Karen Swartz, M.D. highlights key findings from national surveys conducted during the COVID pandemic. “COVID depression” is a heterogeneous mix of symptoms. At risk are young adults, essential workers, minority groups, and those with financial hardships. The mental health system’s ability to screen and identify individuals with worsening or new symptoms and timely referral for evaluations would be one of the steps to manage the psychological and psychiatric consequences of this pandemic. This is a six-minute synopsis of the hour-long presentation that Dr. Swartz presented at the Johns Hopkins Medicine Psychiatry Grand Rounds on “What is COVID Depression?”
I'm going to discuss what is Kobe Depression? This is a term that's being bandied about, and I think we have to understand that there's a difference between the demoralization that so many people are feeling and major depression, which is a potentially life threatening illness during a disaster, any kind of disaster. There's a predictable change in how people are feeling and their sense of emotional well being. As you can see on the Y axis, this is going from very low, emotionally toe high, and the Orange Line is mapping out the typical response you would expect someone to see. This model was developed by George Beverly and colleagues at Johns Hopkins, and we go from being sort of a typical level to then hitting impact. When the disaster happens and initially a community will rally. It would be a lot of community cohesion and response. But then, with time, when people get more tired, there's a drop off where you go into a disillusionment phase where people just have a much lower emotional reserves enter at risk for depression, anxiety and other conditions. This pandemic has a particular challenge of being a disaster of uncertainty. Where were combining serious mortality, long length of the threat as well as ambiguity. It's hard to know exactly what's dangerous, which things can and can't. We dio, and we obviously don't know one will be over. So think about this pattern, which is concerning enough and then having a second wave come on top, where we, as a community are already, and disillusionment. Disasters of uncertainty, like Kobe in 19 are the most likely to lead to serious psychological consequences. In a recent study The Climb Study, they used a standard depression measure, the P H Q nine, and surveyed a national group of over 1400 adults. They then compared their results from this recent study to the End Haynes study, done in 2017 to 2018 using exactly the same depression measure the P H Q nine. What could be seen is that there are dramatically higher rates of depression for moderate, moderately severe and severe depression, and again, anything it moderate and above would be above the standard cut point for PHP nine depression. So while not all of these individuals would have major depression, many of them would, especially in the moderately severe to severe rain, so we're seeing dramatic increases now. Compared to several years ago. Another study was done with 5400 adults, and this was done during the last week of June. And in this collaboration between the CDC, Harvard and Melbourne University, they asked a number of questions and also did a standard depression straight, this time using the P H Q two. What you can see is a pattern that's been replicated in other national surveys, where young adults 18 to 24 at the highest reported prevalence of depressive symptoms. With those rates declining with H. I don't believe that 50% of 18 to 24 year olds have major depression, but it is very concerning that. Half of them are describing depressive symptoms at a level that, on a screen at least, would make you concerned and want to do a fuller evaluation now. In this survey, they also asked specific questions about suicide and substance misuse. What you can see is the percent who reported increasing substance use during the pandemic was also highest among young adults and concerning Lehi, a quarter of them said yes, they had increased their use and then they also asked about having suicidal thoughts in the last 30 days, and this is perhaps the most concerning finding that a quarter of those 18 to 24 in this national survey reported that they had seriously considered suicide again. The pattern is following that of depressive symptoms and the highest rates among the youngest, with the lowest rates among the older age groups. So there are common themes that we see coming from national survey data. There have been several studies that have been done, and certain things were agreed upon first, that there's a significant increase in the prevalence of depressive symptoms 3 to 4 times higher than comparisons to studies done one or two years ago. The second point is that younger adults are much more likely to report depressive symptoms as well as thoughts about suicide. Economic challenges are associated with depressive symptoms, and essential workers report higher rates of depressive symptoms and suicidal thoughts. So to summarize, what is Cova depression? But one thing it is is common. We have half of those 18 24 saying that they've experienced serious depressive symptoms. There's a Malays. There's a concern. There's a people being worn down by the challenges of this pandemic. We know that depressive symptoms and cova depression of more common in young adults, essential workers, minority groups and those with economic challenges. And importantly, we have to recognize the cova. Depression is a heterogeneous mix of demoralization, frustration, anxiety, sadness about circumstances and serious psychiatric disorders like mood disorders, anxiety disorders and PTSD. And I think our ability to recognize those that air having worsening or new depressive symptoms and refer them for evaluation will be critical and helping to manage the psychological and psychiatric consequences of this pandemic.