Nichols Emma, Petrosyan Sarah, Khobragade Pranali, Banerjee Joyita, Angrisani Marco, Dey Sharmistha, Bloom David E, Schaner Simone, Dey A B, Lee Jinkook
Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA.
Department of Economics, University of Southern California, Los Angeles, CA, USA.
medRxiv. 2023 Sep 14:2023.09.13.23295513. doi: 10.1101/2023.09.13.23295513.
The COVID-19 pandemic had large impacts on mental health; however, most existing evidence is focused on the initial lockdown period and high-income contexts. By assessing trajectories of mental health symptoms in India over two years, we aim to understand the effect of later time periods and pandemic characteristics on mental health in a lower-middle income context.
We used data from the Real-Time Insights of COVID-19 in India (RTI COVID-India) cohort study (N=3,662). We used covariate-adjusted linear regression models with generalized estimating equations to assess associations between mental health (PHQ-4 score) and pandemic periods as well as pandemic characteristics (COVID-19 cases and deaths, government stringency, self-reported financial impact, COVID-19 infection in the household) and explored effect modification by age, gender, and rural/urban residence.
Mental health symptoms dropped immediately following the lockdown period but rose again during the delta and omicron waves. Associations between mental health and later pandemic stages were stronger for adults 45 years of age and older (p<0.001). PHQ-4 scores were significantly and independently associated with all pandemic characteristics considered, including estimated COVID-19 deaths (PHQ-4 difference of 0.041 SD units; 95% Confidence Interval 0.030 - 0.053), government stringency index (0.060 SD units; 0.048 - 0.072), self-reported major financial impacts (0.45 SD units; 0.41-0.49), and COVID-19 infection in the household (0.11 SD units; 0.07-0.16).
While the lockdown period and associated financial stress had the largest mental health impacts on Indian adults, the effects of the pandemic on mental health persisted over time, especially among middle-age and older adults. Results highlight the importance of investments in mental health supports and services to address the consequences of cyclical waves of infections and disease burden due to COVID-19 or other emerging pandemics.
新冠疫情对心理健康产生了重大影响；然而，现有的大多数证据都集中在最初的封锁期和高收入背景下。通过评估印度两年多来心理健康症状的轨迹，我们旨在了解在中低收入背景下，后期时间段和疫情特征对心理健康的影响。
我们使用了印度新冠实时洞察队列研究（RTI COVID-India）的数据（N = 3662）。我们使用带有广义估计方程的协变量调整线性回归模型，来评估心理健康（PHQ-4评分）与疫情时期以及疫情特征（新冠病例和死亡人数、政府管控措施严格程度、自我报告的经济影响、家庭中新冠感染情况）之间的关联，并探讨年龄、性别和农村/城市居住情况的效应修正。
心理健康症状在封锁期后立即下降，但在德尔塔和奥密克戎毒株传播阶段再次上升。45岁及以上成年人的心理健康与后期疫情阶段之间的关联更强（p<0.001）。PHQ-4评分与所有考虑的疫情特征均显著且独立相关，包括估计的新冠死亡人数（PHQ-4差异为0.041标准差单位；95%置信区间0.030 - 0.053）、政府管控措施严格程度指数（0.060标准差单位；0.048 - 0.072）、自我报告的重大经济影响（0.45标准差单位；0.41 - 0.49）以及家庭中新冠感染情况（0.11标准差单位；0.07 - 0.16）。
虽然封锁期及相关经济压力对印度成年人的心理健康影响最大，但疫情对心理健康的影响随着时间持续存在，尤其是在中年及老年人中。研究结果凸显了投资心理健康支持和服务以应对因新冠疫情或其他新出现的大流行导致的周期性感染浪潮和疾病负担后果的重要性。
