Loneliness in Older Adults with Major Depression Across the COVID-19 Pandemic

INTRODUCTION: Loneliness has emerged as a distinct clinical construct with detrimental physical and mental health effects. During the COVID-19 outbreak and aftermath, studies examining loneliness in older adults reported mixed results with increased, decreased, and static levels of loneliness. These inconsistent findings likely relate to pandemic-related phenomena of amplified social isolation (e.g., quarantines, social distancing, remote work) for some, and an increased sense of social connectedness (e.g., shared interests, challenges and experiences, greater media engagement) for others. To our knowledge, only one study has examined the effect of the COVID-19 pandemic on older adults with pre-existing major depression. Most were resilient, with no overall change in depression, anxiety, and suicidality scores, however loneliness was not explicitly considered. As such, since loneliness and depression are interrelated in older adults, we sought to examine whether loneliness in non-remitted older depressed patients was impacted during the COVID-19 pandemic. METHODS: A brief survey instrument was developed that included relevant socio-demographic information, a modified Older Americans Resources and Services (OARS) scale for assessing perceived health status, a question on communication during the pandemic adapted from the Questionnaire for Assessing the Impact of the COVID-19 Pandemic in Older Adults (QAICPOA), a question on consumption of COVID-19 related news coverage, and the UCLA 3-item Loneliness Scale for three different time points: prior to the pandemic (retrospective self-rating), during the height of the pandemic (defined as between the declaration of a formal pandemic in March 2020 until vaccinations began in December 2020) (retrospective self-rating), and currently at the time of survey administration in Fall 2021 (contemporaneous rating). To ensure a homogeneous patient population, eligibility criteria included a primary diagnosis of a major depressive disorder without psychosis, cognitive impairment, secondary psychiatric disorders, or a remitted state. All patients were active registrants in the Zucker Hillside Hospital (ZHH) Geriatric Psychiatry Outpatient Clinic. A list of eligible patient names and contacts were generated through the IT department by abstracting information from the electronic health record. As per Northwell's IRB review, this survey project met the criteria outlined in 45 CFR 46.101 for IRB exemption. Eligible patients were called and asked to complete the survey over the phone. Data for the current pilot sample were analyzed using a two-tailed paired t-test with a threshold of significance of p ≤0.05. RESULTS: 106 patients met eligibility criteria. To date, 30 patients completed telephone surveys. The mean age of these respondents was 73.5 (SD ± 6.39) years. 73.3% (n = 22) were female and 26.1% (n = 8) were male. 63.3% of patients were white, 16.6% were Black, 13.3% were Hispanic, and 6.6% were Asian. 50% of patients were married, 26.6% were divorced, and 23.3% were widowed. 10% of patients were still working, while the remaining 90% were retired. 33.3% of patients had an associate, bachelor's, or graduate/advanced degree, 63.3% of patients completed high school, and 3.3% had not. 73% lived with at least one other person and 27% lived alone. 86.7% had one or more children and 13.3% were childless. The mean OARS score was 3.16 (SD ± 1.88) (range 0-6, worse to best perceived health). Compared to prior to the pandemic, 46.6 % of patients reported less communication with friends and family, 46.6 % reported they communicated the same, and 6.7% said they communicated more. Mean COVID-related news consumption rating (range 1-5, 5 = most) was 3.8 (SD ± 1.3). Mean UCLA 3-item loneliness scale (range 3-9) scores were 4.97 (SD ± 1.85) prior to the pandemic, 6.47 (SD ± 1.89) during the height of the pandemic, and 5.37 (SD ± 2.11) in the Fall 2021 vaccination period. A significant difference existed between loneliness scores prior to the pandemic and worsening loneliness during the height of the pandemic (p<0.0001). A significant difference also was found between loneliness scores during the height of the pandemic and improving loneliness during the less acute pandemic vaccination period (p < 0.005). There was no significant difference between loneliness prior to and after the height of the pandemic. CONCLUSIONS: In a representative pilot sample (expansion ongoing) of older depressed adults, loneliness increased significantly during the COVID-19 pandemic. In the context of prior findings of largely stable mental health parameters and resilience during the COVID-19 outbreak in a similar population, this suggests that loneliness is a unique human experience not necessarily alleviated by effective coping strategies. That loneliness significantly improved with a likely sense of incipient normalization reenforces that it is a dynamic psychological state subject to intervention. THIS RESEARCH WAS FUNDED BY: None.