The impact of COVID-19 lockdown on a cohort of adults with recurrent major depressive disorder from Catalonia: a decentralized longitudinal study using remote measurement technology (preprint)

The present study analyzes the effects on depression levels of each containment phase of the first wave of COVID-19 in a cohort of adults with a history of major depressive disorder (MDD). This analysis is part of the Remote Assessment of Disease and Relapse-MDD (RADAR-MDD) study. Depression was evaluated with the Patient Health Questionnaire-8 (PHQ-8) and anxiety with the Generalized Anxiety Disorder-7 (GAD-7). A total of 121 participants from Catalonia were registered from November 1, 2019, to October 16, 2020. Levels of depression were explored across the phases (pre-lockdown, lockdown, four post-lockdown phases) of the restrictions imposed by the Spanish/Catalan governments. Then, a mixed model was fitted to estimate how depression varied over the phases. A significant rise in the depressive severity was found during the lockdown and phase 0 (early post-lockdown), as compared with pre-lockdown phase in this sample with a history of MDD. Those with low pre-lockdown depression experienced a higher increase in depression levels during the new-normality. We observed a significant decrease in the depression levels during the new-normality in those with high pre-lockdown depression, compared to the pre-lockdown period. These findings suggest that COVID-19 restrictions impacted on the depression of individuals diagnosed with MDD, depending on their pre-lockdown depression levels.

The impact of the COVID-19 pandemic on health related quality of life in head and neck cancer survivors: an observational cohort study (preprint)

Background: Physical, psychological, and social aspects of health-related quality of life (HRQOL) among head and neck cancer (HNC) survivors may be more affected during the COVID-19 pandemic than before the pandemic. However, the impact is not yet understood well. Methods: : Prospectively collected data from the NETherlands QUality of life and BIomedical Cohort study in HNC were used. All patients were diagnosed and treated before the COVID-19 pandemic. Patient reported outcome measures (PROMs) collected 24 and 36 months after treatment (M24 and M36) were compared between survivors who completed both assessments before the COVID-19 pandemic and those who completed M24 before but M36 during the pandemic. Personal, clinical, physical, psychological, social, and lifestyle characteristics of the survivors assessed at baseline or M24 were investigated as potential effect modifiers. Results: : In total, 318 HNC survivors were included, of which 199 completed both M24 and M36 before the COVID-19 pandemic and 119 completed M24 before but M36 during the pandemic. Changes in HRQOL between 24 and 36 months follow-up did not differ between the two groups for any of the PROMs. However, in some subgroups of HNC survivors the COVID-19 pandemic negatively affected the course of HRQOL for several PROMs while it positively affected the course of HRQOL for other PROMs. Conclusions: : The COVID-19 pandemic did not affect HRQOL in HNC survivors in general, but some subgroups were affected in a positive and others in a negative way. Funding: This work was supported by the Dutch Cancer Society [grant number VU 2013–5930] and the Dutch Cancer Society, Alpe Young Investigator Grant [grant number 12820].

Biopsychosocial response to the COVID-19 lockdown in people with major depressive disorder and multiple sclerosis. (preprint)

BackgroundChanges in lifestyle, finances and work status during COVID-19 lockdowns may have led to biopsychosocial changes in people with pre-existing vulnerabilities such as Major Depressive Disorders (MDD) and Multiple Sclerosis (MS). MethodsData were collected as a part of the RADAR-CNS (Remote Assessment of Disease and Relapse - Central Nervous System) programme. We analyzed the following data from long-term participants in a decentralized multinational study: symptoms of depression, heart rate (HR) during the day and night; social activity; sedentary state, steps and physical activity of varying intensity. Linear mixed-effects regression analyses with repeated measures were fitted to assess the changes among three time periods (pre, during and post-lockdown) across the groups, adjusting for depression severity before the pandemic and gender. ResultsParticipants with MDD (N=255) and MS (N=214) were included in the analyses. Overall, depressive symptoms remained stable across the three periods in both groups. Lower mean HR and HR variation were observed between pre and during lockdown during the day for MDD and during the night for MS. HR variation during rest periods also decreased between pre-and post-lockdown in both clinical conditions. We observed a reduction of physical activity for MDD and MS upon the introduction of lockdowns. The group with MDD exhibited a net increase in social interaction via social network apps over the three periods. ConclusionsBehavioral response to the lockdown measured by social activity, physical activity and HR may reflect changes in stress in people with MDD and MS.

Understanding the subjective experience of long-term remote measurement technology use for symptom tracking in people with depression: A multisite, longitudinal qualitative analysis (preprint)

Background: Remote Measurement Technologies (RMTs) have the potential to revolutionise major depressive disorder (MDD) disease management by offering the ability to assess, monitor and predict symptom changes. However, the promise of RMT data depends heavily on sustained user engagement over extended periods of time. Here we report a longitudinal qualitative study of the subjective experience of people with MDD engaging with RMTs, to provide insight into system usability and user experience and to provide the basis for future promotion of RMT use in research and clinical practice. Objective We aimed to understand the subjective experience of long-term engagement with RMTs, through qualitative data collected throughout a longitudinal study of RMTs in MDD. The objectives were (1) to explore key themes associated with long-term RMT use, and (2) to identify recommendations for future system engagement. Methods In this multisite, longitudinal qualitative research study, 124 semi-structured interviews were conducted with 99 participants across the United Kingdom, Spain, and The Netherlands at 3-month, 12-month, and 24-month timepoints during a study exploring RMT use (the Remote Assessment of Disease and Relapse- Major Depressive Disorder study). Data was analysed using thematic analysis; interviews were audio recorded, transcribed, and coded in the native language, with resulting quotes translated into English. Results There were five main themes regarding the subjective experience of long-term RMT use: 1) research-related factors, 2) utility of RMTs for self-management, 3) technology-related factors, 4) clinical-related factors, and 5) system amendments and additions. Conclusions The subjective experience of long-term RMT use can be considered from two main perspectives: a) experiential factors (how participants construct their experience of engaging with RMTs), and b) system factors (direct engagement with the technologies). A set of recommendations based on these strands is proposed, for both future research and the real-world implementation of RMTs into clinical practice. Future exploration of experiential engagement with RMTs will be key to successful use of RMTs in clinical care.

Using smartphones and wearable devices to monitor behavioural changes during COVID-19 (preprint)

We aimed to explore the utility of the recently developed open-source mobile health platform RADAR-base as a toolbox to rapidly test the effect and response to NPIs aimed at limiting the spread of COVID-19. We analysed data extracted from smartphone and wearable devices and managed by the RADAR-base from 1062 participants recruited in Italy, Spain, Denmark, the UK, and the Netherlands. We derived nine features on a daily basis including time spent at home, maximum distance travelled from home, maximum number of Bluetooth-enabled nearby devices (as a proxy for physical distancing), step count, average heart rate, sleep duration, bedtime, phone unlock duration, and social app use duration. We performed Kruskal-Wallis tests followed by post-hoc Dunns tests to assess differences in these features among baseline, pre-, and during-lockdown periods. We also studied behavioural differences by age, gender, body mass index (BMI), and educational background. We were able to quantify expected changes in time spent at home, distance travelled, and the number of nearby Bluetooth-enabled devices between pre- and during-lockdown periods. We saw reduced sociality as measured through mobility features, and increased virtual sociality through phone usage. People were more active on their phones, spending more time using social media apps, particularly around major news events. Furthermore, participants had lower heart rate, went to bed later, and slept more. We also found that young people had longer homestay than older people during lockdown and fewer daily steps. Although there was no significant difference between the high and low BMI groups in time spent at home, the low BMI group walked more. RADAR-base can be used to rapidly quantify and provide a holistic view of behavioural changes in response to public health interventions as a result of infectious outbreaks such as COVID-19.