| Younger people are more vulnerable to stress, anxiety and depression during COVID-19 pandemic: A global cross-sectional survey Author links open overlay panelPrernaVarmaMoiraJungeHaileyMeaklimMelinda L.JacksonPerson1Envelope Show
ShareShare Cited ByCite https://doi.org/10.1016/j.pnpbp.2020.110236Get rights and content Highlights• Respondents from over 60 countries endorsed significant symptoms of anxiety, stress, and depression. •Psychological distress was driven by poor sleep, isolation, low resilience and age. •While older adults are more vulnerable to the virus, younger adults are at a greater risk of poor mental health. •Perceived stress, financial uncertainty was linked to poor mental health in young adults. •There is an urgent need for sustained, global public health measures to mitigate the psychological effects. AbstractThe COVID-19 pandemic has had far-ranging consequences for general physical and mental health. Country-specific research reveals a general reduction in mental and physical well-being, due to measures undertaken to stop the spread of COVID-19 disease. However, research is yet to examine the impact of the pandemic on global psychological distress and its effects upon vulnerable groups. Exploration of the factors that potentially mediate the relationship between stress and mental health during this period is needed, to assist in undertaking concrete measures to mitigate psychological distress and support vulnerable groups. Therefore, this study examined the impact of the COVID-19 pandemic on psychological distress globally, and identified factors that may exacerbate decline in mental health. N = 1653 participants (mean age 42.90 ± 13.63 years; 30.3% males) from 63 countries responded to the survey. Depression and anxiety were assessed using the Patient Health Questionnaire and State Trait Anxiety Inventory, respectively. Other measures included the Perceived Stress Scale, the Pittsburgh Sleep Quality Index, 3-item UCLA Loneliness Scale and the Brief Resilient Coping Scale. Globally, consistently high levels of stress, anxiety, depression and poor sleep were observed regardless of number of COVID-19 cases. Over 70% of the respondents had greater than moderate levels of stress, with 59% meeting the criteria for clinically significant anxiety and 39% reporting moderate depressive symptoms. People with a prior mental health diagnosis experienced greater psychological distress. Poor sleep, lower levels of resilience, younger age and loneliness significantly mediated the links between stress and depression, and stress and anxiety. Age-based differences revealed that younger age-groups were more vulnerable to stress, depression and anxiety symptoms. Results show that these vulnerable individuals need more support. Age-specific interventions for modifiable factors that mediate the psychological distress need to urgently deployed to address the global mental health pandemic.
KeywordsYoung adults Perceived stress Depression Anxiety Sleep Resilience Loneliness Recommended articles
1 Current address: School of Psychological Sciences, Monash University 18 Innovation Walk, Clayton, VIC 3800, Australia. Older adults, those aged 60 or above, make important contributions to society as family members, volunteers and as active participants in the workforce. While most have good mental health, many older adults are at risk of developing mental disorders, neurological disorders or substance use problems as well as other health conditions such as diabetes, hearing loss, and osteoarthritis. Furthermore, as people age, they are more likely to experience several conditions at the same time.The problemThe world’s population is ageing rapidly. Between 2015 and 2050, the proportion of the world's older adults is estimated to almost double from about 12% to 22%. In absolute terms, this is an expected increase from 900 million to 2 billion people over the age of 60. Older people face special physical and mental health challenges which need to be recognized. Over 20% of adults aged 60 and over suffer from a mental or neurological disorder (excluding headache disorders) and 6.6% of all disability (disability adjusted life years-DALYs) among people over 60 years is attributed to mental and neurological disorders. These disorders in older people account for 17.4% of Years Lived with Disability (YLDs). The most common mental and neurological disorders in this age group are dementia and depression, which affect approximately 5% and 7% of the world’s older population, respectively. Anxiety disorders affect 3.8% of the older population, substance use problems affect almost 1% and around a quarter of deaths from self-harm are among people aged 60 or above. Substance abuse problems among older people are often overlooked or misdiagnosed. Mental health problems are under-identified by health-care professionals and older people themselves, and the stigma surrounding these conditions makes people reluctant to seek help. Risk factors for mental health problems among older adultsThere may be multiple risk factors for mental health problems at any point in life. Older people may experience life stressors common to all people, but also stressors that are more common in later life, like a significant ongoing loss in capacities and a decline in functional ability. For example, older adults may experience reduced mobility, chronic pain, frailty or other health problems, for which they require some form of long-term care. In addition, older people are more likely to experience events such as bereavement, or a drop in socioeconomic status with retirement. All of these stressors can result in isolation, loneliness or psychological distress in older people, for which they may require long-term care. Mental health has an impact on physical health and vice versa. For example, older adults with physical health conditions such as heart disease have higher rates of depression than those who are healthy. Additionally, untreated depression in an older person with heart disease can negatively affect its outcome. Older adults are also vulnerable to elder abuse - including physical, verbal, psychological, financial and sexual abuse; abandonment; neglect; and serious losses of dignity and respect. Current evidence suggests that 1 in 6 older people experience elder abuse. Elder abuse can lead not only to physical injuries, but also to serious, sometimes long-lasting psychological consequences, including depression and anxiety. Dementia and depression among older people as public health issuesDementiaDementia is a syndrome, usually of a chronic or progressive nature, in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities. It mainly affects older people, although it is not a normal part of ageing. It is estimated that 50 million people worldwide are living with dementia with nearly 60% living in low- and middle-income countries. The total number of people with dementia is projected to increase to 82 million in 2030 and 152 million in 2050. There are significant social and economic issues in terms of the direct costs of medical, social and informal care associated with dementia. Moreover, physical, emotional and economic pressures can cause great stress to families and carers. Support is needed from the health, social, financial and legal systems for both people with dementia and their carers. DepressionDepression can cause great suffering and leads to impaired functioning in daily life. Unipolar depression occurs in 7% of the general older population and it accounts for 5.7% of YLDs among those over 60 years old. Depression is both underdiagnosed and undertreated in primary care settings. Symptoms are often overlooked and untreated because they co-occur with other problems encountered by older adults. Older people with depressive symptoms have poorer functioning compared to those with chronic medical conditions such as lung disease, hypertension or diabetes. Depression also increases the perception of poor health, the utilization of health care services and costs. Treatment and care strategies to address mental health needs of older peopleIt is important to prepare health providers and societies to meet the specific needs of older populations, including:
Health promotionThe mental health of older adults can be improved through promoting Active and Healthy Ageing. Mental health-specific health promotion for older adults involves creating living conditions and environments that support wellbeing and allow people to lead a healthy life. Promoting mental health depends largely on strategies to ensure that older people have the necessary resources to meet their needs, such as:
InterventionsPrompt recognition and treatment of mental, neurological and substance use disorders in older adults is essential. Both psychosocial interventions and medicines are recommended. There is no medication currently available to cure dementia but much can be done to support and improve the lives of people with dementia and their caregivers and families, such as:
Mental health care in the communityGood general health and social care is important for promoting older people's health, preventing disease and managing chronic illnesses. Training all health providers in working with issues and disorders related to ageing is therefore important. Effective, community-level primary mental health care for older people is crucial. It is equally important to focus on the long-term care of older adults suffering from mental disorders, as well as to provide caregivers with education, training and support. An appropriate and supportive legislative environment based on internationally accepted human rights standards is required to ensure the highest quality of services to people with mental illness and their caregivers. WHO responseWHO supports governments in the goal of strengthening and promoting mental health in older adults and to integrate effective strategies into policies and plans. The Global strategy and action plan on ageing and health was adopted by the World Health Assembly in 2016. One of the objectives of this global strategy is to align the health systems to the needs of older populations, for mental as well as physical health. Key actions include: orienting health systems around intrinsic capacity and functional ability, developing and ensuring affordable access to quality older person-centred and integrated clinical care, and ensuring a sustainable and appropriately trained, deployed, and managed health workforce. The Comprehensive Mental Health Action Plan for 2013-2020 is a commitment by all WHO Member States to take specific actions to promote mental well-being, prevent mental disorders, provide care, enhance recovery, promote human rights and reduce the mortality, morbidity and disability for persons with mental disorders including in older adults. It focuses on 4 key objectives to:
Depression, psychoses, suicide, epilepsy, dementia and substance use disorders are included in the WHO Mental Health Gap Action Programme (mhGAP) that aims to improve care for mental, neurological and substance use disorders through providing guidance and tools to develop health services in resource-poor areas. The mhGAP package consists of interventions for prevention and management for each of these priority conditions in non-specialized health settings including in those for older people. WHO recognizes dementia as a public health challenge and published the report, Dementia: a public health priority, to advocate for action at international and national levels. WHO organized the First Ministerial Conference on Global Action Against Dementia in March 2015, which fostered awareness of the public health and economic challenges posed by dementia, a better understanding of the roles and responsibilities of Member States and stakeholders, and led to a “Call for Action” supported by the conference participants. In May 2017, the World Health Assembly endorsed the Global action plan on the public health response to dementia 2017-2025. The Plan provides a comprehensive blueprint for action – for policy-makers, international, regional and national partners, and WHO – in areas such as, increasing awareness of dementia and establishing dementia-friendly initiatives; reducing the risk of dementia; diagnosis, treatment and care; research and innovation; and support for dementia carers. It aims to improve the lives of people with dementia, their carers and families, while decreasing the impact of dementia on individuals, communities and countries. As part of the efforts to operationalize the Plan, an international surveillance platform, the Global Dementia Observatory, has been established for policy-makers and researchers to facilitate monitoring and sharing of information on dementia policies, service delivery, epidemiology and research. Why are older adults at increased risk for stress?Getting older can be stressful because of multiple losses such as: financial, psychosocial, personal, a decline in health, independence, and cognitive and functional abilities.
What puts older adults at risk for vulnerability?There are three main risk factors that contribute to vulnerability in older adults: health status; cognitive ability; and, social network.
Why are older people more vulnerable to disease?As we age, our immune system weakens. This makes us more vulnerable to infections of all types. And any sort of challenge to the body can do more damage. When the immune system gears up in older people, there is also a higher likelihood of a phenomenon called a cytokine storm.
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