Depression and anxiety before and during the COVID-19 lockdown: a longitudinal cohort study with university students

AbstractBackgroundFor young people, just as in the general population, COVID-19 caused many changes in their lives, including an increased risk for mental illness symptoms. We aimed to study the impact of the COVID-19 pandemic in anxiety and depression symptoms in a cohort of university students.MethodsThis study is part of broader longitudinal research on university students’ mental health with data of the Portuguese version of The Patient Health Questionnaire (PHQ-9) and the Portuguese version of the Generalised Anxiety Disorder (GAD-7) with evaluations on January, May and October 2019 and June 2020, as well as socio-demographic information.Results341 university students (257 females and 84 males) were included, with a mean age of 19.91 (SD=1.58). In June 2020, the mean for perceived wellbeing loss was 60.47% (SD=26.56) and 59.54% (SD=28.95) for mental health loss. The proportion of students with scores equal to or above 15 in the PHQ-9 ranged between 22.6% and 25.5% in 2019 and 37.0% in June 2020. The proportion of GAD-7 scores above cut-off ten ranged between 46.0% and 47.8% in 2019 and 64.5% in 2020. Compared with preceding trends, PHQ-9 scores were 3.11 (CI=2.40-3.83) higher than expected, and GAD-7 scores were 3.56 (CI=2.75-5.37) higher.DiscussionCOVID-19 impacted negatively depressive and anxiety symptoms, confirming previous studies and young people’s vulnerability in such uncertain times.

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The Impact of Shift Work on Occupational Health Indicators among Professionally Active Adults: A Comparative Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182111290 ◽

2021 ◽

Vol 18 (21) ◽

pp. 11290

Author(s):

Henrique Pereira ◽

Gergely Fehér ◽

Antal Tibold ◽

Samuel Monteiro ◽

Vítor Costa ◽

...

Keyword(s):

Mental Health ◽

Occupational Health ◽

Shift Work ◽

Work Engagement ◽

Self Efficacy ◽

Health Indicators ◽

Depression Symptoms ◽

Depression And Anxiety ◽

The Impact ◽

Active Adults

The analysis of the impact of shift work on occupational health still needs further contributions. Therefore, we developed this research with the purpose of assessing the impact of shift work on occupational health indicators, namely burnout, work-engagement, occupational self-efficacy, and mental health functioning (symptoms of depression and anxiety), by comparing workers who did shift work (44.2% of participants) with workers who did not (55.8% of participants). A total of 695 Portuguese professionally active adults between 18 and 73 years of age (Mage = 37.71; SD = 12.64) participated in this study and completed a survey containing a sociodemographic questionnaire and four occupational health measures: The Burnout Assessment Tool, The Work-Engagement questionnaire (UWES), The Occupational Self-Efficacy Questionnaire, and the BSI-18 for mental health symptoms. Results showed statistically significant differences (p < 0.05) for all indicators, demonstrating that participants who worked shifts presented lower scores of work-engagement and occupational self-efficacy, and higher scores of burnout, depression, and anxiety when compared to participants who did not work shifts. Linear regressions showed that shift work explained significant but low percentages of anxiety symptoms, low work-engagement, depression symptoms, low occupational self-efficacy, and burnout. We concluded that non-standard working hours (by shifts) are detrimental to employee occupational health, by increasing the risk of anxiety and depression levels, and burnout, and by reducing work-engagement (as a well-being indicator) and occupational self-efficacy perceptions.

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Anxiety and Depression Among Adult Tobacco Users During the COVID-19 Restrictions in India.

10.21203/rs.3.rs-806234/v1 ◽

2021 ◽

Author(s):

Shalini Bassi ◽

Gaurang P. Nazar ◽

Nishigandha Joshi ◽

Nitika Sharma ◽

Aishwarya Pandian ◽

...

Keyword(s):

Mental Health ◽

Tobacco Cessation ◽

Descriptive Analysis ◽

Easy Access ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Indian Government ◽

Patient Health ◽

Indian Cities

Abstract Background The world witnessed a highly contagious and deadly disease, COVID-19, towards the end of 2019. India is one of the worst affected countries. We aimed to assess anxiety and depression levels among adult tobacco users and people who recently quit tobacco during COVID − 19 lockdown in India. Methods The study was conducted across two Indian cities, Delhi and Chennai (July-August, 2020) among adult tobacco users (n = 801). Telephonic interviews were conducted using validated mental health tools (Patient Health Questionnaire-PHQ-9 and Generalized Anxiety Disorder-GAD-7) to assess the anxiety and depression levels of the participants. Descriptive analysis and multiple logistic regression were used to study the prevalence and correlates of depression and anxiety. Results We found that 20.6% of tobacco users had depression symptoms (3.9% moderate to severe); 20.7% had anxiety symptoms (3.8% moderate to severe). Risk factors associated with depression and anxiety included food, housing, and financial insecurity. Conclusion During COVID-19 lockdown, mental health of tobacco users (primarily women) was associated with food, housing and financial insecurity. The Indian Government rightly initiated several health, social and economic measures to shield the most vulnerable from COVID-19, including a ban on the sale of tobacco products. It is also necessary to prioritize easy access to tobacco cessation and mental health services to such vulnerable populations during pandemic situations.

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A Comparison of Depression and Anxiety among University Students in Nine Countries during the COVID-19 Pandemic

Journal of Clinical Medicine ◽

10.3390/jcm10132882 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2882

Author(s):

Dominika Ochnik ◽

Aleksandra M. Rogowska ◽

Cezary Kuśnierz ◽

Monika Jakubiak ◽

Astrid Schütz ◽

...

Keyword(s):

Mental Health ◽

Czech Republic ◽

University Students ◽

Well Being ◽

Cross Cultural ◽

Depression And Anxiety ◽

Cultural Perspective ◽

The Czech Republic ◽

Cross Cultural Differences ◽

Patient Health

The mental health of young adults, particularly students, is at high risk during the COVID-19 pandemic. The purpose of this study was to examine differences in mental health between university students in nine countries during the pandemic. The study encompassed 2349 university students (69% female) from Colombia, the Czech Republic (Czechia), Germany, Israel, Poland, Russia, Slovenia, Turkey, and Ukraine. Participants underwent the following tests: Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7), Exposure to COVID-19 (EC-19), Perceived Impact of Coronavirus (PIC) on students’ well-being, Physical Activity (PA), and General Self-Reported Health (GSRH). The one-way ANOVA showed significant differences between countries. The highest depression and anxiety risk occurred in Turkey, the lowest depression in the Czech Republic and the lowest anxiety in Germany. The χ2 independence test showed that EC-19, PIC, and GSRH were associated with anxiety and depression in most of the countries, whereas PA was associated in less than half of the countries. Logistic regression showed distinct risk factors for each country. Gender and EC-19 were the most frequent predictors of depression and anxiety across the countries. The role of gender and PA for depression and anxiety is not universal and depends on cross-cultural differences. Students’ mental health should be addressed from a cross-cultural perspective.

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The COVID States Project#54: Mental health in the United States

10.31219/osf.io/8fr6s ◽

2021 ◽

Author(s):

Roy H. Perlis ◽

Jon Green ◽

Matthew D Simonson ◽

David Lazer ◽

Matthew Baum ◽

...

Keyword(s):

Mental Health ◽

United States ◽

New York ◽

Major Depression ◽

New York Times ◽

The United States ◽

Economic Stress ◽

Depression And Anxiety ◽

Patient Health ◽

The Impact

With rapid progress toward vaccination in the United States along with falling COVID-19 case rates and a reopening economy, federal and state leaders speak optimistically about a return to normalcy this summer. But as cases diminish, have the unprecedented rates of depression and anxiety documented in our reports, and in other US surveys, also begun to normalize? On the one hand, as a recent New York Times op-ed notes, people in general are remarkably resilient. And in our prior work we showed that depression and anxiety were tied closely to economic stress; as the economy improves, we might expect mental health to improve as well. On the other hand, the impact of a year of COVID-19 quarantine and fear of illness – perhaps compounded by political and societal turmoil – might not resolve so readily.In this report, we characterize rates of depression, anxiety, and sleep disturbance, as we have done on a regular basis since May 2020. We used a standard screening measure drawn from primary care, the Patient Health Questionnaire-9 (PHQ-9), which asks about the symptoms of major depression, as well as 2 items that ask about anxiety (the Generalized Anxiety Disorder-2, or GAD-2). We define major depression as a score on the PHQ-9 of 10 or greater, or moderate depression, often the point at which an individual would be referred for treatment. Sleep disruption and thoughts of suicide are defined based on items on the PHQ-9.

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Long-Term Outcomes of a Therapist-Supported, Smartphone-Based Intervention for Elevated Symptoms of Depression and Anxiety: Quasiexperimental, Pre-Postintervention Study

JMIR mhealth and uhealth ◽

10.2196/14284 ◽

2019 ◽

Vol 7 (8) ◽

pp. e14284 ◽

Cited By ~ 5

Author(s):

Marcos Economides ◽

Kristian Ranta ◽

Albert Nazander ◽

Outi Hilgert ◽

Philippe R Goldin ◽

...

Keyword(s):

Mental Health ◽

Mental Health Problems ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Intention To Treat ◽

Symptoms Of Depression ◽

Point Reduction ◽

Patient Health ◽

Common Mental Health Problems ◽

Clinically Significant

Background Depression is one of the most common mental health disorders and severely impacts one’s physical, psychological, and social functioning. To address access barriers to care, we developed Ascend—a smartphone-delivered, therapist-supported, 8-week intervention based on several evidence-based psychological treatments for depression and anxiety. A previous feasibility study with 102 adults with elevated depression reported that Ascend is associated with a postintervention reduction in depression symptoms. Objective We aimed to examine whether Ascend is associated with a reduction in symptoms of anxiety, and importantly, whether reductions in symptoms of depression and anxiety are maintained up to 12-months postintervention. Methods We assessed whether the previously reported, end-of-treatment improvements seen in the 102 adults with elevated symptoms of depression extended up to 12 months posttreatment for depression symptoms (measured by the Patient Health Questionnaire-9 [PHQ-9]) and up to 6 months posttreatment for anxiety symptoms (added to the intervention later and measured using the Generalized Anxiety Disorder-7 [GAD-7] scale). We used linear mixed effects models with Tukey contrasts to compare time points and reported intention-to-treat statistics with a sensitivity analysis. Results The intervention was associated with reductions in symptoms of depression that were maintained 12 months after the program (6.67-point reduction in PHQ-9 score, 95% CI 5.59-7.75; P<.001; Hedges g=1.14, 95% CI 0.78-1.49). A total of 60% of the participants with PHQ-9 scores above the cutoff for major depression at baseline (PHQ≥10) reported clinically significant improvement at the 12-month follow-up (at least 50% reduction in PHQ-9 score and postprogram score <10). Participants also reported reductions in symptoms of anxiety that were maintained for at least 6 months after the program (4.26-point reduction in GAD-7 score, 95% CI 3.14-5.38; P<.001; Hedges g=0.91, 95% CI 0.54-1.28). Conclusions There is limited evidence on whether outcomes associated with smartphone-based interventions for common mental health problems are maintained posttreatment. Participants who enrolled in Ascend experienced clinically significant reductions in symptoms of depression and anxiety that were maintained for up to 1 year and 6 months after the intervention, respectively. Future randomized trials are warranted to test Ascend as a scalable solution to the treatment of depression and anxiety.

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Prospective examination of mental health in university students during the COVID-19 pandemic

10.1101/2021.07.29.21261196 ◽

2021 ◽

Author(s):

Ru Jia ◽

Holly Knight ◽

Kieran Ayling ◽

Carol Coupland ◽

Jessia Corner ◽

...

Keyword(s):

Mental Health ◽

University Students ◽

Health Outcomes ◽

Positive Mood ◽

Poor Mental Health ◽

Female Students ◽

Mental Health Outcomes ◽

Depression And Anxiety ◽

Mental Health Difficulties ◽

The Impact

Background: The impact of changing social restrictions on the mental health of students during the COVID-19 pandemic warrants exploration. Aims: To prospectively examine changes to university students mental health during the pandemic. Methods: Students completed repeated online surveys at three time points (October 2020 (baseline), February 2021, March 2021) to explore relationships between demographic and psychological factors (loneliness and positive mood) and mental health outcomes (depression, anxiety, and stress). Results: A total of 893 students participated. Depression and anxiety levels were higher at all timepoints than pre-pandemic normative data (p<.001). Scores on all mental health measures were highest in February, with depression and anxiety remaining significantly higher in March than baseline. Female students and those with previous mental health disorders were at greatest risk of poor mental health outcomes. Lower positive mood and greater loneliness at baseline were associated with greater depression and anxiety at follow-ups. Baseline positive mood predicted improvement of depression and anxiety at follow-ups. Conclusion: Depression and anxiety were significantly higher than pre-pandemic norms, with female students and those with previous mental health difficulties being at greatest risk. Given these elevated rates, universities should ensure adequate support is available to meet potentially increased demand for services.

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Mental Health and Behavior During the Early Phases of the COVID-19 Pandemic: A Longitudinal Mobile Smartphone and Ecological Momentary Assessment Study in College Students

10.31234/osf.io/4enzm ◽

2020 ◽

Cited By ~ 9

Author(s):

Jeremy F Huckins ◽

alex dasilva ◽

weichen wang ◽

Elin L. Hedlund ◽

Courtney Rogers ◽

...

Keyword(s):

Mental Health ◽

College Students ◽

News Coverage ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Health Changes ◽

And Behavior ◽

Ecological Momentary ◽

Mobile Smartphone ◽

The Impact

BackgroundWorldwide, the vast majority of people have been impacted by COVID-19. While millions of individuals have become infected, billions of individuals have been asked or required by local and national governments to change their behavioral patterns. Previous research on epidemics or traumatic events suggest this can lead to profound behavioral and mental health changes, but rarely are researchers able to track these changes with frequent, near real-time sampling or compare these to previous years of data on the same individuals.ObjectivesWe seek to answer two overarching questions by combining mobile phone sensing and self-reported mental health data among college students participating in a longitudinal study for the past two years. First, have behaviors and mental health changed in response to the COVID-19 pandemic as compared to previous time periods within the same participants? Second, did behavior and mental health changes track the relative news coverage of COVID-19 in the US media?MethodsBehaviors were measured using the StudentLife mobile smartphone sensing app. Depression and anxiety were assessed using weekly self-reported Ecological Momentary Assessments (EMAs). Differences in behaviors and self-reported mental health collected during the Winter 2020 term (the term in which the coronavirus pandemic started), as compared to prevous terms in the same cohort, were modeled using mixed linear models.ResultsDuring the initial COVID-19 impacted academic term (Winter 2020), individuals were more sedentary and reported increased anxiety and depression symptoms (P<.001), relative to the previous academic terms and subsequent academic breaks. Interactions between the Winter 2020 term and week of academic term (linear and quadratic) were significant. In a mixed linear model, phone usage, number of locations visited, and week of the term, were strongly associated with increased coronavirus-related news. When mental health metrics (e.g., depression and anxiety) were added to the previous measures (week of term, number of locations visited, and phone usage), both anxiety (P<.001) and depression (P<.05) were significantly associated with coronavirus-related news.ConclusionsCompared with prior academic terms, individuals in Winter 2020 were more sedentary, anxious, and depressed. A wide variety of behaviors, including increased phone usage, decreased physical activity, and fewer locations visited, are associated with fluctuations in COVID-19 news reporting. While this large-scale shift in mental health and behavior is unsurprising, its characterization is particularly important to help guide the development of methods that could reduce the impact of future catastrophic events on the mental health of the population.

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Mental Health and Behavior During the Early Phases of the COVID-19 Pandemic: A Longitudinal Mobile Smartphone and Ecological Momentary Assessment Study in College Students (Preprint)

10.2196/preprints.20185 ◽

2020 ◽

Author(s):

Jeremy F Huckins ◽

Alex W DaSilva ◽

Weichen Wang ◽

Elin Hedlund ◽

Courtney Rogers ◽

...

Keyword(s):

Mental Health ◽

College Students ◽

News Coverage ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Health Changes ◽

And Behavior ◽

Ecological Momentary ◽

Mobile Smartphone ◽

The Impact

BACKGROUND Worldwide, the vast majority of people have been impacted by COVID-19. While millions of individuals have become infected, billions of individuals have been asked or required by local and national governments to change their behavioral patterns. Previous research on epidemics or traumatic events suggest this can lead to profound behavioral and mental health changes, but rarely are researchers able to track these changes with frequent, near real-time sampling or compare these to previous years of data on the same individuals. OBJECTIVE We seek to answer two overarching questions by combining mobile phone sensing and self-reported mental health data among college students participating in a longitudinal study for the past two years. First, have behaviors and mental health changed in response to the COVID-19 pandemic as compared to previous time periods within the same participants? Second, did behavior and mental health changes track the relative news coverage of COVID-19 in the US media? METHODS Behaviors such as the number of locations visited, distance traveled, duration of phone usage, number of phone unlocks, sleep duration and sedentary time were measured using the StudentLife mobile smartphone sensing app. Depression and anxiety were assessed using weekly self-reported Ecological Momentary Assessments (EMAs) of the Patient Health Questionnaire-4 (PHQ-4). Participants were 217 undergraduate students, with 178 students having data during the Winter 2020 term. Differences in behaviors and self-reported mental health collected during the Winter 2020 term (the term in which the coronavirus pandemic started), as compared to previous terms in the same cohort, were modeled using mixed linear models. RESULTS During the initial COVID-19 impacted academic term (Winter 2020), individuals were more sedentary and reported increased anxiety and depression symptoms (P<.001), relative to the previous academic terms and subsequent academic breaks. Interactions between the Winter 2020 term and week of academic term (linear and quadratic) were significant. In a mixed linear model, phone usage, number of locations visited, and week of the term, were strongly associated with increased coronavirus-related news. When mental health metrics (e.g., depression and anxiety) were added to the previous measures (week of term, number of locations visited, and phone usage), both anxiety (P<.001) and depression (P=.029) were significantly associated with coronavirus-related news. CONCLUSIONS Compared with prior academic terms, individuals in Winter 2020 were more sedentary, anxious, and depressed. A wide variety of behaviors, including increased phone usage, decreased physical activity, and fewer locations visited, are associated with fluctuations in COVID-19 news reporting. While this large-scale shift in mental health and behavior is unsurprising, its characterization is particularly important to help guide the development of methods that could reduce the impact of future catastrophic events on the mental health of the population. CLINICALTRIAL

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Impact of the COVID-19 pandemic on psychological well-being of students in an Italian university: a web-based cross-sectional survey

Globalization and Health ◽

10.1186/s12992-021-00680-w ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Leonardo Villani ◽

Roberta Pastorino ◽

Enrico Molinari ◽

Franco Anelli ◽

Walter Ricciardi ◽

...

Keyword(s):

Mental Health ◽

University Students ◽

Well Being ◽

Depression Symptoms ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Psychological Well Being ◽

Self Rating ◽

The Impact

Abstract Background Italy was the first European country to implement a national lockdown because of the COVID-19 pandemic. Worldwide, this pandemic had a huge impact on the mental health of people in many countries causing similar reaction in terms of emotions and concerns at the population level. Our study investigated the impact of the COVID-19 pandemic on psychological well-being in a cohort of Italian university students. Methods We conducted a cross-sectional survey in the period immediately after the first lockdown through the administration of a questionnaire on the personal websites of students attending their undergraduate courses at the Università Cattolica del Sacro Cuore. We used the Patient-Health-Engagement-Scale, Self-Rating-Anxiety-Scale, and Self-Rating-Depression-Scale to assess engagement, anxiety symptoms, and depression symptoms of our sample. Results The sample size was 501 subjects, of which 35.33% were classified as anxious and 72.93% as depressed. Over 90% of respondents had good understanding of the preventive measures despite over 70% suffered from the impossibility of physically seeing friends and partners. Around 55% of students would have been willing to contribute much more to face the pandemic. An increase in the occurrences of anxiety was associated with being female, being student of the Rome campus, suffering from the impossibility of attending university, being distant from colleagues, and being unable of physically seeing one’s partner. Performing physical activity reduced this likelihood. Conclusion University students are at risk of psychological distress in the case of traumatic events. The evolution of the pandemic is uncertain and may have long-term effects on mental health. Therefore, it is crucial to study the most effective interventions to identify vulnerable subgroups and to plan for acute and long-term psychological services to control and reduce the burden of psychological problems.

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Heterogeneity in Symptoms in Depression - A replication study in a Digital Mental Health Intervention using the PHQ-9 Questionnaire (Preprint)

10.2196/preprints.31560 ◽

2021 ◽

Author(s):

Silvan Hornstein ◽

Valerie Forman-Hoffman ◽

Nicholas C. Peiper ◽

Markus J. Rantala

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Severe Depression ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Symptom Pattern ◽

Patient Health ◽

Symptom Patterns ◽

Treatment Procedures ◽

Core Symptoms

BACKGROUND Past work has shown massive variation in depressive symptoms between patients, challenging the perception of major depressive disorder (MDD) as being uniform. This appears quite relevant also for digital mental health (DMH) interventions. While individualization is one of the key potentials of these approaches, this is regularly not utilized and the same static depression treatment is offered to all patients. OBJECTIVE This paper aims to replicate the approach from Fried & Nesse (2015), analyzing the variation of depressive symptoms within 1757 participants in a DMH intervention for depression and anxiety. METHODS Participants’ answers to the single items of the Patient Health Questionnaire 9-item scale (PHQ-9) were used to identify distinct patterns out of the 9 core symptoms of the DSM-5. RESULTS Overall, the 1757 participants showed 231 different patterns of symptoms. The most regular pattern occurred for 8% of the patients. 85% of the participants had a symptom pattern that was shared with less than 4% of the whole sample. The number of unique symptom patterns per participant decreased with higher symptom severity, but the 342 patients with overall severe depression symptoms still exhibited 34 different constellations of single symptoms. CONCLUSIONS The large variation in symptoms challenges the assignment of static depression interventions in DMH and calls for more individualized treatment procedures. Luckily, such procedures can be implemented particularly easily in an app-based context, for example by modular program structures.

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