Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA.
BMJ Glob Health. 2024 Jan 29;9(1):e013365. doi: 10.1136/bmjgh-2023-013365.
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 2 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 cohort study (N=3709). We used covariate-adjusted linear regression models with generalised estimating equations to assess associations between mental health (Patient Health Questionnaire (PHQ-4) score; range 0-12) 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 associated with all pandemic characteristics considered, including estimated COVID-19 deaths (PHQ-4 difference of 0.10 units; 95% CI 0.06 to 0.13), government stringency index (0.14 units; 95% CI 0.11 to 0.18), self-reported major financial impacts (1.20 units; 95% CI 1.09 to 1.32) and COVID-19 infection in the household (0.36 units; 95% CI 0.23 to 0.50).
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-aged 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，大多数现有证据都集中在最初的封锁期间和高收入国家。通过评估印度超过 2 年的心理健康症状轨迹，我们旨在了解后期时间和大流行特征对中低收入国家心理健康的影响。
我们使用了来自印度新冠实时洞察队列研究（N=3709）的数据。我们使用广义估计方程调整协变量的线性回归模型来评估心理健康（PHQ-4 评分；范围 0-12）与大流行时期以及大流行特征（新冠病例和死亡、政府严格程度、自我报告的财务影响、家庭中的新冠感染）之间的关联，并探讨了年龄、性别和城乡居住情况的调节作用。
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波期间再次上升。对于 45 岁及以上的成年人，心理健康与后期大流行阶段之间的关联更强（p<0.001）。PHQ-4 评分与所有考虑到的大流行特征显著相关，包括估计的新冠死亡人数（PHQ-4 差异为 0.10 个单位；95%CI 0.06 至 0.13）、政府严格程度指数（0.14 个单位；95%CI 0.11 至 0.18）、自我报告的重大财务影响（1.20 个单位；95%CI 1.09 至 1.32）和家庭中的新冠感染（0.36 个单位；95%CI 0.23 至 0.50）。
虽然封锁期和相关的经济压力对印度成年人的心理健康产生了最大的影响，但疫情对心理健康的影响随着时间的推移持续存在，尤其是在中年和老年人中。研究结果强调了投资于心理健康支持和服务的重要性，以应对由于新冠病毒或其他新出现的大流行而导致的周期性感染和疾病负担的后果。
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