Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.
Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China.
Epidemiol Psychiatr Sci. 2021 Feb 15;30:e20. doi: 10.1017/S2045796021000044.
The coronavirus disease 2019 (COVID-19) pandemic represents an unprecedented threat to mental health. Herein, we assessed the impact of COVID-19 on subthreshold depressive symptoms and identified potential mitigating factors.
Participants were from Depression Cohort in China (ChiCTR registry number 1900022145). Adults (n = 1722) with subthreshold depressive symptoms were enrolled between March and October 2019 in a 6-month, community-based interventional study that aimed to prevent clinical depression using psychoeducation. A total of 1506 participants completed the study in Shenzhen, China: 726 participants, who completed the study between March 2019 and January 2020 (i.e. before COVID-19), comprised the 'wave 1' group; 780 participants, who were enrolled before COVID-19 and completed the 6-month endpoint assessment during COVID-19, comprised 'wave 2'. Symptoms of depression, anxiety and insomnia were assessed at baseline and endpoint (i.e. 6-month follow-up) using the Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7) and Insomnia Severity Index (ISI), respectively. Measures of resilience and regular exercise were assessed at baseline. We compared the mental health outcomes between wave 1 and wave 2 groups. We additionally investigated how mental health outcomes changed across disparate stages of the COVID-19 pandemic in China, i.e. peak (7-13 February), post-peak (14-27 February), remission plateau (28 February-present).
COVID-19 increased the risk for three mental outcomes: (1) depression (odds ratio [OR] = 1.30, 95% confidence interval [CI]: 1.04-1.62); (2) anxiety (OR = 1.47, 95% CI: 1.16-1.88) and (3) insomnia (OR = 1.37, 95% CI: 1.07-1.77). The highest proportion of probable depression and anxiety was observed post-peak, with 52.9% and 41.4%, respectively. Greater baseline resilience scores had a protective effect on the three main outcomes (depression: OR = 0.26, 95% CI: 0.19-0.37; anxiety: OR = 1.22, 95% CI: 0.14-0.33 and insomnia: OR = 0.18, 95% CI: 0.11-0.28). Furthermore, regular physical activity mitigated the risk for depression (OR = 0.79, 95% CI: 0.79-0.99).
The COVID-19 pandemic exerted a highly significant and negative impact on symptoms of depression, anxiety and insomnia. Mental health outcomes fluctuated as a function of the duration of the pandemic and were alleviated to some extent with the observed decline in community-based transmission. Augmenting resiliency and regular exercise provide an opportunity to mitigate the risk for mental health symptoms during this severe public health crisis.
2019 年冠状病毒病（COVID-19）大流行对心理健康构成了前所未有的威胁。在此，我们评估了 COVID-19 对亚临床抑郁症状的影响，并确定了潜在的缓解因素。
参与者来自中国抑郁队列研究（ChiCTR 注册号 1900022145）。在 2019 年 3 月至 10 月期间，我们招募了患有亚临床抑郁症状的成年人（n=1722），在一项为期 6 个月的基于社区的干预研究中，使用心理教育预防临床抑郁症。共有 1506 名参与者在中国深圳完成了研究：726 名参与者于 2019 年 3 月至 2020 年 1 月（即 COVID-19 之前）完成研究，组成“第 1 波”组；780 名参与者在 COVID-19 之前入组，并在 COVID-19 期间完成了 6 个月的终点评估，组成“第 2 波”组。在基线和终点（即 6 个月随访）时，使用患者健康问卷-9（PHQ-9）、广泛性焦虑障碍-7（GAD-7）和失眠严重指数（ISI）评估抑郁、焦虑和失眠症状。在基线时评估韧性和定期锻炼措施。我们比较了第 1 波和第 2 波组的心理健康结果。我们还研究了心理健康结果如何在中国 COVID-19 不同阶段发生变化，即高峰（2020 年 2 月 7-13 日）、高峰后（2 月 14-27 日）、缓解平台（2 月 28 日至今）。
COVID-19 增加了三种精神健康结果的风险：（1）抑郁（优势比[OR] = 1.30，95%置信区间[CI]：1.04-1.62）；（2）焦虑（OR = 1.47，95% CI：1.16-1.88）和（3）失眠（OR = 1.37，95% CI：1.07-1.77）。高峰后观察到最可能的抑郁和焦虑比例最高，分别为 52.9%和 41.4%。基线时较高的韧性评分对三种主要结果具有保护作用（抑郁：OR = 0.26，95% CI：0.19-0.37；焦虑：OR = 1.22，95% CI：0.14-0.33；失眠：OR = 0.18，95% CI：0.11-0.28）。此外，定期体育锻炼可降低患抑郁的风险（OR = 0.79，95% CI：0.79-0.99）。
COVID-19 大流行对抑郁、焦虑和失眠症状产生了非常显著和负面的影响。心理健康结果随大流行的持续时间而波动，并在社区传播观察到的下降的情况下在一定程度上得到缓解。增强韧性和定期锻炼为减轻严重公共卫生危机期间的心理健康症状提供了机会。
