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

ABSTRACT

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.