ABSTRACT
Background: The 2019 coronavirus disease (COVID-19) poses great demands on medical care and resulted in delayed prescribing. Objective: To evaluate the number of newly dispensed antidepressant and anxiolytic drugs among the Dutch population, before and during COVID-19. Methods: Pharmacy dispensing data was obtained from Stichting Farmaceutische Kentallen on newly dispended antidepressants and anxiolytics, covering 96% of the Dutch population. The number and week of first-time dispensed drugs were determined for the period January – June 2019 and 2020, and age and sex of patients was recorded. Using independent t-tests, data was compared between men and women, age groups, and between 2019 and 2020. Age groups considered were children (0-9 years old), adolescents (10-19 years old), adults (20-64 years old), and elderly (65 year and older). Three time periods were considered: week 1-11 (in 2020 corresponding to the pre-COVID-19 lockdown period), week 12-19 (in 2020 corresponding to the COVID-19 lockdown), and week 20-26 (in 2020 corresponding to the post-COVID-19 lockdown). Results: An overall reduction was observed in 2020 for the number of newly dispensed antidepressants (139.186 in 2019 and 126.487 in 2020, respectively) and anxiolytics (200.661 in 2019 and 189.559 in 2020, respectively). In both 2019 and 2020, the drugs were significantly more often dispensed to women than men, and most were prescribed to adults followed by the elderly. For antidepressants, in both male and female adolescents, adults and elderly, for week 1-11 no significant differences were found between 2019 and 2020. Compared to 2019, a significant reduction in the number of dispensed antidepressants was seen in during 2020 COVID-19 lockdown in these groups (p<0.05). In adolescents, but not for the other age groups, a significant reduction in dispensing was also found post COVID-19 lockdown (p<0.001). For children, a general reduction in the number of dispensed antidepressant drugs was seen in 2020 before and during COVID-19 lockdown (p<0.001). In male children there was a significant reduction in dispensing during COVID-19 lockdown (p=0.04), which was not significant among female children. For anxiolytics, in both male and female children and adolescents, a general reduction of dispensing was seen throughout 2020 (p<0.05). In male adults, in 2020 a significant reduction in dispensing was found during COVID-19 lockdown (p=0.01), and for both male and female adults post-COVID-19 lockdown (p<0.05). For elderly, no significant differences in dispending were found between 2019 and 2020. Conclusions: Across all age groups a significant reduction was seen for the number of newly dispensed antidepressant drugs. For all age groups except the elderly a significant reduction in dispensed anxiolytic drugs was seen during COVID-19 lockdown. This data corresponds with reports of delayed care. However, in elderly no reduction was found for dispensed anxiolytics during COVID-19 lockdown. Future research should determine if the continued dispensing of anxiolytics among elderly during lockdown may reflect the fact that fear of COVID-19 may be greater among this age group, as they are over-represented in COVID-19 related hospital admissions and have the highest mortality rates. No conflict of interest
ABSTRACT
Background: To address the rapid spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) around the world, in the absence of a vaccine or adequate treatment for the 2019 coronavirus disease (COVID-19), many governments around the world enforced lockdown periods. While lockdowns are beneficial in reducing the spread of the virus, literature shows that lockdowns may also have a significant negative impact on mood, wellbeing, and health. In this context, we hypothesized that negative mood changes increase overall stress levels, which in turn has a negative effect on perceived immune fitness, expressed in a greater presence and severity of COVID-19 symptoms [1]. Objective: The aim of this study was to investigate the impact of mood and stress during COVID-19 lockdown on perceived immune fitness and reported COVID-19 symptoms. Methods: An online retrospective survey was held among Dutch adults, to evaluate the first lockdown in The Netherlands [1]. Questions were answered for the period before the lockdown (15 January–14 March 2020) as well as for the lockdown period (15 March–11 May 2020). Mood was assessed via 1-item scales including “stress”, “anxiety”, “depression”, “fatigue”, “hostile”, “lonely” and “happy” [2]. Perceived immune fitness was assessed on a scale ranging from 0 (very poor) to 10 (excellent) [3]. The COVID-19 Symptoms Scale comprised the items sneezing, running nose, sore throat, cough, and malaise/feeling sick, high temperature (up to 38 Celsius), fever (38 Celsius and higher), shortness of breath, and chest pain [1]. The severity of each of the nine items could be rated as none (0), mild (1), moderate (2), or severe (3). The sum score of items served as COVID-19 symptom severity score, with a possible range from 0 (no complaints) to 27 (severe complaints). In addition, the presence of COVID-19 symptoms was calculated by counting the number of symptoms with a score > 0. Assessments before and during COVID19 lockdown were compared using the Related Samples Wilcoxon Signed Rank Test. For each variable, difference scores (Δ, lockdown – before lockdown) were calculated. Pearson's correlations were calculated between difference scores. Results: Data of 1415 Dutch adults (64% women, age range: 18 to 94 years old) were analyzed. During lockdown, all mood ratings, stress, and perceived immune fitness were significantly poorer compared to the period before lockdown (p<0.0001). The COVID-19 symptom severity score as significantly higher during the lockdown period (p=0.018), but no difference was found for the number of reported COVID-19 symptoms (p=0.256). Significant correlations were found between mood changes and Δ stress (r ranged from 0.334 to 0.557, all p<0.0001). The correlation between Δ stress and Δ perceived immune fitness was also significant (r=-0.310, p<0.0001). Finally, Δ perceived immune fitness correlated significantly with difference scores for the presence (r=-0.223, p<0.0001) and severity (r=-0.245, p<0.0001) of COVID-19 related symptoms. Conclusions: The findings support the hypothesis that lockdown has a negative effect on mood and increases stress. This is reflected in poorer perceived immune fitness, which in turn is associated with a greater presence and severity of COVID-19 symptoms. No conflict of interest
ABSTRACT
Background: Immune fitness has been defined as a state where an individual's immune system is resilient, having an inbuilt capacity to adapt to challenges by establishing, maintaining, and regulating an appropriate immune response in order to promote health and prevent and resolve disease [1]. Perceived reduced immune fitness can be a possible reason for absenteeism (staying home from work) or presenteeism (attending work despite health problems, possibly with reduced work performance). Objective: The purpose of the current study was to investigate the impact of reduced immune fitness on absenteeism and presenteeism at work, and the estimated associated costs for the Dutch economy. Methods: Dutch adults were recruited via Facebook to complete an online survey [2]. Participants could indicate whether in 2019 (i.e. pre-COVID-19) they were employed (owner or employee). Absenteeism and presenteeism related to perceived reduced immune fitness were assessed. To this end, questions were adapted from a recent study examining the cost of workplace hangovers and intoxication to the UK economy [3]. Questions concerned the number of days in 2019 that participants (a) did not work because they experienced reduced immune fitness and (b) did work although they experienced reduced immune fitness. With regard to presenteeism, they could further indicate, in comparison to a regular working day, how well they performed at work on days when they experienced reduced immune fitness. This was done by rating their performance on a scale ranging from 0% (compared to a regular day I achieved nothing/did not work) to 100% (my work was absolutely not influenced by experiencing reduced immune fitness). Statistics Netherlands provided information on the average Dutch income. Perceived immune fitness was assessed with the immune status questionnaire [1]. In line with Bhattacharya's method [3], the economic costs of absenteeism and presenteeism due to reduced immune fitness were calculated. Results: Data of N=466 participants with a mean (SD) age of 37 (15.2) years old (range: 18-65 years old), 67.4% female, was evaluated. Overall, 4.4 days of absenteeism, 27.1 days of presenteeism, and a 21% reduction of performance level were reported for presenteeism days. Females, higher educated, and older participants reported significantly higher rates of absenteeism and presenteeism, and lower performance levels on days working with reduced immune fitness. Significant correlations (p<0.05) were found between perceived immune fitness and the number of absenteeism (r = -0.350) and presenteeism days (r = -0.339). The estimated economic cost of absenteeism (€6.8± 0.064 billion euro) and presenteeism (€8.8 ± 0.083 billion euro) sum up to a total cost of €15.6± 0.147 billion euro. Conclusions: Perceived reduced immune fitness has a significant negative impact on work performance, expressed in both absenteeism and presenteeism. Based on the present sample, the associated annual costs for the Dutch economy for 2019 were estimated at 15.6 billion Euro. These high costs warrant further investigation. A large nationally representative sample should be conducted to verify these findings and yield a more accurate estimate of the associated economic costs of perceived reduced immune fitness. No conflict of interest