Impact of the COVID-19 pandemic on some modifiable risk factors of dementia in an aging, rural Indian population.

Introduction: The impact of the COVID-19 pandemic and associated lockdowns is likely to have caused adverse changes in lifestyle-related/cardiovascular risk factors and other such modifiable risk factors of dementia. We aimed to examine the pandemic's impact on some modifiable risk factors of dementia among rural Indians belonging to a large, prospective aging cohort-Srinivaspura Aging, NeuoSenescence, and COGnition (SANSCOG). Methods: This was a cross-sectional study among adults aged ≥ 45 years (n = 3,148; 1,492 males and 1,656 females) residing in the villages of Srinivaspura in Karnataka state, India. SANSCOG study data (clinical and biochemical assessments) of these participants were obtained from three distinct periods: (i) the "pre-COVID period"-before India's nationwide lockdown on 24 March 2020, (ii) the "COVID period"-during the first and second waves of the pandemic, wherein the social restrictions were prominent (25 March 2020 to 30 September 2021), and (iii) the "post-COVID period"-after easing of restrictions (from 1 October 2021 onward). Proportions of participants with diabetes, hypertension, obesity, dyslipidemia (diagnosed using standard criteria), and depression (diagnosed using the Geriatric Depression Scale) were compared between the above three periods. Results: The odds of having obesity, abnormal triglycerides, and depression among individuals in the COVID period were 1.42 times, 1.38 times, and 2.65 times more than the odds in the pre-COVID period, respectively. The odds of having hypertension, obesity, abnormal total cholesterol, abnormal triglycerides, abnormal LDL, and depression among individuals in the post-COVID period were 1.27 times, 1.32 times, 1.58 times, 1.95, 1.23, and 3.05 times more than the odds in the pre-COVID period, respectively. The odds of diabetes did not differ between any of the three periods. Discussion: We found significantly higher odds of some of the studied risk factors in the COVID and post-COVID periods compared to the pre-COVID period, suggesting that the pandemic adversely impacted the physical and psychological health of this marginalized, rural Indian population. We call for urgent public health measures, such as multimodal, lifestyle-based, and psychosocial interventions, to mitigate this negative impact and reduce the future risk of dementia.

Approaches to engage an aging, rural cohort in southern India during the COVID-19 crisis and the psychological impact of COVID-19 in this cohort.

INTRODUCTION: The COVID-19 pandemic produced an unprecedented crisis across the world. Long-term cohort studies were stalled, including our longitudinal aging cohort study in rural India. METHODS: We describe approaches undertaken to engage with our cohort (n = 1830) through multiple rounds of calls and how we provided useful services to our subjects during the lockdown period. Consenting subjects also underwent telephonic assessments for depression and anxiety using validated, self-report questionnaires. RESULTS: Subjects reported benefitting from our telephonic engagement strategies, including the COVID-related safety awareness and counselling service. The proportion of subjects with depression increased from 7.42% pre-COVID to 28.97% post-COVID. DISCUSSION: We envisage that such engagement strategies would improve subject rapport and cohort retention, and thus, could be adopted by similar cohort studies across the world. This marginalized, rural Indian community had severe, adverse psychological impact in this pandemic. Urgent public health measures are needed to mitigate this impact and develop appropriate preventive strategies. This article is protected by copyright. All rights reserved.

Depression and anxiety during the two waves of the COVID‐19 pandemic in two large, prospective, aging cohorts in rural and urban India

Background India was severely impacted by both the first and second waves of COVID‐19 in 2020 and 2021. We aimed to estimate proportions of depression and anxiety disorder during both waves, among rural and urban Indians, and to compare depression trends during four distinct periods before and after the pandemic. Method Aging adults (≥45 years) from two, parallel, harmonized cohorts in rural (SANSCOG) and urban (TLSA) sites in India, underwent telephonic assessments for depression (GDS‐7) and anxiety (GAD‐7) during both waves of COVID‐19. Utilizing prior data from depression assessments (GDS‐30) during regular evaluations pre‐ pandemic and during an interim period between the two waves, we compared trends in overall proportions of depression between the two cohorts during four periods: pre‐COVID (684 rural, 317 urban);post‐COVID first wave (733 rural, 297 urban);post‐COVID interim period (458 rural, 204 urban);post‐COVID second wave (611 rural, 305 urban). Result Overall proportion of depression among rural subjects during both waves was 28.8%. Corresponding numbers for anxiety disorder were 5.5% and 3.9%. Among urban subjects, 6.5% and 15.1% were depressed, whereas 1.7% and 0.66% had anxiety disorder, during the first and second waves, respectively. Depression trends during the four periods mentioned above were starkly different between rural and urban Indians. Sub‐analysis of the same subset of rural subjects with pre‐COVID and post‐COVID (both waves) data, revealed that subjects ≥ 65 years and those with comorbidities had significantly higher depression (36.8% vs. 25.3% and 32% vs. 15.7%, respectively) during the first wave only. Conclusion Multi‐fold increase in depression among aging, rural Indians during both waves, with alarmingly high depression among subjects ≥ 65 years and those with comorbidities during first wave, is seriously concerning. Urgent public health measures are needed to address this added mental health burden and prevent further potential adverse consequences.

Depression and anxiety during the first and second waves of the COVID-19 pandemic in two large, prospective, aging cohorts in rural and urban India.

Introduction: The COVID-19 pandemic resulted in a wide variety of adverse consequences, including disruption of long-term, human research studies globally. Two long-term, prospective, aging cohort studies, namely, Srinivaspura Aging, Neurosenescence and COGnition (SANSCOG) study and Tata Longitudinal Study of Aging (TLSA), conducted in rural and urban India, respectively, had to be suspended during first and second waves of COVID-19. Methods: We conducted telephonic assessments to screen for depression and anxiety in the above two cohorts comprising of adults ≥45 years, during the first wave (2020) and second wave (2021) lockdown periods in India. Further, we included depression assessments data from two additional time periods-pre-COVID (2019) and the "inter-wave" period (between the first and second waves) to compare proportions of depression in these cohorts, during four distinct time periods-(i) pre-COVID, (ii) COVID first wave lockdown, (iii) inter-wave period, and (iv) COVID second wave lockdown (rural: 684, 733, 458, 611 and urban: 317, 297, 204, 305 respectively). Results: During COVID first wave, 28.8% and 5.5% had depression and anxiety, respectively in the rural cohort. Corresponding figures in the urban cohort were 6.5% and 1.7%. During second wave, 28.8% of rural subjects had depression and 3.9% had anxiety, whereas corresponding figures in urban subjects were 13.1% and 0.66%. During the above-mentioned four time periods, proportions of depression were: rural-8.3%, 28.8%, 16.6%, 28.8%; urban-12%, 6.1%, 8.8%, 13.1%. Conclusions: Multi-fold increase in depression among aging, rural Indians during first and second waves, with high depression among subjects ≥65 years and those with comorbidities during the first wave, is concerning. Urgent public health measures are needed to address this added mental health burden and thereby, prevent further potential adverse consequences.

Approaches to engage an aging cohort in rural India during the COVID-19 crisis and the psychological impact of COVID-19 in this cohort

Background The COVID-19 crisis brought most cohort studies around the world to a standstill. India, which had implemented one of the strictest nation-wide lockdowns in the world, was no exception. Owing to this, recruitments and assessments in our aging cohort in rural India, namely, Srinivaspura Aging Neurosenescence and COGnition (SANSCOG), had to be abruptly suspended. Method The SANSCOG study team undertook active measures to keep our subjects engaged remotely during the COVID-19-related lockdown period and also, provided useful services telephonically, to address their anxiety and distress. We collaborated with a local digital health service initiative, to offer counselling on awareness about the disease and safety precautions to be adopted. To assess the psychological impact of the pandemic on our cohort, the study team?s clinicians telephonically administered the Geriatric Depression Scale (GDS-7) and the Generalized Anxiety Disorder (GAD-7) questionnaire to consenting subjects. These instruments are brief, validated and sensitive instruments to screen for depression and anxiety disorder, respectively. Among subjects who had pre-COVID GDS scores (obtained from their baseline clinical assessments), the proportion of subjects having pre-COVID versus post-COVID depression was compared. Result A total of 1890 subjects from the rural (SANSCOG) cohort were contacted during the lockdown period. Our periodic telephone calls to enquire about the subjects? well-being as well as our providing of psychological support and medical advice, when necessary, were appreciated by our subjects. Our collaborative initiative to provide awareness about the pandemic was well-received, as many of our subjects had inadequate awareness about the pandemic. Overall, these strategies resulted in better bonding between our study team and our cohort. On screening for depression and anxiety disorder, 28.4% scored above the threshold score for depressive disorder on GDS-7, whereas 5.5% scored above the threshold score for anxiety disorder on GAD-7. We found that the proportion of subjects with depression had quadrupled after the COVID-19 pandemic (pre-COVID - 7.74%, post-COVID - 28.98%). Conclusion The above approaches of cohort engagement during times of crisis are deemed valuable by subjects and we envisage that this would improve subject retention. This rural Indian cohort had a severe psychological impact due to the COVID-19 pandemic.