Study finds older adults with asthama are at higher risk of depression

A new prospective research of around 2,000 Canadian older people published online in the journal Respiratory Medicine revealed that older adults with asthma were more likely to suffer from depression during the COVID-19 epidemic. The results were especially concerning for older persons with asthma who had previously experienced depression, with almost one-half reporting a recurrence of depression by the fall of 2020, which was much higher than recurrence rates among their peers who did not have asthma. Loneliness was associated with significantly higher risks of depression.

“When considering the high comorbidity between asthma and depression prior to the pandemic, combined with the loneliness associated with extended periods of lockdown and the stress over being labelled high risk for severe COVID-19-related outcomes, it is unsurprising that this population experienced a precipitous decline in mental health during the pandemic” says first author Andie MacNeil, a research assistant at the Factor-Inwentash Faculty of Social Work (FIFSW).

The Canadian Longitudinal Study on Aging, a nationwide longitudinal study of older Canadians, provided the sample. Using longitudinal data, this study was able to distinguish between individuals with a pre-pandemic history of depression (n=770) and those who had never had depression previous to the pandemic (n=1247) among the 2,017 respondents with asthma. Although respondents with a history of depression were at the greatest risk, 1 in 7 of those with no pre-pandemic history of depression were depressed in the fall of 2020, illustrating the toll the pandemic took on many previously psychologically healthy older persons with asthma.

“The pandemic has had detrimental consequences for the mental health of older adults, particularly those who are also navigating chronic health conditions, such as asthma,” says co- author Grace Li, a Ph.D. candidate at the University of Victoria. “It is important for clinicians and healthcare professionals to be screening for depressive symptoms among their patients with asthma, even among those who have not showed signs of depression in the past.”

While there is a growing corpus of data demonstrating high rates of depression during the pandemic, few previous studies have particularly focused on the risks among persons with asthma. The researchers discovered numerous characteristics that were linked to an increased incidence of depression in this cohort, such as interruptions in healthcare access. These findings have the potential to highlight important sites of intervention for this group.

“The pandemic severely disrupted access to healthcare services, which may be especially detrimental for older adults with chronic illness, including asthma,” says senior author Professor Esme Fuller-Thomson at University of Toronto’s FIFSW and director of the Institute for Life Course & Aging. “This emphasizes the critical importance of ensuring healthcare remains accessible, even in the absence of in-person services.”

Respondents with asthma who had an increase in family conflict during the pandemic were shown to be more likely to develop depression by autumn 2020.

“High levels of family conflict are already a known risk factor for depression in later life. The pandemic had the added effect of severely disrupting coping mechanisms that can help buffer interpersonal conflict, such as social support and time spent outside the home, resulting in increases in depression,” says co-author Ying Jiang, Senior Epidemiologist at the Public Health Agency of Canada.

The researchers also discovered that having a loss of income or being unable to obtain basic supplies or food during the pandemic was linked to depression in those with asthma. “The economic precarity and income loss particularly early in the pandemic had devastating effects on many Canadian households with ramifications for mental wellbeing” explains co-author Margaret de Groh, Scientific Manager at the Public Health Agency of Canada.

The findings were reported in the journal Respiratory Medicine. The study comprised 2,017 Canadian Longitudinal Study on Aging (CLSA) asthma participants who supplied data in the baseline wave (2011-2015), follow-up 1 wave (2015-2018), and during the pandemic (September-December 2020).

This study was partially funded by the Canadian Institutes of Health Research (CIHR) grant #172862. Esme Fuller-Thomson (PI). “As life gradually returns to normal following the pandemic, it is still important to consider the potential longstanding mental health effects,” MacNeil said. “We hope these findings can help inform targeted screening and referral to efficacious treatments such as cognitive behavioural therapy to support older adults with asthma who are experiencing depression”