Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic | Depressive Disorders | JAMA Network Open | JAMA Network
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    2 Comments for this article
    EXPAND ALL
    Differentiating Depression From Anxiety and Lonelinesslinessymptoms
    Edward Volpintesta, MD | retired general practice
    Physicians may benefit more from this interesting study if some of the major depressive symptoms, besides anxiety and lack of sleep were included.
    For example mentioning anger, irritability, hopelessness, trouble thinking or concentrating, vague physical pains, reduced appetite, lack of energy and the many other symptoms associated with depression would have clarified how depression can be confused with loneliness and sadness both of which continue to afflict many in the Covid-19 pandemic.
    CONFLICT OF INTEREST: None Reported
    COVID-19: Depression, Should Also Consider Encephalopathy As a Cause.
    Gary Ordog, MD, DABEM, DABMT | County of Los Angeles, Department of Health Services, (retired)
    Thank you for your interesting study on depression during the COVID-19 pandemic. Your psychological and sociological examination provides evidence of major changes occurring in your subjects during this time. I will point out that you barely touched on the medical infection as a variable affecting your results. We are not given any data on this potential major confounding variable. "Encephalitis lethargica" was described in detail a hundred years ago during and after the 1918 pandemic. During the current pandemic there have been many medical reports of encephalopathic changes probably produced in the majority of patients during and after COVID-19 infections. One of the common symptoms of encephalopathy is depression. I agree with you that depression is a major consequence of the societal and psychological effects of the pandemic, but consideration must be given to what may be the major confounding and in this case contributing variable to depression, and that is SARS-Cov-2 encephalopathic changes. I have includes several current COVID-19 peer-reviewed medical references that support this premise. Thank you and stay safe.

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    Adeel S. Zubair, MD; Lindsay S. McAlpine, MD; Tova Gardin, MD, MPP; et alShelli Farhadian, MD, PhD; Deena E. Kuruvilla, MD; Serena Spudich, MD
    JAMA Neurol. 2020;77(8):1018-1027. doi:10.1001/jamaneurol.2020.2065

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    JAMA Neurol. 2020; 77(8):1028-1029. doi: 10.1001/jamaneurol.2020.2125

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    JAMA Neurol. 2020;77(6):679-680. doi:10.1001/jamaneurol.2020.1065

    Li Y-X, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may be at least partially responsible for the respiratory failure of COVID-19 patients.  J Med Virol. Published online February 26, 2020. doi:10.1002/jmv.25728

    Giacomelli A, Pezzati L, Conti F, et al. Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study.  Clin Infect Dis. 2020;ciaa330. doi:10.1093/cid/ciaa330

    Paniz-Mondolfi A, Bryce C, Grimes Z, et al. Central nervous system involvement by severe acute respiratory syndrome coronavirus–2 (SARS-CoV-2).  J Med Virol. 2020. Published online April 21, 2020.

    Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host-virus interaction, and proposed neurotropic mechanisms.  ACS Chem Neurosci. 2020;11(7):995-998. doi:10.1021/acschemneuro.0c00122

    Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China.  JAMA Neurol. April 10, 2020. doi:10.1001/jamaneurol.2020.1127

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    COVID-19: can we learn from encephalitis lethargica? Antonino Giordano, Ghil Schwarz, Laura Cacciaguerra, Federica Esposito, Massimo Filippi; The Lancet Neurology; July, 2020DOI:https://doi.org/10.1016/S1474-4422(20)30189-7
    CONFLICT OF INTEREST: None Reported
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    Original Investigation
    Public Health
    September 2, 2020

    Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic

    Author Affiliations
    • 1Boston University School of Public Health, Boston, Massachusetts
    • 2Brown University School of Public Health, Providence, Rhode Island
    • 3Columbia Mailman School of Public Health, New York, New York
    • 4Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
    JAMA Netw Open. 2020;3(9):e2019686. doi:10.1001/jamanetworkopen.2020.19686
    Key Points

    Question  What is the burden of depression symptoms among US adults during the coronavirus disease 2019 (COVID-19) pandemic compared with before COVID-19, and what are the risk factors associated with depression symptoms?

    Findings  In this survey study that included 1441 respondents from during the COVID-19 pandemic and 5065 respondents from before the pandemic, depression symptom prevalence was more than 3-fold higher during the COVID-19 pandemic than before. Lower income, having less than $5000 in savings, and having exposure to more stressors were associated with greater risk of depression symptoms during COVID-19.

    Meaning  These findings suggest that there is a high burden of depression symptoms in the US associated with the COVID-19 pandemic and that this burden falls disproportionately on individuals who are already at increased risk.

    Abstract

    Importance  The coronavirus disease 2019 (COVID-19) pandemic and the policies to contain it have been a near ubiquitous exposure in the US with unknown effects on depression symptoms.

    Objective  To estimate the prevalence of and risk factors associated with depression symptoms among US adults during vs before the COVID-19 pandemic.

    Design, Setting, and Participants  This nationally representative survey study used 2 population-based surveys of US adults aged 18 or older. During COVID-19, estimates were derived from the COVID-19 and Life Stressors Impact on Mental Health and Well-being study, conducted from March 31, 2020, to April 13, 2020. Before COVID-19 estimates were derived from the National Health and Nutrition Examination Survey, conducted from 2017 to 2018. Data were analyzed from April 15 to 20, 2020.

    Exposures  The COVID-19 pandemic and outcomes associated with the measures to mitigate it.

    Main Outcomes and Measures  Depression symptoms, defined using the Patient Health Questionnaire-9 cutoff of 10 or higher. Categories of depression symptoms were defined as none (score, 0-4), mild (score, 5-9), moderate (score, 10-14), moderately severe (score, 15-19), and severe (score, ≥20).

    Results  A total of 1470 participants completed the COVID-19 and Life Stressors Impact on Mental Health and Well-being survey (completion rate, 64.3%), and after removing those with missing data, the final during–COVID-19 sample included 1441 participants (619 participants [43.0%] aged 18-39 years; 723 [50.2%] men; 933 [64.7%] non-Hispanic White). The pre–COVID-19 sample included 5065 participants (1704 participants [37.8%] aged 18-39 years; 2588 [51.4%] women; 1790 [62.9%] non-Hispanic White). Depression symptom prevalence was higher in every category during COVID-19 compared with before (mild: 24.6% [95% CI, 21.8%-27.7%] vs 16.2% [95% CI, 15.1%-17.4%]; moderate: 14.8% [95% CI, 12.6%-17.4%] vs 5.7% [95% CI, 4.8%-6.9%]; moderately severe: 7.9% [95% CI, 6.3%-9.8%] vs 2.1% [95% CI, 1.6%-2.8%]; severe: 5.1% [95% CI, 3.8%-6.9%] vs 0.7% [95% CI, 0.5%-0.9%]). Higher risk of depression symptoms during COVID-19 was associated with having lower income (odds ratio, 2.37 [95% CI, 1.26-4.43]), having less than $5000 in savings (odds ratio, 1.52 [95% CI, 1.02-2.26]), and exposure to more stressors (odds ratio, 3.05 [95% CI, 1.95-4.77]).

    Conclusions and Relevance  These findings suggest that prevalence of depression symptoms in the US was more than 3-fold higher during COVID-19 compared with before the COVID-19 pandemic. Individuals with lower social resources, lower economic resources, and greater exposure to stressors (eg, job loss) reported a greater burden of depression symptoms. Post–COVID-19 plans should account for the probable increase in mental illness to come, particularly among at-risk populations.

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