COVID-19 collateral damage—psychological burden and behavioural changes among older adults during the first outbreak in Stockholm, Sweden: a cross-sectional study

  1. Giorgi Beridze
  2. Federico Triolo
  3. Giulia Grande
  4. Laura Fratiglioni
  5. Amaia Calderón-Larrañaga

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Abstract

To explore the indirect negative effects of COVID-19 restrictions (collateral damage) on the lives and health of older adults living in central Stockholm, and to characterise the sociodemographic profile of those with the highest susceptibility to this damage.

Design

Cross-sectional study.

Setting

District of Kungsholmen in Stockholm, Sweden.

Participants

Older adults aged 68 years and above (n=1231) who participated in the ad hoc COVID-19-related phone questionnaire administered by trained staff between May and June 2020 and who had previously attended the regular follow-up assessment of the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) during 2016–2019.

Primary and secondary outcome measures

Three dimensions of collateral damage: psychological burden (feelings of worry, stress and loneliness), reductions in social and physical activities, and reductions in medical and social care use since the beginning of the pandemic. Logistic regression models were used to test the association between age, sex, education and living arrangement, and the risk of collateral damage.

Results

Vast majority of participants adhered to the national public health recommendations, with over three-quarters practising self-isolation (n=928). Half of the sample reported psychological burden, 55.3% reported reductions in social or physical activity, and 11.3% reported decreased medical or social care use. Over three quarters of participants (77.8%) were affected by at least one of the three collateral damage dimensions. Female sex was the strongest sociodemographic predictor of both individual and co-occurring dimensions of collateral damage.

Conclusions

COVID-19 and its restrictions during the first half of 2020 had a negative effect on the health and lives of a majority of the elderly living in central Stockholm. Women were at a higher risk of these negative consequences. We emphasise the need for predefined, evidence-based interventions to support those who are most susceptible to these consequences, both during the pandemic and once the outbreak is overcome.

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  1. Version published to 10.1136/bmjopen-2021-058422
  2. ScreenIT

    SciScore for 10.1101/2021.03.16.21253750: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: Ethical considerations: Informed consent was obtained from all participants.
    IRB: The study was approved by the Regional Ethics Review Board in Stockholm (dnr: 2020-02497).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableSubjects who refused to participate or could not be contacted had similar age and educational attainment to those who participated, but were more likely to be male (45.4% vs 35.7%, p=0.044).

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical tests were performed in StataSE 15 (StataCorp LLC, College Station, TX, USA).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    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:
    Strengths and limitations: To the best of our knowledge, this study is the first to examine the consequences of the Swedish COVID-19 strategy in a random sample of urban older adults. Further strengths include the use of an ad hoc questionnaire developed by a multidisciplinary team of experts, and the study sample coming from a well-characterized population-based study. Being based on data from Sweden, the study also provides a unique opportunity for comparison with other settings, as the Swedish strategy against COVID-19 differed from most countries. Certain limitations also need to be highlighted. We did not have recent pre-pandemic measures of physical and mental health. Thus, despite participants being asked to answer the questions for the period since March, the cross-sectional design does not allow us to assess temporal relationship between the onset of the pandemic and the studied outcomes. The findings from this cohort of older adults living in an affluent neighborhood of Stockholm may not be generalizable to the entire Swedish population. However, these findings could be viewed as a best-case scenario, and the identified collateral damage would be expected to be of higher magnitude in less urban and affluent parts of the country.

    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.

    About SciScore

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  3. Version published to 10.1101/2021.03.16.21253750 on medRxiv