Longitudinal analyses of depression and anxiety highlight greater prevalence during COVID-19 lockdowns in the Dutch general population and a continuing increase in suicidal ideation in young adults

  1. Anil P. S. Ori
  2. Martijn Wieling
  3. Lifelines Corona Research Initiative
  4. Hanna M. van Loo

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Abstract

Objective

The pandemic of the coronavirus disease 2019 (COVID-19) has led to an increased burden on mental health. This study therefore investigated the development of major depressive disorder (MDD), generalized anxiety disorder (GAD), and suicidal ideation in the Netherlands during the first fifteen months of the pandemic and three nation-wide lockdowns.

Methods

Participants of the Lifelines Cohort Study –a Dutch population-based sample-reported current symptoms of MDD and GAD, including suicidal ideation, according to DSM-IV criteria using a digital structured questionnaire. Between March 2020 and June 2021, 36,106 participants (aged 18-96) filled out a total of 629,811 questionnaires across 23 time points. Trajectories over time were estimated using generalized additive models and analyzed in relation to age, sex, and lifetime history of MDD/GAD to identify groups at risk.

Results

We found non-linear trajectories for MDD and GAD with a higher number of symptoms and prevalence rates during periods of lockdown. The point prevalence of MDD and GAD peaked during the third hard lockdown at 2.88% (95% CI: 2.71%–3.06%) and 2.92% (95% CI: 2.76%-3.08%), respectively, in March 2021. Women, younger adults, and participants with a history of MDD/GAD reported significantly more symptoms. For suicidal ideation, we found a linear increase over time in younger participants which continued even after the lockdowns ended. For example, 4.63% (95% CI: 3.09%-6.96%) of 20-year-old participants reported suicidal ideation at our last measured time point in June 2021, which represents a 4.14x increase since the start of the pandemic.

Conclusions

Our study showed greater prevalence of MDD and GAD during COVID-19 lockdowns suggesting that the pandemic and government enacted restrictions impacted mental health in the population. We furthermore found a continuing increase in suicidal ideation in young adults. This warrants for alertness in clinical practice and prioritization of mental health in public health policy.

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  1. ScreenIT

    SciScore for 10.1101/2022.05.02.22273554: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: All participants provided written informed consent.
    IRB: The Lifelines Cohort Study was approved by the Medical Ethics Committee of the University Medical Center Groningen, The Netherlands.
    Sex as a biological variablenot detected.
    RandomizationSecond, because individuals were repeatedly assessed over time, we used a random intercept and linear random slope to account for the nested structure of the data within individuals and families.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, our findings should be interpreted considering several limitations. First, due to the large computational resources required to run GAMs with random effects, we were only able to account for individual- and family-specific variation in a subsample of our cohort. While this subsample was similar to our larger sample in its main characteristics, we cannot exclude that our analyses may have missed important insights due to limited statistical power, especially for more rare phenotypes. We did show that analyses on the youngest study participants is worthwhile to prioritize as a significant proportion of the variation in MDD/GAD outcomes lies in younger adults, which increases statistical power to identify group differences. Second, we fitted each outcome in a separate model and thus could only compare the prevalence within a single trajectory and not between trajectories of different outcomes. As depression and anxiety are known to have comorbidity, how changes in trajectories relate among outcomes is an important question to investigate in future research. Third, we did not have information on the prevalence of MDD, GAD and suicidality in the year before the start of the pandemic and thus could not account for that, nor for seasonal effects. Fourth, we assessed current symptoms of GAD within the past seven and fourteen days. We therefore did not assess GAD according to the DSM-IV criteria that requires symptoms to be present for at least six months. Fifth, we did not a...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2022.05.02.22273554v1 on medRxiv