High levels of depression found among Canadian older adults with cancer during the COVID-19 pandemic

Older adults who have had cancer had a high risk of experiencing symptoms of depression during the early months of the COVID-19 pandemic according to a study published in Cancer Management and Research.

The study was focused on a sample of 2,486 adults aged 50 and older with a history of cancer who participated in the Canadian Longitudinal Study on Aging. Among the 1,765 individuals from the study who had a history of cancer but no lifetime history of depression, researchers found that one in eight experienced depression for the first time during the early stages of the pandemic.

"The findings of our study indicate the substantial impact the pandemic had on the mental health of individuals with cancer," said first author Meghan Bird, research assistant at the Factor-Inwentash Faculty of Social work at the University of Toronto. "Even among those with no history of depression, the pandemic took a significant toll on worsening their mental health."

"Older adults with cancer also have to navigate the stress of being particularly vulnerable to severe COVID-19 related morbidity and mortality," said co-author Andie MacNeil, researcher in the Institute for Life Course and Aging at the University of Toronto.

"While strict adherence to lockdowns was an important step for many cancer patients to minimize their risk of COVID-19 infection, for many individuals this also meant forgoing social support, which is an important source of strength during cancer treatment and recovery."

When the researchers focused on the 786 individuals who had previously experienced depression, they found that approximately one-half of these individuals experienced a recurrence or persistence of depression during the COVID-19 pandemic.

"Older adults who experienced depression in the past were a particularly vulnerable subset of the population," said co-author Ying Jiang, Senior Epidemiologist at the Public Health Agency of Canada. She emphasized that "their difficulties were amplified if they had functional limitations, which doubled the odds of depression in this group."

Experiencing family conflict during the pandemic was associated with an approximate four-fold risk of both new and recurrent depression among older adults with a history of cancer. This finding is in keeping with research that has identified interpersonal conflict as a risk factor for depression among older adults. Other research indicates extended periods of lockdown and quarantine increase familial conflict.

"Of particular concern, the pandemic also reduced access to many coping strategies that can help mitigate family conflict, such as time spent outside the home and time spent with friends." said co-author Grace Li, Ph.D. candidate in the Sociology Department at the University of Victoria.

Incident depression (or depression experienced for the first time) was almost 50% higher among women. Gender roles may have contributed to this increased risk for depression.

"Women are more likely to take on time-consuming caretaking roles and household labor. This aligns with existing research which suggests that caretaking roles may be associated with an increased risk of depression," said co-author, Margaret de Groh, Scientific Manager at the Public Health Agency of Canada.

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

"Future research should continue to examine depression among older adults with cancer to better understand the pandemic's long-term impacts," Fuller-Thomson said.