Greig Flora, Perera Gayan, Tsamakis Konstantinos, Stewart Robert, Velayudhan Latha, Mueller Christoph
South London and Maudsley NHS Foundation Trust, London, UK.
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Int J Geriatr Psychiatry. 2021 Oct 6;37(1). doi: 10.1002/gps.5630.
Loneliness is associated with psychiatric morbidity. Restrictions placed on the population during the first COVID-19 lockdown may have disproportionately affected older adults, possibly through increasing loneliness. We sought to investigate this by examining loneliness in referrals to mental health of older adults (MHOA) services during the first UK COVID-19 lockdown.
Referrals to MHOA services from a large South London catchment area were identified for the 16-week period of the UK lockdown starting in March 2020 and for the corresponding period in 2019. A natural language processing algorithm identified loneliness in the patients' records. We applied logistic regression models adjusted for age, gender, ethnicity and diagnosis, to examine associations of loneliness in the study population.
1991 referrals were identified, 56.9% of whom were female, with a mean age of 77.9 years. Only 26.9% occurred during the 2020 lockdown, but with a higher prevalence of loneliness (22.0 vs. 17.7%, p = 0.028). In the whole sample, loneliness was associated with non-accidental self-injury (Odds ratio [OR]: 1.65), depressed mood (OR: 1.73), psychotic symptoms (OR: 1.65), relationship problems (OR: 1.49), problems with daytime activities (OR: 1.36), and antidepressant use (OR: 2.11). During lockdown, loneliness was associated with non-accidental self-injury (OR: 2.52), problem drinking or drug-taking (OR 2.33), and antidepressant use (OR 2.10).
Loneliness is associated with more severe symptoms of affective illness, worse functional problems and increased use of antidepressant medication in older adults. During lockdown, loneliness in referrals to MHOA services increased and was associated with increased risk-taking behaviour. Loneliness is a potential modifiable risk factor for mental illness, and efforts to minimise it in older adults should be prioritised as we emerge from the pandemic.
孤独与精神疾病发病率相关。在首次新冠疫情封锁期间对人群实施的限制措施可能对老年人产生了 disproportionately 的影响，可能是通过加剧孤独感。我们试图通过研究英国首次新冠疫情封锁期间转介至老年人心理健康（MHOA）服务机构的案例中的孤独情况来对此进行调查。
确定了来自伦敦南部一个大集水区的转介至 MHOA 服务机构的案例，涵盖从 2020 年 3 月开始的英国封锁的 16 周期间以及 2019 年的相应时期。一种自然语言处理算法识别患者记录中的孤独情况。我们应用了针对年龄、性别、种族和诊断进行调整的逻辑回归模型，以研究研究人群中孤独的关联因素。
共识别出 1991 例转介案例，其中 56.9%为女性，平均年龄为 77.9 岁。只有 26.9%的案例发生在 2020 年封锁期间，但孤独患病率更高（22.0%对 17.7%，p = 0.028）。在整个样本中，孤独与非意外性自我伤害（优势比[OR]：1.65）、情绪低落（OR：1.73）、精神病症状（OR：1.65）、人际关系问题（OR：1.49）、日间活动问题（OR：1.36）以及使用抗抑郁药（OR：2.11）相关。在封锁期间，孤独与非意外性自我伤害（OR：2.52）、问题饮酒或吸毒（OR 2.33）以及使用抗抑郁药（OR：2.10）相关。
孤独与老年人更严重的情感疾病症状、更差的功能问题以及抗抑郁药物使用增加相关。在封锁期间，转介至 MHOA 服务机构案例中的孤独情况增加，且与冒险行为增加相关。孤独是精神疾病的一个潜在可改变风险因素，在我们走出疫情之际，应优先努力将老年人中的孤独感降至最低。
