People who have or had COVID-19 symptoms are more likely to develop general psychiatric disorders and are lonelier, with women and young people more at risk, says a just-published study co-authored at Cambridge Judge Business School.
Having a job and living with a partner are significant protective factors against general psychiatric disorders and loneliness, says the study in the journal Psychiatry Research, based on 15,530 UK respondents, which is described as the first such large-scale, nationally representative survey in a developed country.
Although there has been previous research on specific coronavirus-related disorders such as anxiety, depression and insomnia, prior to this research we knew "little about the broader psychological impact of the pandemic on a wider population", says the study in the journal's September 2020 issue.
"Only focusing on specific disorders underestimates the psychiatric burdens of the pandemic in more subtle forms and overlooks the needs for psychiatric care of the people who have not been clinically diagnosed," the study says.
"Although the minor psychiatric disorders are often less urgent concerns of the public health policies, they are not negligible given the large proportion of the population that have been affected," says the study co-authored by Lambert Zixin Li of Stanford University, who holds an MPhil in Innovation, Strategy & Organisation from Cambridge Judge Business School (MPhil 2018), and Senhu Wang, a Research Fellow at the Centre for Business Research at Cambridge Judge Business School, who holds a PhD in Sociology from the University of Cambridge.
The study measures general psychiatric disorders based on the 12 items in the widely accepted General Health Questionnaire, which looks at factors ranging from depressive anxiety symptoms to confidence to overall happiness, while loneliness was assessed by a question adapted from the English Longitudinal Study on Aging about how often respondents felt lonely in the previous four weeks.
"Loneliness is linked to long-term health outcomes including all-cause mortality, so public health policies need to be aware of the (mental) health consequences of the disease control measures," the study says.
The research found that 29.2 per cent of all respondents (representing the general British population) scored '4' (the "caseness" or clinical referral threshold) or more on a five-point scale for general psychiatric disorders, while 35.86 per cent of respondents sometimes or often feel lonely; further analysis of the results showed that those who have or had coronavirus symptoms were more likely to have such disorders or feel lonely.
"People with current or past COVID-19 symptoms were perhaps more likely to develop general psychiatric disorders because they are more anxious about infection, and their greater loneliness may reflect the fact that they were isolated from family and friends," says co-author Senhu Wang of the Centre for Business Research at Cambridge Judge.
Women and young people (aged 18-30) who responded were significantly more at risk from general psychiatric disorders and loneliness, which the study says may reflect the fact that, compared to older people, these younger people's social and economic lives are more disrupted by the public health crisis.
Having a job and living with a partner are both "significant protective factors", said the study, which suggested further research into how social support from work and family buffer the psychological impacts of a pandemic.
The survey was conducted toward the end of April, at a time when there were around 23,000 coronavirus-related deaths in the UK. The study found no significant differences across different UK regions on either general psychiatric disorder or loneliness.
"Future research and public health policies need to move beyond specific psychiatric disorders to attend to the general psychiatric disorders and loneliness of a larger proportion of the population," the study concludes. "They need to pay special attention to vulnerable populations including women, the younger, the unemployed, those not living with a partner, and those who have or had COVID-19 symptoms.
"A pandemic like COVID-19 could exaggerate social disparities in mental health in subtle ways, calling for research on effective interventions such as mindfulness, mediation-based stress reduction and timely provision of psychiatric services."
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The study in the journal Psychiatry Research is entitled "Prevalence and predictors of general psychiatric disorders and loneliness during COVID-19 in the United Kingdom".
More lonely deaths in hospitals and nursing homes from COVID
Patients who died from COVID-19 in 2020 are 12 times more likely to die in a hospital than patients who died from any cause in 2018
CHICAGO--- Patients who died from COVID in 2020 were almost 12 times more likely to die in a medical facility than patients who died from any cause in 2018, reports a new Northwestern Medicine study.
This the first study to look at place of death for patients with COVID-19 and how these distributions compare to previous trends in location of death for non-COVID-19 illnesses.
The paper was published July 9 in the Journal of the American Geriatrics Society.
"Where you die is important and reflects end-of-life quality for the patient and the family," said lead author Dr. Sadiya Khan, assistant professor of preventive medicine in epidemiology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. "The patients dying of COVID-19 in medical facilities may not have any family with them because of visitor restrictions.
"A loved one dying alone takes a huge mental toll on families," Khan said. "It impairs the family's ability to grieve and cope with the loss. For patients, we've all thought about how terrible it would be to have to die alone. This is the horror happening to thousands of people in medical facilities where no family member or loved one is able to be present with them during their final moments on earth."
The new study analyzed data from the Centers for Disease Control and Prevention for deaths related to COVID-19 from February 1, 2020, to May 23, 2020, and found 68.7% of patients who die of COVID-19 died in medical facilities, 22.7% in nursing homes, 5.2% at home and 1.9% in hospice facilities. When compared with 2018 deaths due to all causes over a similar time period, 35.7% of deaths took place in medical facilities, 19.1% in nursing homes, 31.1% at home, and 7.9% in hospice facilities.
There was significant variability across states, with some states having a much higher proportion of nursing home deaths (e.g. Minnesota, 60%) and home deaths (e.g. New York, 8%) deaths.
"High rates of nursing home deaths in several states reveal a highly vulnerable population and the inability to optimize resources such as PPE (personal protection equipment) to prevent infection transmission these high-risk locations," Khan said. "It's especially important as nursing homes are reopening to visitors and may be exposing residents, especially in areas where there are increasing rates of cases."
But nursing home statistics in the study only capture a glimpse of the high proportion of deaths linked to these facilities. It doesn't include people who contracted COVID-19 in a nursing home and were transferred to a hospital or staff who got it working there.
To address the heightened risk in nursing homes, Khan suggests access to adequate PPE for staff and universal testing/screening of people before they are allowed to enter the facilities, even if they don't have symptoms.
To support lonely COVID-19 patients in hospital beds and nursing homes, Khan said these facilities need a virtual infrastructure.
"We can't just rely on individual's iPhones and iPads," Khan said. "There is a land line phone in every room, why couldn't we have a virtual phone in every room or access to face-to-face communication for each patient and their families?"
"These results highlight yet another way that COVID-19 has impacted the health care system," said first author Dr. Sarah Chuzi, a Northwestern Medicine fellow in cardiovascular diseases. "While recent research shows U.S. deaths in medical facilities are decreasing and deaths at home and in hospice facilities are increasing, the burden of deaths attributed to COVID-19 may reverse these overall trends.
"End-of-life care is a hugely important but understudied aspect of medicine. We wanted to ensure this aspect of patient-centered care was acknowledged and studied in order to motivate efforts to improve our current system," Chuzi added.
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Other Northwestern authors include Dr. Sarah Chuzi, Rebecca Molsberry, Megan McCabe, Dr. Clyde Yancy, Dr. Adeboye Ogunseitan, Norrina Allen, Rebecca Molsberry and Megan McCabe.
The research was supported in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, grant KL2TR001424.
