Study highlights the mental health impact of COVID-19 on older adults with a history of stroke

A new longitudinal study from the University of Toronto highlights the significant mental health toll of the COVID-19 pandemic on older adults with a history of stroke.

Researchers examined a sample of more than 500 older adults with a history of stroke from the Canadian Longitudinal Study on Aging, a large dataset of older Canadians. Their findings showed that high levels of depression were occurring in this population during the COVID-19 pandemic.

People who have had a stroke are already highly susceptible to negative mental health outcomes such as depression. Unfortunately, the pandemic has caused many disruptions to the care of stroke patients, significantly impacting this population’s physical and mental health. ”

Andy McNeil, first author, research assistant at the Factor Inwentash Faculty of Social Work (FIFSW), University of Toronto

Using longitudinal data, researchers were able to distinguish between respondents with a history of depression and those who had never experienced depression before the pandemic. They found that one in seven older adults with a history of stroke experienced depression for the first time during the pandemic. When restricting the analysis to people with a history of depression, the prevalence was much higher, with 1 in 2 of them experiencing a relapse or persistence of depression during the pandemic.

“Our findings highlight that even among people who were mentally healthy before the pandemic, many stroke survivors were experiencing difficulties during the lockdown period,” said co-author and University of Victoria Society said Grace Lee, an undergraduate doctoral candidate. “These findings highlight the importance of screening for depressive symptoms in older adults with a history of stroke, even those without a lifetime history of depression.”

The researchers also looked at risk factors for both first-time and recurrent depression. Among respondents with a history of depression, the risk of depression during the pandemic was associated with approximately double the risk of functional impairment.

“Older adults with a lifetime history of both stroke and depression are, unsurprisingly, a population that was at particularly high risk of experiencing depression during the pandemic. Functional status may play an important role in this relationship. ,” co-author Aneisha Taunk said. Research Assistant at the University of Toronto’s Institute for Life Course and Aging. “A vast amount of research has demonstrated that post-stroke functional impairment significantly increases the risk of depression. Unfortunately, the pandemic has caused many disruptions to rehabilitation services, leading to a worsening of the functional status of this population. It may lead to.”

Respondents who had difficulty accessing regular health care services had more than three times the risk of developing depression.

“In addition to disrupting rehabilitation services, the pandemic has also caused other stressors for stroke patients, such as delays in follow-up appointments and intravenous thrombolysis,” said co-author and University of Toronto Dalla Lana Master of Public Health student. reported Ishnaa Gulati, a student. School of Public Health. “Experiencing health care access challenges can be extremely stressful, especially for people with complex health needs. Our findings highlight the impact that continuity of care has on mental health. I am.”

Older people with a history of stroke and who often felt lonely early in the pandemic were more likely to develop new depression than those who felt less lonely. “There is robust literature showing that loneliness is a major risk factor for depression. Because they are at high risk for serious outcomes from COVID-19, stroke patients should adhere to physical distancing recommendations and socialize. “Limiting social interactions may have made people more cautious, potentially increasing feelings of loneliness and social isolation,” said FIFSW professor and director of the Institute for Life Course and Aging. said Esme Fuller-Thomson, senior author.

They also found that among respondents with no history of depression, immigrant status approximately tripled the risk of developing depression.

“Early in the pandemic, disproportionately high rates of COVID-19-related morbidity and mortality were observed in Canadian communities with a large immigrant population, leading to psychological stress among people in these communities. is likely to be increasing,” said Ying Jiang, a senior epidemiologist. Public Health Agency of Canada.

Family stressors, such as separation from family members and caregiving challenges, were found to increase the risk of both relapse and recurrence of depression.

“People who have experienced a stroke may rely on support from loved ones to help them recover. For many families, the pandemic has created significant caregiving challenges and concerns about illness and coronavirus infection. “It has created a situation where loved ones are separated,” he said.

Margaret de Grau, Scientific Manager, Public Health Agency of Canada. “We found that this significantly increased the risk of depression in this population.”

The researchers also conducted a sensitivity analysis to examine the incidence of depression and the prevalence of recurrent depression in people who suffered a stroke during the two pre-pandemic periods. They found that the prevalence of depression was significantly lower in the pre-pandemic period, highlighting the unique impact of COVID-19 on the mental health status of this population.

“Our study helps inform clinicians about some of the important risk factors for depression in patients with a history of stroke,” said Dr. Fuller-Thomson. “We hope these results will help inform targeted screening and interventions and, in turn, support the mental health of this population.”