Mental Health Status of the Elderly Chinese Population During COVID-19: An Online Cross-Sectional Study

Differences in depression prevalence among older adults in China before and during the COVID-19 pandemic: a systematic review and meta-analysis

Objective

Changes in the prevalence of depression during the COVID-19 (Coronavirus disease 2019) pandemic among older adults in China have not been systematically evaluated. We aimed to systematically summarize existing evidence to conduct a meta-analysis to quantify changes in the prevalence of depression before and during the COVID-19 pandemic.

Methods

The PubMed, Web of Science, Scopus, Embase, PsycINFO, China National Knowledge Infrastructure (CNKI), WangFang Data, CQVIP, and China Biology Medicine disc (CBMdisc) databases were searched from January 1, 2017, to November 20, 2024. Studies reporting the prevalence of depression among Chinese individuals aged 60 or older using validated diagnostic tools were included. A random-effects model was applied to estimate pooled prevalence, with subgroup analyses performed by demographic and socio-economic factors. Relative risks (RR) were calculated to compare prevalence across different pandemic stages.

Results

A total of 101 studies involving 264,758 participants were included. The pooled prevalence of depression among older adults was 25.8% (95% CI [21.7-29.9]) from 2017-2019 and 23.8% (95% CI [19.8-27.8]) from 2020-2023. During the early pandemic stage (January-April 2020), prevalence significantly decreased (RR = 0.849, P < .001) but increased in later stages, reaching 24.4% by 2021-2023. The prevalence of depression among older adults during the COVID-19 pandemic showed a significant increasing trend (P trend  < .001). Subgroup analyses revealed higher prevalence among females, rural residents, individuals with lower education levels, and those living alone.

Conclusion

Depression prevalence among older adults in China decreased during the early pandemic response but showed an increasing trend over time, reflecting the complex mental health impact of prolonged public health measures. Effective interventions are needed to address the specific needs of vulnerable subgroups during and beyond public health crises.

Managing Uncertainty and Loneliness: Protective and Risk Factors Impacting on Older People's Mental Health in Hong Kong

This study investigated the roles of loneliness and prospective intolerance of uncertainty (IU-P) on mental health, and identified the sources of stress and joy during the COVID-19 in Hong Kong. Two thousand two hundred and fifty-eight older adults completed the survey. Older adults who had higher levels of loneliness and IU-P were more likely to have poor mental health. IU-P was found to partially and positively mediate the relationship between loneliness and mental health. Top stressors were contracting the virus, uncertainty about the future, and loneliness; while family/friends, peace of mind, and hobbies were identified as protective factors.

Physical and mental health status and influencing factors of older adults in community-dwelling in Northeast China: a cross-sectional study

Background

Between 2020 and 2022, the COVID-19 pandemic spread globally, and the implementation of preventive measures led to reduced outdoor activities for older adults, resulting in a decline in social functioning. This study aims to improve community-based health interventions tailored to older adults experiencing physical and psychological declines following the COVID-19 pandemic.

Methods

This study utilized previous data mining results to estimate the demand for community health services for older adults. It involves collecting questionnaire responses to understand the basic characteristics and lifestyle behaviors of older adults. The severity of health issues among older adults was assessed using the KCL and GHQ-12 scales. Statistical analyses included descriptive statistics, chi-square tests, t-tests, ANOVA, non-parametric tests as applicable, and stratified binary logistic regression to determine the factors influencing the health status of older adults.

Results

Over 60% of the older adult population suffers from chronic diseases, and more than 70% do not participate in social activities. In the overall older adults, the detection rate for poor health is 15.60%. Chronic illness, reduced ability to perform daily activities, anxiety, poor self-rated health, sleep disturbances, and nutritional imbalance were identified as key risk factors affecting the health of older adults in the community.

Conclusion

Older adults mainly engage in physical exercise, maintain a healthy lifestyle, and control their diet as self-care strategies. Early signs of frailty are characterized by declines in lower limb muscle function and memory. The most common manifestation of poor health among older adults is anxiety.

Social support and health behaviors of older adults during the COVID-19 pandemic in China: a moderated mediation model of loneliness and economic income

BACKGROUND

The literature shows that social support is an important factor influencing health behaviors. This study aimed to explore the relationships and intrinsic pathways of social support, loneliness, economic income, and health behaviors among older adults during the Corona Virus Disease 2019 (COVID-19) pandemic, and to provide a theoretical basis for the implementation of health behaviors interventions for older adults.

METHODS

A cluster-random-sampling survey was adopted within two towns in Dongguan, China. Demographic characteristics, social support, loneliness, economic income and health behaviors were measured. The Social Support Appraisals scale (SS-A), the ULS-8 Loneliness Scale, and the Self-rated abilities for health practice scale (SRAHPS) were used to measure social support, loneliness, and health behaviors in older adults, respectively. A moderated mediation model was built to examine the relationships among social support, loneliness, economic income, and health behaviors using the SPSS PROCESS 4.0 macro. We conducted bootstrapping of regression estimates with 5000 samples and a 95% confidence interval.

RESULTS

621 older adults completed the questionnaire. Most of the participants were female, accounting for 75.0%, and the average age was 81.11 years (SD = 8.11). The median (interquartile range) of the participants' average monthly economic income was 800 (500-1000)RMB. The results of the mediation analysis showed that loneliness partly mediated the relationship between social support and health behaviors (B = 0.024, 95%CI: 0.007, 0.042), with the mediating effect accounting for 4.56% of the total effect. The moderation mediation analysis revealed a positive moderating role of economic income in the relationship between social support and loneliness (B = 0.114, 95%CI: 0.054, 0.174). Specifically, the relationship between social support and loneliness was found to be weaker for older adults with a high economic income compared to those with a lower economic income.

CONCLUSION

The provision of enhanced social support and the alleviation of loneliness among older adults during an epidemic can facilitate the development of healthy behaviours, particularly among those who are economically disadvantaged.

Cross-cultural adaptation and psychometric properties of the Chinese version of the German social support questionnaire among older adults with chronic diseases

BACKGROUND

Social support is widely recognized as a protective factor against psychological distress, especially for the elderly with chronic diseases. Therefore, effective tools for measuring social support are of great significance for both research and clinical practice. This study aims to cross-culturally adapt the German Social Support Scale (F-SozU) into Chinese and assess its psychometric properties among older adults with chronic diseases.

METHODS

A cross-sectional study was conducted in a Chinese tertiary hospital. Four hundred ninety-six older adults that were approached via a convenience sampling method completed the Chinese version of the F-SozU. Content validity was evaluated using the two-round Delphi method. Psychometric properties, including item analysis, content validity, structure validity, convergent and discriminant validity and reliability were examined.

RESULT

The final version of C-F-SozU is a three-factor structure consisting of 23 items. All indicators of item analysis are acceptable. Adequate content validity was ensured by the expert panel (I-CVI = 0.80-1.00, S-CVI = 0.965) and participants. The confirmatory factor analysis model revealed that the factor structure of the C-F-SozU fitted the original scale (χ 2 /df = 2.088, CFI = 0.998, GFI = 0.943, TLI = 0.997, IFI = 0.998, RMSEA = 0.064 and SRMR = 0.043). The total Cronbach's α was 0.956, and the test-retest reliability coefficient was 0.887. The convergent validity (average variance extracted = 0.517-0.995) and discriminant validity were found to be satisfactory. No floor/ceiling effect was found.

CONCLUSION

The 23-item C-F-SozU demonstrates robust reliability and validity, rendering it a valuable instrument for evaluating social support among older adults with chronic diseases in China. The three-factor structure of the scale allows for a more detailed assessment of the social support, with the scores of each dimension and the total score being of significant reference value. More comprehensive studies may be required to confirm its effectiveness and applicability.

A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain

BACKGROUND

Covid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)-a multifaceted construct that measures a person's socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders.

METHODS

Following PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into 'actual versus perceived' and 'static versus fluid' classes to explore their differential effects on emotional health.

RESULTS

Out of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed 'expected' results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst.

CONCLUSIONS

This review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.

Chinese college students' mental health during the first three months of the COVID-19 pandemic: the protective role of family functioning

Background

Various psychological theories suggest that a supportive family environment protects the mental health of young adults during stressful life events. However, evidence is limited regarding the protective role of family support during a major public health crisis.

Objective

To examine the role of family functioning on mental health among Chinese college students during first stage of the COVID-19 pandemic.

Methods

Between January-March 2020, 1,555 college students (44% female, on average 19 years old) from five Chinese universities participated. Participants rated their family functioning on the Family APGAR Index and their mental health on the Psychological Questionnaires for Emergent Events of Public Health, measuring depression, neurasthenia, fear, obsessive-anxiety and hypochondriasis.

Results

Better family functioning was associated with having fewer psychological symptoms. In addition, we identified three mental health profiles related to the severity across the psychological symptoms: Low-level, medium-level and high-level symptom clusters. Latent profile analysis showed that as family function improved, students were, respectively, 16 to 24% more likely to be in the low-level symptom group, compared to being in the medium symptom group or the high-level symptom group.

Conclusion

These results support the notion that family support may act as a psychological buffer for young adults during a large-scale public health crisis like the COVID-19 pandemic.

Fear of COVID-19 and Adverse Psychological Health Outcomes Among Chinese Elderly: a Serial Mediation Model of Social Participation and Loneliness

This cross-sectional study examined fear of COVID-19, social participation, loneliness, and adverse psychological health outcomes among Chinese older adults after the pandemic control measures were relaxed. We also tested the correlations among these variables and examined the serial-mediating effects of social participation and loneliness on the relationship between fear of COVID-19 and adverse psychological health outcomes. Participants were 508 Chinese elderly individuals (Mage = 70.53 ± 7.90 years; 56.5% women). We used Pearson correlation analyses and Hayes' PROCESS macro analysis (Model 6). Respondents had a relatively higher level of fear of COVID-19 compared to the general population. Their levels of loneliness, anxiety, and depression were higher than those of Chinese older adults who were surveyed before the restriction policy changed in previous research. The correlations among fear of COVID-19, social participation, loneliness, and adverse psychological health outcomes were significant, supporting the serial-mediating effects of social participation and loneliness on the relationship between fear of COVID-19 and adverse psychological health outcomes. Attention should be paid to the mental health issues of Chinese older adults, and the impacts of fear of COVID-19 and social participation on their mental health should be emphasized. Future researchers should use random systematic sampling methods, conduct longitudinal tracking and perform intervention studies.

Psychological Status of Men Who Have Sex with Men during COVID-19: An Online Cross-Sectional Study in Western China

Background: The psychological status of men who have sex with men (MSM) as a vulnerable population during COVID-19 is worthy of attention. However, studies of Chinese MSM are limited. The aim of this study was to investigate the psychological status and influencing factors of MSM population and to provide a scientific basis for this group to actively respond to public health emergencies. Methods: From June to September 2020, we conducted an online survey. MSMs were recruited through collaboration with non-governmental organizations (NGOs) and peer recommendations. The variables we collected included four aspects: demographic and HIV-related characteristics; COVID-19-related knowledge, attitudes, and behaviors; COVID-19-related risk perception; epidemic exposure. The psychological status was assessed by the Psychological Questionnaire for Emergent Events of Public Health (PQEEPH), which defined the psychological status as five primary disorders: depression, neurasthenia, fear, anxiety, and hypochondria. Multivariate logistic regression was used to explore the influences of COVID-19-related factors on the psychological status. Results: We surveyed 412 MSM online during COVID-19. The five psychological status of high-risk states accounted for 16.99% (depression), 14.08% (neurasthenia), 16.75% (fear), 16.50% (anxiety), and 18.20% (hypochondria), respectively. Not being well-informed about the causes of COVID-19 (p = 0.020) and having experienced epidemic exposure (p = 0.006) were able to promote the occurrence of depression. Lack of knowledge of the curative effect of COVID-19 has a higher risk of occurrence neurasthenia (p < 0.001). Being afraid of the novel coronavirus (p < 0.001) promoted fear. The perceived prevalence of the epidemic (p = 0.003), being more susceptible to COVID-19 (p < 0.001), and not being well-informed about the causes of COVID-19 (p = 0.005) had a positive effect on anxiety. Considering that the epidemic was not effectively controlled (p = 0.017), being more susceptible to COVID-19 (p < 0.001) was a contributing factor to the hypochondria. Conclusions: The incidence of psychological disorders in Chinese MSM was higher than that in other groups during COVID-19. Factors associated with COVID-19 may cause a range of mental health problems in this population. Greater attention should be paid to the mental health status of special populations during the epidemic, and effective preventive education and intervention measures should be taken.

The Mental Health Impact of the COVID-19 Pandemic on Older Adults in China: A Systematic Review

Considered at a high risk during the COVID-19 pandemic, older adults in China not only face the disadvantages caused by their relatively low immune systems, but also the challenges brought about by the complex psychological environment in which they spend this special period of their life. However, a thorough study on the impact of the pandemic on older adults' mental health in China remains scant. Hence, this research aimed to investigate the question: What are the mental health outcomes and associated risk factors of the COVID-19 pandemic on older adults in China? Two Chinese academic databases (China National Knowledge Infrastructure and WANFANG DATA) as well as six English academic databases (PubMed, Scopus, Web of Science, MEDLINE, Social Science, and Google Scholar) were searched while following PRISMA guidelines. Studies were selected according to the predetermined inclusion criteria. Further, relatively high detective rates of mental health disorders, including anxiety symptoms (4.9% to 48.6%), depression symptoms (13.8% to 58.7%), hypochondria (11.9%), suicidal ideation (4.1%), along with worries and fear (55.7%) were all reported. The COVID-19 pandemic has presented a threat to not only the physical, but also the psychological health of Chinese older adults. The most common risk factors of psychological distress among Chinese older adults were found in female gender, living in rural areas, coexisting chronic diseases, and insufficient knowledge about the COVID pandemic. As a result, government policy and psychological guidelines that are created in order to alleviate the adverse effects of COVID-19 on older adults' mental health, need to be further developed.

Longitudinal changes in depression and anxiety during COVID-19 crisis in Uruguay

Longitudinal studies have reported decreased mental health symptoms throughout the COVID-19 crisis, while others have found improvements or no changes across time. However, most research was carried out in developed countries, with a high incidence of COVID-19 and, in several cases, mandatory lockdowns. Considering that Uruguay (a developing country) had a low COVID-19 incidence at the moment of this study and has implemented a mild lockdown, we aimed to evaluate the effect of time and mobility (using Google mobility data) on symptoms of anxiety and depression. A longitudinal panel study with six repeated measures was carried out to evaluate depressive (BDI-II) and anxiety (STAI-S) symptoms during the pandemic. A decline in symptoms of anxiety and depression was found across time. Interestingly, this effect was modulated by age; a greater difference in the symptomatology between age groups was found at the beginning of the measurements than at the end, with the youngest reporting the most severe symptoms. Finally, we found that depressive symptoms decreased as mobility increased. Overall, our findings indicate an improvement in mental health as quarantine passed and mobility increased but following a different pattern depending on age. Monitoring these trajectories is imperative moving forward, especially in vulnerable groups.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03460-w.

Factors Associated With Depression and Anxiety in Korean Adolescents During the COVID-19 Pandemic

OBJECTIVE

This study was performed to identify factors associated with depression and anxiety among Korean adolescents during the coronavirus disease (COVID-19) pandemic.

METHODS

We conducted a cross-sectional study of 1,898 Korean adolescents (55.2% male, 44.8% female) ranging in age from 12 to 17 years (mean±standard deviaion age, 15.4±2.6 years). Depression and anxiety were defined as a Patient Health Questionnaire-9 score ≥10 and Generalized Anxiety Disorder-7 score ≥10, respectively. Other questionnaires included sociodemographic data, psychosocial stresses, and experiences in association with COVID-19. Psychiatric scales included Gratitude Questionnaire-6, Perceived Stress Scale-10, and UCLA Loneliness Scale-3.

RESULTS

The prevalence rates of depressive and anxiety symptoms among participants were 13.8% and 21.0%, respectively. Multivariable logistic regression analysis revealed that female sex, fear of COVID-19 infection, low gratitude were risk factors for depression. Fear of COVID-19 infection, increased TV watching time, and academic-related stress were risk factors for anxiety.

CONCLUSION

Depression and anxiety were prevalent during the pandemic in Korean adolescents, and were associated with fear of COVID-19 infection. Providing appropriate information on COVID-19, helping adolescents manage academic-related stress and maintain daily life patterns, and implementing interventions to foster gratitude are important for preventing depression and anxiety in Korean adolescents.

Life in a New Normal with a Self-Care Routine: A Cross-Sectional Study of Older Adults' Daily Health Behaviors (DHB) Performance during the Initial Outbreak of COVID-19 in China

For older adults, self-care begins with daily health behaviors (DHB), which refers to a series of basic behaviors beneficial to health in daily life; it is the foundation for promoting health, preventing disease, and maintaining health with or without the support of a healthcare provider. Thus, this study aimed to observe the changes in DHB among older adults when the COVID-19 pan-demic first erupted in China (at the beginning of 2020) and explore the impact factors on self-care routines in daily life. We applied a cross-sectional study among 1256 (83.7%) valid older Chinese from 19 February 2020 to 19 March 2020, the score of DHB changes (mean ± SD, 14.70 ± 2.140; range, 8−18) presented a significant growth (t1256 = 44.636, p < 0.001) during COVID-19. From 3 hierarchical linear regression models, the older Chinese who received a higher education include high school (β = 0.403, 95% CI [0.009, 0.797], p = 0.045) and college degree and above (β = 0.488, 95% CI [0.034, 0.943], p = 0.035), and lived in the eastern China (β = 0.771, 95% CI [0.392, 1.151], p < 0.001) took DHB more frequently. However, the high-risk infection (β = −0.740, 95% CI [−1.248, −0.231], p = 0.004), overweight/obese character (β = −0.265, 95% CI [−0.526, −0.004], p = 0.047), and alcohol consumption (β = −0.350, 95% CI [−0.634, −0.065], p = 0.016) are significant factors in decreasing a senior’s DHB performance. For China, self-care offers a straightforward strategy among the range of measures required to combat COVID-19 and future health threats. In summary, findings in this study can build a foundation for developing healthcare policy and services for the relevant government and departments on prompting DHB and the importance of self-care among the older population.

Changes in the mental health status of the general Chinese population during the COVID-19 pandemic: A longitudinal study

The study is based on a longitudinal evaluation of the public, during the initial COVID-19 outbreak in China and 8 months after. It aimed to explore the changes in the mental health of the public at the beginning of the pandemic and during the regular epidemic prevention and control. An online survey questionnaire was used to collect data during the initial COVID-19 outbreak (February 10, 2020-February 18, 2020; T1) and 8 months after the outbreak (October 21, 2020-December 29, 2020; T2). Psychological distress was assessed using the Patient Health Questionnaire-9 (PHQ-9), Self-rating Anxiety Scale (SAS), and Post-traumatic Stress Disorder Checklist (PCL-5). A chi-square test was used to compare the changes in the depression and anxiety scores at T1 and T2, and the correlation between symptoms was analyzed through Spearman's rank correlation. In T1, 1,200 people were recruited, while 168 people responded in T2. Depression (48.2-31.0%; p=0.001) and anxiety (17.9-9.5%; p = 0.026) symptoms decreased over time; two participants developed post-traumatic stress disorder (PTSD) in T2. The scores of the PHQ-9 scale and the SAS scale were both positively correlated with the score of the PCL-5 scale and negatively correlated with sleep time. During the COVID-19 pandemic, part of the general population's anxiety and depression significantly reduced with time, and they rarely developed PTSD. PTSD occurrence was related to severe depression and anxiety.

Predictors of Anxiety, Stress, and Concern of COVID-19 Infection in Older Adults During the First and the Second Waves of the COVID-19 Pandemic in Slovakia

OBJECTIVES

This cross-sectional online study examined the role of socio-demographic and psychological characteristics in predicting anxiety, stress, and concern of coronavirus (COVID-19) infection in older adults during the first and second waves of the COVID-19 pandemic in Slovakia.

METHODS

Six hundred and seven older adults (Sample 1) and 156 older adults (Sample 2) participated in the study during the first and second waves of the COVID-19 pandemic, respectively. The older adults completed a battery of validated instruments for anxiety, stress, concern of COVID-19 infection (outcome variables), satisfaction with health, perceived danger of COVID-19, loneliness, intolerance of uncertainty (IU), optimism, powerlessness, and coping self-efficacy (predictor variables). The data were analyzed using multiple linear regression.

RESULTS

The older adults in both samples experienced moderate levels of anxiety, stress, and concern of COVID-19 infection. The greatest amount of variability in anxiety and stress was explained by powerlessness, IU, optimism, and coping self-efficacy. Concern of COVID-19 infection was best predicted by the perceived danger of COVID-19.

CONCLUSION

The findings contribute to the existing knowledge about the mental health of older adults during the COVID-19 pandemic and highlight the role of the psychological predictors of anxiety, stress, and concern of COVID-19 infection during both waves.

Analyzing Predictors of Control Measures and Psychosocial Problems Associated with COVID-19 Pandemic: Evidence from Eight Countries

COVID-19 has harshly impacted communities globally. This study provides relevant information for creating equitable policy interventions to combat the spread of COVID-19. This study aims to predict the knowledge, attitude, and practice (KAP) of the COVID-19 pandemic at a global level to determine control measures and psychosocial problems. A cross-sectional survey was conducted from July to October 2020 using an online questionnaire. Questionnaires were initially distributed to academicians worldwide. These participants distributed the survey among their social, professional, and personal groups. Responses were collected and analyzed from 67 countries, with a sample size of 3031. Finally, based on the number of respondents, eight countries, including Bangladesh, China, Japan, Malaysia, Mexico, Pakistan, the United States, and Zambia were rigorously analyzed. Specifically, questionnaire responses related to COVID-19 accessibility, behavior, knowledge, opinion, psychological health, and susceptibility were collected and analyzed. As per our analysis, age groups were found to be a primary determinant of behavior, knowledge, opinion, psychological health, and susceptibility scores. Gender was the second most influential determinant for all metrics except information about COVID-19 accessibility, for which education was the second most important determinant. Respondent profession was the third most important metric for all scores. Our findings suggest that health authorities must promote health educations, implement related policies to disseminate COVID-19-awareness that can prevent and control the spread of COVID-19 infection.