Adults in England (preprint)

Background: Despite the emphasis placed on the psychological impact of the COVID-19 pandemic, evidence from representative studies of older adults including pre-COVID-19 data and repeated assessments during the pandemic is scarce. We examined changes in mental health before and during the initial and later phases of the pandemic and tested whether patterns varied with sociodemographic characteristics. Methods: The sample included 5146 older adults from the English Longitudinal Study of Ageing (53% women, average age 66·74 years) who provided data before the pandemic (2018-19) and at two occasions in 2020 (June-July and November-December). We tested changes in depression, quality of life, loneliness, and anxiety before and during the pandemic using fixed-effects regression models. Findings: The prevalence of clinically significant depressive symptoms increased from 12·5% pre-pandemic to 22·6% in June-July 2020, with a further rise to 28·5% in November-December. This was accompanied by increased loneliness and deterioration in quality of life. The prevalence of anxiety rose from 9·4% to 10·9% between June-July and November-December 2022. Women and non-partnered people experienced worse changes in mental health. Participants with less wealth had lowest levels of mental health before and during the pandemic. Higher socioeconomic groups had better mental health overall, but responded to the pandemic with more negative changes. Patterns of changes were similar across age groups. Interpretation: Mental health and wellbeing continued to worsen as lockdown continued, and socioeconomic inequalities persisted. Women and non-partnered people experienced greater deterioration in all mental health outcomes.Funding Information: ESRC/UKRI; National Institute on Aging; UK Government Departments.Declaration of Interests: All authors declare no conflict of interests.Ethics Approval Statement: All respondents provided informed consent. Ethical approval for the regular ELSA study was obtained from the National Research Ethics Service. The ELSA COVID-19 Substudy has been approved by the University College London Research Ethics Committee.

The immediate and longer-term impact of the COVID-19 pandemic on the mental health and wellbeing of older adults in England (preprint)

ObjectiveTo evaluate changes in mental health and wellbeing before and during the initial and later phases of the COVID-19 pandemic and investigate whether patterns varied with age, sex, and socioeconomic status. DesignProspective cohort study. ParticipantsEnglish Longitudinal Study of Ageing cohort of 5146 community dwelling adults aged 52 years and older (53% women, average age 66.74 years, standard deviation 10.62) who provided data before the pandemic (2018-19) and at two occasions in 2020 (June-July and November-December). Main outcome measureDepression, poor quality of life, loneliness and anxiety. ResultsThe prevalence of clinically significant depressive symptoms increased from 12.5% pre-pandemic to 22.6% in June-July 2020, with a further rise to 28.5% in November-December. This was accompanied by increased loneliness and deterioration in quality of life. The prevalence of anxiety rose from 9.4% to 10.9% between June-July and November-December 2022. Women and non-partnered people experienced worse changes in mental health and wellbeing. Participants with less wealth had lowest levels of mental health before and during the pandemic. Higher socioeconomic groups had better mental health overall, but responded to the pandemic with more negative changes. Patterns of changes were similar across age groups, the only exception was for depression which showed a smaller increase in the 75+ age group than in the youngest age group (50-59 years). ConclusionsThese data showed that mental health and wellbeing continued to worsen as lockdown continued, and that socioeconomic inequalities persisted. Women and non-partnered people experienced greater deterioration in all mental health outcomes. The immediate provision of diagnosis of mental health problems and targeted psychological interventions should target and support sociodemographic groups of older people at higher risk of psychological distress. What is already known on this topic- The COVID-19 pandemic and mitigation measures have upended the economic and social lives of many, leading to widespread psychological distress. - During the early months of the pandemic, levels of depression, anxiety and loneliness were high and lower levels of wellbeing were reported across the adult population, with certain higher risk groups identified. - However, evidence from longitudinal studies of representative samples of older adults that include pre-pandemic data is scarce, and little is known about mental health beyond the initial period of the pandemic. Repeated assessments are needed in order to understand whether mental health and wellbeing levels recovered or continued to deteriorate throughout 2020. What this study adds- These data suggest that mental health and wellbeing deteriorated significantly during June-July 2020 compared with pre-pandemic levels and continued to deteriorate during the second national lockdown in November-December 2020, showing that older individuals did not adapt to circumstances. - Inequalities in experiences of mental ill-health and poor wellbeing during 2020 were evident, with women, individuals living alone and those with less wealth being particularly vulnerable. Furthermore, socioeconomic inequalities in mental health have persisted during the pandemic.

Trajectories of depressive symptoms among vulnerable groups in the UK during the COVID-19 pandemic (preprint)

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic has affected many aspects of the human condition, including mental health and psychological wellbeing. This study examined trajectories of depressive symptoms (DST) over time among vulnerable individuals in the UK during the COVID-19 pandemic. MethodsThe sample consisted of 51,417 adults recruited from the COVID-19 Social Study. Depressive symptoms were measured on seven occasions (21st March - 2nd April), using the Patient Health Questionnaire (PHQ-9). Sociodemographic vulnerabilities included non-white ethnic background, low socio-economic position (SEP), and type of work (keyworker versus no keyworker). Health-related and psychosocial vulnerabilities included pre-existing physical and mental health conditions, experience of psychological and/or physical abuse, and low social support. Group-based DST were derived using latent growth mixture modelling and multivariate logistic regression models were fitted to examine the association between these vulnerabilities and DSTs. Model estimates were adjusted for age, sex, and suspected COVID-19 diagnosis. ResultsThree DSTs were identified: low [N=30,850 (60%)] moderate [N=14,911 (29%)], and severe [N=5,656 (11%)] depressive symptoms. DSTs were relatively stable across the first 6 weeks of lockdown. After adjusting for covariates, experiences of physical/psychological abuse (OR 13.16, 95% CI 12.95-13.37), pre-existing mental health conditions (OR 13.00 95% CI 12.87-13.109), pre-existing physical health conditions (OR 3.41, 95% CI 3.29-3.54), low social support (OR 12.72, 95% CI 12.57-12.86), and low SEP (OR 5.22, 95% CI 5.08-5.36) were significantly associated with the severe DST. No significant association was found for ethnicity (OR 1.07, 95% 0.85-1.28). Participants with key worker roles were less likely to experience severe depressive symptoms (OR 0.66, 95% 0.53-0.80). Similar but smaller patterns of associations were found for the moderate DST. ConclusionsPeople with psychosocial and health-related risk factors, as well as those with low SEP seem to be most vulnerable to experiencing moderate or severe depressive symptoms during the COVID-19 pandemic.