BACKGROUND: Numerous studies reported higher levels of mental health issues during the COVID-19 pandemic but only a minority used repeated measurements. We investigated change in depressive symptoms in the Czech ageing cohort and the impact of pre-existing and COVID-19-related stressors. METHODS: We used data on 2853 participants (mean age 73.4 years) from the Czech part of the prospective Health, Alcohol and Psychosocial factors In Eastern Europe cohort that participated in postal questionnaire surveys before (September 2017-June 2018) and during the pandemic (October 2020-April 2021). Participants reported their depressive symptoms using the Centre for Epidemiological Studies-Depression Scale including 10 (CESD-10) tool. A principal component analysis (PCA) was used to create representative components of the pandemic-related stressors. The impact of the stressors on change in depressive symptoms was tested using multivariable linear regression, after adjustment for age and potential confounders. RESULTS: Three patterns of the pandemic-related stressors ('financial stressors', 'social and perception stressors' and 'death and hospitalisation stressors') were extracted from the PCA. The mean CESD-10 score increased from 4.90 to 5.37 (p<0.001). In fully adjusted models, significantly larger increases in depression score were reported by older people (β=0.052; p=0.006), those with poor self-rated health (β=0.170; p<0.001), those who experienced death or hospitalisation of a close person (β=0.064; p<0.001), social deprivation (β=0.057; p<0.001), delays in healthcare (β=0.048; p=0.005) and those who suffered from COVID-19 (β=0.045; p=0.008). CONCLUSION: This study confirms an increase in depressive symptoms in older persons during the pandemic and identified several pandemic-related risk factors suggesting that public health policies should address this vulnerable group by adopting the preventing strategies.

Department of Epidemiology and Public Health University College London London UK

National Institute of Public Health Prague Czech Republic

RECETOX Faculty of Science Masaryk University Brno Czech Republic

See more in PubMed

GBD 2019 Mental Disorders Collaborators . Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019. Lancet Psychiatry 2022;9:137–50. 10.1016/S2215-0366(21)00395-3 PubMed DOI PMC

Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed 2020;91:157–60. 10.23750/abm.v91i1.9397 PubMed DOI PMC

Holmes EA, O'Connor RC, Perry VH, et al. . Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry 2020;7:547–60. 10.1016/S2215-0366(20)30168-1 PubMed DOI PMC

Müller F, Röhr S, Reininghaus U, et al. . Social isolation and loneliness during COVID-19 Lockdown: associations with depressive symptoms in the German old-age population. Int J Environ Res Public Health 2021;18:3615. 10.3390/ijerph18073615 PubMed DOI PMC

Fruehwirth JC, Biswas S, Perreira KM. The Covid-19 pandemic and mental health of first-year college students: examining the effect of Covid-19 stressors using longitudinal data. PLoS One 2021;16:e0247999. 10.1371/journal.pone.0247999 PubMed DOI PMC

Li Y, Zhao J, Ma Z, et al. . Mental health among college students during the COVID-19 pandemic in China: a 2-Wave longitudinal survey. J Affect Disord 2021;281:597–604. 10.1016/j.jad.2020.11.109 PubMed DOI

Novotný JS, Gonzalez-Rivas JP, Kunzová Šárka, et al. . Risk factors underlying COVID-19 Lockdown-Induced mental distress. Front Psychiatry 2020;11:603014. 10.3389/fpsyt.2020.603014 PubMed DOI PMC

Saragih ID, Tonapa SI, Saragih IS, et al. . Global prevalence of mental health problems among healthcare workers during the Covid-19 pandemic: a systematic review and meta-analysis. Int J Nurs Stud 2021;121:104002. 10.1016/j.ijnurstu.2021.104002 PubMed DOI PMC

Bruine de Bruin W. Age differences in COVID-19 risk perceptions and mental health: evidence from a national U.S. survey conducted in March 2020. Journals Gerontol Ser B 2021;76:e24–9. 10.1093/geronb/gbaa074 PubMed DOI PMC

Kivi M, Hansson I, Bjälkebring P. Up and about: older adults' well-being during the COVID-19 pandemic in a Swedish longitudinal study. J Gerontol B Psychol Sci Soc Sci 2021;76:e4–9. 10.1093/geronb/gbaa084 PubMed DOI PMC

Dalecká A, Šlachtová H, Tomášková H, et al. . Perception of health risk and compliance with preventive measures related to COVID-19 in the Czech population: preliminary results of a rapid questionnaire survey. Int J Occup Med Environ Health 2021;34:165–76. 10.13075/ijomeh.1896.01747 PubMed DOI

Röhr S, Reininghaus U, Riedel-Heller SG. Mental wellbeing in the German old age population largely unaltered during COVID-19 lockdown: results of a representative survey. BMC Geriatr 2020;20:489. 10.1186/s12877-020-01889-x PubMed DOI PMC

Chan S-M, Chung GK-K, Chan Y-H, et al. . Resilience and coping strategies of older adults in Hong Kong during COVID-19 pandemic: a mixed methods study. BMC Geriatr 2022;22:299. 10.1186/s12877-022-03009-3 PubMed DOI PMC

Zhou F, Yu T, Du R, et al. . Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054–62. 10.1016/S0140-6736(20)30566-3 PubMed DOI PMC

Porter C, Favara M, Hittmeyer A, et al. . Impact of the COVID-19 pandemic on anxiety and depression symptoms of young people in the global South: evidence from a four-country cohort study. BMJ Open 2021;11:e049653. 10.1136/bmjopen-2021-049653 PubMed DOI PMC

Courtin E, Knapp M. Social isolation, loneliness and health in old age: a scoping review. Health Soc Care Community 2017;25:799–812. 10.1111/hsc.12311 PubMed DOI

Bailey L, Ward M, DiCosimo A, et al. . Physical and mental health of older people while cocooning during the COVID-19 pandemic. QJM 2021;114:648–53. 10.1093/qjmed/hcab015 PubMed DOI PMC

Perrig-Chiello P, Spahni S, Höpflinger F, et al. . Cohort and gender differences in psychosocial adjustment to later-life Widowhood. J Gerontol B Psychol Sci Soc Sci 2016;71:765–74. 10.1093/geronb/gbv004 PubMed DOI

Handing EP, Strobl C, Jiao Y, et al. . Predictors of depression among middle-aged and older men and women in Europe: a machine learning approach. Lancet Reg Health Eur 2022;18:100391. 10.1016/j.lanepe.2022.100391 PubMed DOI PMC

Vink D, Aartsen MJ, Schoevers RA. Risk factors for anxiety and depression in the elderly: a review. J Affect Disord 2008;106:29–44. 10.1016/j.jad.2007.06.005 PubMed DOI

Zaninotto P, Iob E, Demakakos P, et al. . Immediate and longer-term changes in the mental health and well-being of older adults in England during the COVID-19 pandemic. JAMA Psychiatry 2022;79:151–9. 10.1001/jamapsychiatry.2021.3749 PubMed DOI PMC

van Tilburg TG, Steinmetz S, Stolte E, et al. . Loneliness and mental health during the COVID-19 pandemic: a study among Dutch older adults. J Gerontol B Psychol Sci Soc Sci 2021;76:e249–55. 10.1093/geronb/gbaa111 PubMed DOI PMC

Mendez-Lopez A, Stuckler D, McKee M, et al. . The mental health crisis during the COVID-19 pandemic in older adults and the role of physical distancing interventions and social protection measures in 26 European countries. SSM Popul Health 2022;17:101017. 10.1016/j.ssmph.2021.101017 PubMed DOI PMC

Peasey A, Bobak M, Kubinova R, et al. . Determinants of cardiovascular disease and other non-communicable diseases in central and eastern Europe: rationale and design of the HAPIEE study. BMC Public Health 2006;6:255. 10.1186/1471-2458-6-255 PubMed DOI PMC

Andresen EM, Malmgren JA, Carter WB, et al. . Screening for depression in well older adults: evaluation of a short form of the CES-D. Am J Prev Med 1994;10:77–84. 10.1016/S0749-3797(18)30622-6 PubMed DOI

Björgvinsson T, Kertz SJ, Bigda-Peyton JS, et al. . Psychometric properties of the CES-D-10 in a psychiatric sample. Assessment 2013;20:429–36. 10.1177/1073191113481998 PubMed DOI

Creese B, Khan Z, Henley W, et al. . Loneliness, physical activity, and mental health during COVID-19: a longitudinal analysis of depression and anxiety in adults over the age of 50 between 2015 and 2020. Int Psychogeriatr 2021;33:505–14. 10.1017/S1041610220004135 PubMed DOI PMC

Kekäläinen T, Hietavala E-M, Hakamäki M, et al. . Personality traits and changes in health behaviors and depressive symptoms during the COVID-19 pandemic: a longitudinal analysis from Pre-pandemic to onset and end of the initial emergency conditions in Finland. Int J Environ Res Public Health 2021;18:7732. 10.3390/ijerph18157732 PubMed DOI PMC

Pierce M, Hope H, Ford T, et al. . Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population. Lancet Psychiatry 2020;7:883–92. 10.1016/S2215-0366(20)30308-4 PubMed DOI PMC

Vahia IV, Jeste DV, Reynolds CF. Older adults and the mental health effects of COVID-19. JAMA 2020;324:2253–4. 10.1001/jama.2020.21753 PubMed DOI

Dalecká A, Tomášková H, Šlachtová H, et al. . Self-Reported mental health and lifestyle behaviour during the COVID-19 pandemic in the Czech population: evidence from two cross-sectional surveys. Int J Public Health 2022;67:1604395. 10.3389/ijph.2022.1604395 PubMed DOI PMC

Richardson RA, Keyes KM, Medina JT, et al. . Sociodemographic inequalities in depression among older adults: cross-sectional evidence from 18 countries. Lancet Psychiatry 2020;7:673–81. 10.1016/S2215-0366(20)30151-6 PubMed DOI PMC

Donizzetti AR, Lagac M. COVID-19 and the Elderly ’ s Mental Illness : The Role of Risk Perception, Social Isolation, Loneliness and Ageism, 2022. PubMed PMC

Ksinan Jiskrova G, Bobák M, Pikhart H, et al. . Job loss and lower healthcare utilisation due to COVID-19 among older adults across 27 European countries. J Epidemiol Community Health 2021;75:1078–83. 10.1136/jech-2021-216715 PubMed DOI

Smith ML, Steinman LE, Casey EA. Combatting social isolation among older adults in a time of physical distancing: the COVID-19 social connectivity paradox. Front Public Health 2020;8:403. 10.3389/fpubh.2020.00403 PubMed DOI PMC

Robb CE, de Jager CA, Ahmadi-Abhari S, et al. . Associations of social isolation with anxiety and depression during the early COVID-19 pandemic: a survey of older adults in London, UK. Front Psychiatry 2020;11:591120. 10.3389/fpsyt.2020.591120 PubMed DOI PMC