Canadian older adults with COPD faced high levels of depression during the COVID pandemic

A new longitudinal study published online in the International Journal of Chronic Obstructive Pulmonary Disease found that older adults with COPD had a heightened risk of depression during the early stages of the COVID-19 pandemic.

Researchers examined a sample of 875 individuals with chronic obstructive pulmonary disease (COPD) from the Canadian Longitudinal Study on Aging, a national study of Canadian older adults. Using longitudinal data, researchers were able to differentiate between 369 respondents with COPD who had a pre-pandemic history of depression and 506 respondents who had never experienced depression prior to the pandemic.

Among individuals with COPD who had no lifetime history of depression, researchers found that one in six experienced depression for the first time during the early stages of the pandemic. These findings highlight the toll that the pandemic took on many individuals who had been free from depression prior to COVID-19.

"Our findings highlight the substantial burden of COVID-19 on those who were mentally healthy prior to the pandemic," said first author Aneisha Taunque, research assistant at the Institute for Life Course and Aging at the University of Toronto. "It is evident that the pandemic has had a detrimental impact on the mental health of many individuals, even those who had no lifetime history of depression."

When the analysis was restricted to those who had a history of depression prior to the pandemic, the prevalence of depression was substantially higher, with approximately one-half of these individuals experiencing a recurrence or persistence of depression during the autumn of 2020.

"Older adults who have a history of depressive episodes are a highly vulnerable subset of the population, particularly those who faced numerous challenges with managing their chronic health conditions during the pandemic when access to regular health care was severely disrupted," said co-author Grace Li, Ph.D. candidate in the Sociology Department at the University of Victoria.

"The COVID-19 pandemic further exacerbated the risk of depression among those with COPD," says co-author Ishnaa Gulati, a Master of Public Health Student at the University of Toronto's Dalla Lana School of Public Health.

"There was already an established higher risk of depression among individuals with COPD when compared to those without COPD prior to the pandemic," Gulati said.

"When considering the mental health stressors during the pandemic, such as extended periods of lockdown, economic precarity, and concerns about contracting or spreading COVID-19, it is unsurprising that this group experienced major mental health challenges during this period."

Although there is a burgeoning body of research examining depression during the pandemic, very little research has specifically examined the vulnerabilities among those with COPD. Understanding the risk factors for depression in subpopulations of older adults can aid health professionals in more effectively targeting treatment.

The study's researchers highlighted several risk factors for both incident and recurrent depression among those with COPD, including loneliness, family conflict, and functional limitations.

"We found that experiencing functional limitations approximately doubled the risk of depression among older adults with COPD," said co-author Ying Jiang, Senior Epidemiologist at the Public Health Agency of Canada.

"Physical activity is integral for maintaining functional status and reducing functional limitations among COPD patients, however many individuals with COPD are hesitant to engage in physical activity. Increases in time spent sedentary during periods of lockdown may have further ramifications for this population, potentially contributing to increases in depression."

Women with COPD also had nearly double the risk of recurrent depression when compared to their male counterparts.

"During the pandemic, many women experienced an exacerbation of gendered roles, such as increased time spent care-giving and doing household labor, which may have contributed to declines in their mental health," said co-author Margaret de Groh, Scientific Manager at the Public Health Agency of Canada.

Among individuals with no history of depression, experiencing disruptions to health care access was associated with approximately double the risk of incident depression.

"Many people with COPD encountered difficulties accessing pulmonary rehabilitation services during the pandemic, which are essential for supporting both the physical and mental health of COPD patients," said co-author Andie MacNeil, research assistant at the University of Toronto's Factor Inwentash Faculty of Social Work (FIFSW).

"Our finding that disruptions to health care access were associated with incident depression highlights the reverberating consequences when health care is inaccessible."

Senior author, Esme Fuller-Thomson, a Professor at FIFSW and Director of the Institute for Life Course & Aging says she hopes the study's findings can help inform health care workers and social service providers about the pandemic's impact on the mental health of people with COPD.

"Future research should continue to examine depression among older adults with COPD to better understand the pandemic's cascading impact, even in the post-COVID era," Fuller-Thomson said.