Pandemic exacerbated depression in older adults with diabetes

Risk factors for depression included loneliness, chronic pain and being female.
Risk factors for depression included loneliness, chronic pain and being female.

 A recent study of more than 2,700 older Canadians reported older adults with diabetes faced a heightened risk of depression during the COVID-19 pandemic. In this cohort, almost 50% of those who had a pre-pandemic history of depression experienced depression during the pandemic.

Those who experienced loneliness were among the most impacted.

“During the pandemic, loneliness almost tripled the risk of depression in older adults with diabetes,” says clinical pharmacist and first author ZhiDi Deng. “This not only highlights the impact of quarantines and lock-downs on individuals’ mental health. It also shows us that there is room for improvement on how we can better deliver services to older adults with diabetes in future public health crises.”

Although not as severely impacted as those with a history of depression, one in eight older adults with diabetes who had no history of depression prior to the pandemic were depressed in the autumn of 2020. “The pandemic has taken a significant toll on the mental health of everyone, particularly older adults with chronic conditions such as diabetes,” says co-author Grace Li, a research assistant at the University of Toronto’s Institute for Life Course and Aging (ILCA). “It’s important for primary health providers to be vigilant for signs of depression among their older patients, even those who were doing well in the past.”

The researchers identified several other factors that were associated with a higher risk of depression among those with diabetes, such as being female, having functional limitations or chronic pain, and experiencing family conflict.

They also reported some unexpected findings. The researchers found that those who were separated, divorced, or widowed had lower odds of recurrent depression during the pandemic than those who were married or in common-law relationships. “This is different from research conducted before the pandemic that indicated married individuals usually are less depressed,” said co-author Dorina Cadar, Senior Lecturer in Neuroepidemiology and Dementia at the Centre for Dementia Studies at Brighton and Sussex Medical School and the director of the Cognitive Epidemiology, Dementia, and Ageing Research lab. “We hypothesized that participants who were married during the pandemic experienced worse mental health because the need to stay for extended periods of time in close living proximity during the lockdowns or quarantine could possibly exacerbate any relationship conflicts. Our findings indicate that those who were experiencing family conflict during the pandemic had more than triple the risk of depression during the pandemic.”

The second unexpected finding was that those with higher income prior to the pandemic had a greater risk of depression during the pandemic than those who were poorer.  In pre-pandemic research, higher income is associated with a lower prevalence of depression. 

“We hypothesized that this finding may have been influenced by the generous response of the Canadian government with the Canadian Emergency Response Benefit (CERB), which may have had a protective impact on the mental health of low-income Canadians. CERB provided Canadians who lost employment during the pandemic with a $2000 monthly income. For some low-income individuals and households, this would actually increase their monthly income, thereby reducing financial-related stress among this population,” said co-author Maria Rowsell, a research assistant at the University of Toronto’s ILCA.

The study was conducted using data from the Canadian Longitudinal Study on Aging (CLSA) surveys. The CLSA is a large national longitudinal study involving older Canadians with diabetes. This study identified 2,730 individuals with diabetes in the CLSA sample. In this group, 1,757 individuals had no pre-pandemic history of depression, and 973 had a pre-pandemic history of depression. The study was published online this month in the journal Archives of Gerontology and Geriatrics Plus.

“The long-term implications of the pandemic extend far beyond physical health,” said senior author Professor Esme Fuller-Thomson of the University of Toronto’s Factor-Inwentash Faculty of Social Work and Director of the ILCA. “It is important to improve access to mental health services for people with diabetes, particularly during periods of increased stress. Interventions that have shown promising results to support the mental health of individuals with comorbid depression and diabetes include cognitive behavioural therapy and psychoeducation.  We need to improve access to these important services.”

Autism and Mental Health – The talk takes an indepth look at autism and various mental illnesses




Image result for An autism talk given by Dr Victoria Hughes on the subject of Autism and Mental Health. The talk takes an indepth look at autism and various mental illnesses and explores the links between the two.




An autism talk given by Dr Victoria Hughes on the subject of Autism and Mental Health. The talk takes an indepth look at autism and various mental illnesses and explores the links between the two.




‘Autism and Mental Health: Recognising the early warning signals and what to do about them’




This speech, on 'Autism and Mental Health: Recognising the early warning signals and what to do about them' was given by Dr Michael Fitzpatrick at the NAS Conference 15th January 2015.

This speech, on ‘Autism and Mental Health: Recognising the early warning signals and what to do about them’ was given by Dr Michael Fitzpatrick at the NAS Conference 15th January 2015.




This speech, on ‘Autism and Mental Health: Recognising the early warning signals and what to do about them’ was given by Dr Michael Fitzpatrick at the NAS Conference 15th January 2015.

Go here to watch the video.




Report calls for better mental health support in the workplace




Mental Health

Mental Health




“Up to 300,000 people with long-term mental health problems have to leave their jobs each year, a report says,” writes BBC News. This was just one of the UK media outlets that published the findings of a report looking at the extent of mental ill health in the workplace, and the related economic and social costs.

Most of the media led with headlines stating that 300,000 people with long-term mental health conditions leave work each year – twice the rate of those without mental health conditions.

The loss to the economy was estimated to be up to £99 billion a year, including lost productivity output, the cost of providing benefits and healthcare costs.

 

What is the basis for these news stories?

They are based on a report, “Thriving at Work: a review of mental health and employers”, commissioned by Prime Minister Theresa May in January 2017.

It was written by Lord Dennis Stevenson (mental health campaigner and former HBOS chief) and Paul Farmer (chief executive of the mental health charity Mind), and was jointly published by the Department of Health and the Department for Work and Pensions. It includes research by audit firm Deloitte on costs to employers and the state.

The report is free to download from the government’s website.

The prime minister welcomed the publication and said she wanted the recommendations to be implemented.




 

What were the main findings?

The 88-page report looked at the extent of the problem of poor mental health in the workplace and its associated costs. It examined case studies of good practice and makes recommendations for employers in both the public and private sector, and for the government, to improve the situation.

Key findings include:

Around 15% of people in work have symptoms of a mental health condition.

Around 6% of people with a long-term mental health condition lose their job each quarter – amounting to 300,000 people each year – compared with 4% of those with a physical health condition.

The authors say that everyone – not just people with long-term mental health conditions – has a mental health status, which can move between “thriving at work” to “struggling at work”.

Some of those struggling will be off sick. However, the report stresses that people with mental health conditions can still thrive at work if given the right support.

The key effects of mental ill health include:

people being off work sick (absenteeism)

people being at work but unable to work effectively (so-called “presenteeism”)

increased workload for the rest of the workforce

increased turnover of the workforce

lack of career progression for people with mental health conditions

The costs to employers are estimated at:

£8 billion for absenteeism

£17-26 billion for lost productivity from presenteeism

£8 billion for staff turnover

Costs varied widely between different private sector industries and were higher for the public sector.

What does the report recommend?

It says that all employers of any size in the UK should adopt six “core standards” for improving mental health at work:

Produce, implement and communicate a “mental health at work” plan.

Develop mental health awareness among employees.

Encourage open conversations about mental health and the support available when employees are struggling.

Provide employees with good working conditions.

Promote effective people management.

Routinely monitor employee mental health and wellbeing.

These recommendations are based on best practice or evidence, and the authors state there is a “pressing need” for more robust evidence about what works to support improved mental health at work.

In addition, they say public sector employers – such as the NHS, civil service and education service – and private sector employers with more than 500 employees should adopt “enhanced” standards to:

increase transparency and accountability through internal and external reporting

demonstrate accountability

improve the disclosure process

ensure provision of tailored in-house mental health support and signposting to clinical help

Recommendations for the government include introducing legal changes to enhance protection for people with mental health conditions and the development of a more flexible model for statutory sick pay, to help people return to work gradually.

The authors conclude: “At a time when there is a national focus on productivity, the inescapable conclusion is that it is massively in the interest of both employers and Government to prioritise and invest far more in improving mental health. The UK can ill-afford the productivity cost of this poor mental health.”

 

What does this mean for you?

Many people go through periods of mental ill health that make it more difficult for them to work. For some, this is a short-term problem and they can continue at work, or return to work after sickness absence, with appropriate support.

Many people with longer-term mental health problems can also continue working, or return to work after absence, although the report suggests some people struggle or are unable to do so.

It stresses that people with long-term mental health conditions are able to work and should be supported to continue to do so by their employers.

Under the Equality Act (2010), your employer has a legal duty to make “reasonable adjustments” to your work.

Depending on your circumstances, you might like to ask about:

flexible hours – for instance, you might like to return to work part-time, or start later in the day if you’re sleepy from medication in the mornings

support from a colleague in the short or long term

a place you can go for a break when needed

Returning to the workplace after a mental health issue can be daunting at first, but research suggests it usually has a positive effect on wellbeing in the long run.

Read more advice about Returning to work after mental health issues.