Older adults with asthma at high risk for depression during the COVID-19 pandemic

A recent, prospective study of approximately 2,000 older adults in Canada published online this month in the journal Respiratory Medicine found that older adults with asthma were at high risk of depression during the COVID-19 pandemic.

For older adults with asthma who had experienced depression in the past, the numbers were extremely worrying, with approximately one-half experiencing a recurrence of depression during the autumn of 2020, which was significantly higher than recurrence rates among their peers who did not have asthma. Those who were lonely had substantially elevated rates of depression.

"When considering the high comorbidity between asthma and depression prior to the pandemic, combined with the loneliness associated with extended periods of lockdown and the stress over being labeled high risk for severe COVID-19-related outcomes, it is unsurprising that this population experienced a precipitous decline in mental health during the pandemic", says first author, Andie MacNeil, a research assistant at the Factor-Inwentash Faculty of Social Work (FIFSW) and the Institute for Life Course and Aging, University of Toronto.

The sample came from the Canadian Longitudinal Study on Aging, a national longitudinal study of older Canadian. By using longitudinal data, this study was able to differentiate among the 2,017 respondents with asthma, between those with a pre-pandemic history of depression (n=770) and those who had never experienced depression prior to the pandemic (n=1247).

Although respondents with a history of depression had the highest risk, 1 in 7 of those who had no pre-pandemic history of depression were depressed during the autumn of 2020, highlighting the toll the pandemic took on many formerly mentally healthy older adults with asthma.

"The pandemic has had detrimental consequences for the mental health of older adults, particularly those who are also navigating chronic health conditions, such as asthma," says co- author Grace Li, a Ph.D. candidate at the University of Victoria. "It is important for clinicians and healthcare professionals to be screening for depressive symptoms among their patients with asthma, even among those who have not showed signs of depression in the past."

While there is a growing body of research indicating high rates of depression during the pandemic, few studies prior to this have focused specifically on the vulnerabilities among those with asthma. The researchers identified several factors that were associated with a higher risk of depression among this population, such as experiencing disruptions to healthcare access. These findings can help to inform critical points of intervention to support this population.

"The pandemic severely disrupted access to healthcare services, which may be especially detrimental for older adults with chronic illness, including asthma," says senior author Professor Esme Fuller-Thomson at University of Toronto's FIFSW and director of the Institute for Life Course & Aging. "This emphasizes the critical importance of ensuring healthcare remains accessible, even in the absence of in-person services."

Respondents with asthma who experienced an increase in family conflict during the pandemic were also found to have a higher risk of depression by autumn 2020.

"High levels of family conflict are already a known risk factor for depression in later life. The pandemic had the added effect of severely disrupting coping mechanisms that can help buffer interpersonal conflict, such as social support and time spent outside the home, resulting in increases in depression," says co-author Ying Jiang, Senior Epidemiologist at the Public Health Agency of Canada,

The researchers also found that experiencing a loss of income or an inability to access necessary supplies or food during the pandemic was associated with depression among those with asthma.

"The economic precarity and income loss particularly early in the pandemic had devastating effects on many Canadian households with ramifications for mental well-being" says co-author Margaret de Groh, Scientific Manager at the Public Health Agency of Canada.

The study was published in the journal Respiratory Medicine. The study included 2,017 participants of the Canadian Longitudinal Study on Aging (CLSA) with asthma, who provided data at the baseline wave (2011–2015), follow-up 1 wave (2015–2018), and during the pandemic (September–December 2020). This research was supported, in part, by the Canadian Institutes of Health Research (CIHR) grant #172862. (PI Esme Fuller-Thomson).

"As life gradually returns to normal following the pandemic, it is still important to consider the potential longstanding mental health effects," said MacNeil. "We hope these findings can help inform targeted screening and referral to efficacious treatments such as cognitive behavioral therapy to support older adults with asthma who are experiencing depression"