Social determinants of major depressive disorder. Exploring the interplay of age, loneliness, and the COVID-19 pandemic

[eng] INTRODUCTION: Depression is a highly prevalent condition, recognized as one of the leading causes of years lived with disability worldwide. Its global prevalence continues to rise, with major depressive disorder (MDD) emerging as the most common form. MDD is significantly influenced by social determinants, particularly those related to interpersonal interactions. Social support and loneliness, representing objective and subjective dimensions of interpersonal relationships respectively, have been associated with depression, affecting its onset and severity. The COVID-19 pandemic and its containment measures reshaped social interactions and amplified socioeconomic inequalities. It led to heightened feelings of loneliness, altered social support networks, and exacerbated mental disorders symptoms, particularly depressive symptoms and MDD. Despite considerable attention from the scientific community, significant gaps persist in our understanding of the interplay between social determinants and depression. For instance, the way in which loneliness interacts with objective aspects of social relationships affecting the risk and disease course of MDD remains poorly understood. Similarly, the causes explaining the age differences in the impact of the COVID-19 pandemic on depression, as well as the effect of other social determinants, warrant deeper investigation. Based on these gaps, we have formulated the different hypotheses and objectives of the present thesis. HYPOTHESES: 1. Individuals with poor social support and experiencing loneliness are more likely to present a worse course of MDD. 2. Loneliness acts as a mediating factor in the association between social support and MDD. 3. The risk of MDD increased during the pandemic, particularly among younger adults. 4. The different risks of MDD by age group might be explained by disparities on the impact of the pandemic on social relationships and socioeconomic conditions. 5. Younger adults with pre-pandemic mental disorders (PPMD) were the most affected by loneliness during pandemic. 6. The impact of loneliness on depression during the pandemic was higher among younger adults with PPMD. 7. While many cases of loneliness during the pandemic were transient, a portion of the population will continue to experience persistent levels of loneliness and depressive symptoms. 8. Individuals who have shown greater vulnerability to loneliness during the pandemic (young adults, with PPMD, and a low socioeconomic status) are at higher risk of experiencing chronic courses of loneliness after the pandemic.[cat] INTRODUCCIÓ: La depressió és una condició altament prevalent i una de les principals causes d'anys viscuts amb discapacitat a nivell mundial. La seva prevalença global continua augmentant, amb el trastorn depressiu major (TDM) com la forma més comuna. El TDM està significativament influït pels determinants socials, especialment aquells relacionats amb les interaccions socials. El suport social i la soledat, representant dimensions objectives i subjectives de les relacions interpersonals, s'han associat amb la depressió, afectant-ne la incidència i la gravetat. La pandèmia de la COVID-19 i les mesures de contenció han modificat les interaccions socials i estès les desigualtats socioeconòmiques, fomentant els sentiments de soledat, alteracions en les xarxes de suport social i l’empitjorament de la salut mental, especialment els símptomes depressius i el TDM. Malgrat la investigació científica en aquest àmbit, persisteixen mancances significatives en el coneixement sobre la interacció dels determinants socials amb la depressió. Per exemple, cal entendre millor com la soledat interacciona amb els aspectes objectius de les relacions socials afectant el risc del TDM i, concretament, el seu curs. O les causes que expliquen les diferències d'edat en l'impacte de la pandèmia de la COVID-19 en la depressió, així com l'efecte d'altres determinants socials. Basant-nos en aquestes mancances, hem formulat les diferents hipòtesis i objectius del nostre estudi. HIPÒTESIS: 1. Les persones amb un suport social pobre i sentiments de soledat tenen més probabilitats de presentar un curs pitjor del TDM. 2. La soledat actua com a factor mediador en l'associació entre el suport social i el TDM. 3. El risc del TDM va augmentar durant la pandèmia, especialment entre les persones més joves. 4. La diferència en el risc de TDM per grup d'edat s’explica per les disparitats en l'impacte de la pandèmia en les relacions socials i les condicions socioeconòmiques. 5. Les persones joves amb trastorns mentals pre-pandèmics (TMPP) van ser les més afectades per la soledat durant la pandèmia. 6. L'impacte de la soledat en la depressió durant la pandèmia va ser més elevat entre les persones joves amb TMPP. 7. Tot i que molts casos de soledat durant la pandèmia són transitoris, una part de la població continuarà experimentant nivells persistents de soledat i símptomes depressius. 8. Les persones que han mostrat una major vulnerabilitat a la soledat durant la pandèmia (joves, amb TMPP i baix nivell socioeconòmic) tindran un major risc de patir cursos crònics de soledat després de la pandèmia

Chronic and transient loneliness in Western countries: risk factors and association with depression. A two-year follow-up study

Introduction. Our aim was to test risk factors for chronic and transient loneliness as well as cross-sectional and longitudinal associations of courses of loneliness with depression. Methods. Responses from participants in Wave 5 (T1, 2013) and Wave 6 (T2, 2015) of The Survey of Health, Ageing and Retirement in Europe (SHARE) (N=45,490) were analyzed. The existence of clinically significant symptoms of depression was defined as reporting a value≥4 on the Euro-D scale. Loneliness was measured through the 3-item UCLA loneliness scale and a single question. Both measures were tested in separate regression models to identify risk factors for transient (loneliness at T1) and chronic (loneliness at T1 and T2) loneliness as well as their associations with depression. Results. Chronic loneliness was observed in 47% to 40% of the cases, according to the UCLA scale and the single question, respectively. Risk factors for chronic loneliness in both models were being female, not being married, having a low educational level, having poor mental and physical health, being limited in activities, having a poor social network, and living in a culturally individualistic country. Risk factors for transient loneliness were less robust and no significant effects were found for variables such as sex and physical health, education level in the UCLA measure model, and social network size in the single question model. Chronic loneliness also showed a strong association with depression in the cross-sectional model and a marked one in the longitudinal model. Conclusion. The courses of loneliness are relevant in the study of its risk factors and association with depressio

The Association of Social Support and Loneliness with Symptoms of Depression, Anxiety, and Posttraumatic Stress during the COVID-19 Pandemic: A Meta-Analysis

Background: Research suggests that changes in social support and loneliness have affected mental disorder symptoms during the COVID-19 pandemic. However, there are a lack of studies comparing the robustness of these associations. Aims: The aims were to estimate the strength of the associations of loneliness and social support with symptoms of depression, anxiety, and posttraumatic stress during the COVID-19 pandemic (2020–2022) in the general population. Method: The method entailed a systematic review and random-effects meta-analysis of quantitative studies. Results: Seventy-three studies were included in the meta-analysis. The pooled correlations of the effect size of the association of loneliness with symptoms of depression, anxiety, and posttraumatic stress were 0.49, 0.40, and 0.38, respectively. The corresponding figures for social support were 0.29, 0.19, and 0.18, respectively. Subgroup analyses revealed that the strength of some associations could be influenced by the sociodemographic characteristics of the study samples, such as age, gender, region, and COVID-19 stringency index, and by methodological moderators, such as sample size, collection date, methodological quality, and the measurement scales. Conclusions: Social support had a weak association with mental disorder symptoms during the COVID-19 pandemic while the association with loneliness was moderate. Strategies to address loneliness could be highly effective in reducing the impact of the pandemic on social relationships and mental health

The Association of Social Support and Loneliness with Symptoms of Depression, Anxiety, and Posttraumatic Stress during the COVID-19 Pandemic: A Meta-Analysis

Background: Research suggests that changes in social support and loneliness have affected mental disorder symptoms during the COVID-19 pandemic. However, there are a lack of studies comparing the robustness of these associations. Aims: The aims were to estimate the strength of the associations of loneliness and social support with symptoms of depression, anxiety, and posttraumatic stress during the COVID-19 pandemic (2020–2022) in the general population. Method: The method entailed a systematic review and random-effects meta-analysis of quantitative studies. Results: Seventy-three studies were included in the meta-analysis. The pooled correlations of the effect size of the association of loneliness with symptoms of depression, anxiety, and posttraumatic stress were 0.49, 0.40, and 0.38, respectively. The corresponding figures for social support were 0.29, 0.19, and 0.18, respectively. Subgroup analyses revealed that the strength of some associations could be influenced by the sociodemographic characteristics of the study samples, such as age, gender, region, and COVID-19 stringency index, and by methodological moderators, such as sample size, collection date, methodological quality, and the measurement scales. Conclusions: Social support had a weak association with mental disorder symptoms during the COVID-19 pandemic while the association with loneliness was moderate. Strategies to address loneliness could be highly effective in reducing the impact of the pandemic on social relationships and mental health

La influencia del duelo en la salud mental y el papel de la soledad durante la pandemia de COVID-19

Previous research found that bereavement is associated with several pathological responses affecting both physical and mental health. During the COVID-19 pandemic and the socially disruptive measures implemented, losses of close contacts have occurred under exceptional circumstances, and it is reasonable to expect that many bereaved people would be unable to overcome their loss adaptively, resulting in dysfunctional grief leading to mental health alterations. Loneliness, which has increased during the pandemic, has been identified as a significant risk factor for mental health that is common when people grieve. In this study, we aimed to gauge the effects of bereavement on mental health in the context of the COVID-19 pandemic and to explore the mediating role of loneliness on the relationship between grief and mental health alterations by surveying a representative sample of 2000 Spanish adults interviewed by phone during the pandemic (February-March 2021). Logistic regressions were performed to examine the effects of grief levels on depression, anxiety, panic attacks, post-traumatic stress disorder, substance abuse, and suicidal thoughts and behaviors. Our results confirmed that how the loss of a loved one is processed is associated with the development of mental health conditions. Dysfunctional grief was significantly associated with all mental health conditions, particularly depression (OR = 14.28) and anxiety (OR = 11.61). As predicted, loneliness accounted for a substantial percentage (8-30%) of the impact of grief on mental health outcomes.Diversas investigaciones muestran que el proceso de duelo se asocia con una variedad de respuestas patológicas tanto a nivel mental como físico. Durante la pandemia de COVID-19 y las medidas restrictivas implementadas, se han producido pérdidas de personas cercanas en condiciones excepcionales. Es razonable pensar que muchas de las personas que estan en proceso de duelo no puedan superar su pérdida de una forma adaptativa, y que esto conlleve dificultades para procesar el duelo conducentes a alteraciones de su salud mental. La soledad, que se incrementó durante la pandemia, se ha identificado com un factor de riesgo significativo para la salud mental que resulta común para las personas que están en duelo. En este estudio, nos propusimos estimar los efectos del proceso de duelo en la salud mental en el contexto de la pandemia de COVID-19 y explorar el posible papel mediador de la soledad en la relación entre duelo y salud mental. Para ello, se realizaron encuestas en una muestra española representativa de 2000 personas adultas entrevistadas por teléfono durante la pandemia (Febrero-Marzo de 2021). Con estos datos, se realizaron regresiones logísticas para examinar los efectos del duelo en la depresión, ansiedad, ataques de pánico, estrés postraumático, abuso de substancias, y pensamientos y conductas suicidas. Nuestros resultados confirmaron que la forma en la que se procesa la pérdida de un ser querido influye en la salud mental de las personas. Las dificultades para elaborar el duelo resultaron asociadas de forma más significativa a la depresión (OR = 14.28) y ansiedad (OR = 11.61). Según se había previsto, la soledad explicó un porcentaje substancial (8-30%) del impacto del duelo disfuncional en los indicadores de salud mental. Nuestros resultados sugieren que, a la hora de abordar las consecuencias en la salud mental de la pandemia de COVID-19, los profesionales deberían considerar el papel del duelo y la soledad como objetos de evaluación y tratamiento

The association of age with depression, anxiety, and posttraumatic stress symptoms during the COVID-19 pandemic in Spain: The role of loneliness and prepandemic mental disorder

Objective: Older adults may be at lower risk of common mental disorders than younger adults during the coronavirus disease 2019 (COVID-19) pandemic. Previous research has shown shown differences by age in psychosocial well-being during the pandemic and have highlighted the moderating effect of prepandemic mental disorders on that association. In this line, we examined the association of age with self-reported symptoms of loneliness, depression, anxiety, and posttraumatic stress, as well as potential roles of loneliness symptoms and prepandemic mental disorders on the association between age and mental disorder symptoms. Methods: Cross-sectional data of 2000 adults in Spain interviewed by telephone during the COVID-19 pandemic (February-March 2021) were analyzed. Depression, anxiety, and posttraumatic stress were measured with the eight-item Patient Health Questionnaire, the seven-item Generalized Anxiety Disorder Scale, and the four-item checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), respectively. Loneliness was measured with the three-item University of California at Los Angeles Loneliness Scale. Several regression models were constructed to assess factors related to loneliness and mental disorders. Results: According to cutoff points used, 12.4% of participants revealed depression, 11.9% revealed anxiety, and 11.6% revealed posttraumatic stress. Age was negatively related to mental disorder symptoms and loneliness. Loneliness was associated with higher levels of mental disorder symptoms. This association was stronger in younger adults without prepandemic mental disorders and in older adults with them. The association between age and loneliness was stronger in those with prepandemic mental disorders. Loneliness mediated the association of age with mental disorder symptoms. Conclusions: Interventions focused on loneliness could alleviate the impact of the COVID-19 pandemic on mental health.This work was supported by the Instituto de Salud Carlos III (ISCIII), Ministry of Science, Innovation and Universities, Government of Spain (MCIU), (grant number COV20/00711). Philippe Mortier has a Sara Borrell research contract awarded by the ISCIII (CD18/00049). Aina Gabarrell-Pascuet’s work is supported by the Secretariat of Universities and Research of the Generalitat de Catalunya and the European Social Fund (2021 FI_B 00839). Joan Domènech-Abella has a ‘Juan de la Cierva’ research contract awarded by the MCIU (FJC2019-038955-I). His work is also supported by the Centro de Investigación Biomédica Red de Salud Mental (CIBERSAM) and the PGC2018-094324-B-I00 research project, funded by the MCIU, the State Research Agency (AEI), and the European Regional Development Fund (ERDF)

The impact of COVID-related perceived stress and social support on generalized anxiety and major depressive disorders: moderating effects of pre-pandemic mental disorders

Background: We assessed the moderating effect of pre-pandemic mental disorders on the association of COVID-related perceived stress and social support with mental health. Methods: A nationally representative sample of 3500 Spanish adults was interviewed in June 2020 (mean age 49.25 years, ± 15.64; 51.50% females). Mental health included Generalized Anxiety Disorders (GAD; GAD-7, cut-off point of ≥ 10), Major Depressive Disorders (MDD; PHQ-8, cut-off point of ≥ 10) and the comorbid form (those screening positive for GAD and MDD). COVID-related stress was assessed using an adapted version of the Peri Life Events Scale, and social support using the Oslo Social Support Scale. Logistic regression models were used to assess if COVID-related stress and social support were related to mental health outcomes and interactions were conducted to examine whether these relationships differed according to the presence of pre-pandemic mental disorders. Results: Higher COVID-related stress was associated with a higher risk of lower mental health. The association between COVID-related stress with GAD and MDD was significantly moderated by pre-pandemic mental disorders, except for comorbid GAD + MDD. Higher levels of social support were linked to better mental health. Only the association between social support and GAD was significantly moderated by pre-pandemic mental disorders. That is, for those without pre-pandemic mental disorders, higher levels of social support decreased the odds of GAD, while minor decreases were observed in those with pre-pandemic mental disorders. Conclusions: The impact of COVID-related stress and social support on specific indicators of mental health may vary depending on the existence of a previous mental disorder

Factors Associated with Depression and Anxiety Symptoms among Migrant Population in Spain during the COVID-19 Pandemic

Migrants are likely to experience mental health conditions, being one of the most vulnerable groups during the COVID-19 pandemic. The present study aims to: (1) estimate the prevalence of depressive and anxious symptoms and (2) examine the impact of risk and protective factors on this symptomatology. A sample of 129 migrants living in Spain during the COVID-19 pandemic completed an anonymous online survey, including information on sociodemographic and individual characteristics, migration, basic needs, social environment and perceived health domains. Multiple Poisson regression models analysed the effects of risk and protective factors on depression and anxiety symptoms. The prevalence of depressive and anxiety symptoms was 22.3% and 21.4%, respectively. Risk factors such as living in a rented house and previous mental health conditions were associated with higher depression symptoms, whereas unemployment was related to anxiety symptoms. Conversely, older age, better self-esteem, and higher levels of social support were associated with fewer depression symptoms. Older age and better quality of life were related to fewer anxiety symptoms. These findings addressing risk and protective factors (e.g., social support, self-esteem) help to design culturally effective programs, particularly in migrants with pre-existing mental health conditions, adjusting the organisation of mental healthcare services in difficult times in Spain