Psychosocial Factors Associated with Depression and Anxiety During COVID-19 Pandemic Among Outpatients with Depression

Abstract

Objective Long-term social distancing, isolation, and economic fallout may be significant psychological triggers during pandemic, such as COVID-19, especially for those with underlying psychiatric illness. This study was conducted to address the psychological impact of COVID-19 pandemic among patients with depression based at a teaching hospital in Malaysia. Methods This is a cross-sectional online study among patients with depression from University Malaya Medical Centre, using Generalized Anxiety Disorder-7 (GAD-7), Montgomery-Åsberg Depression Rating Scale-Self Assessment (MADRS-S), Insomnia Severity Index (ISI), Multidimensional Scale of Perceived Social Support (MSPSS), Knowledge, Attitudes, and Practices (KAP), and Social Media Addiction during COVID-19 Pandemic (SMACOP). Results One hundred seventy-eight patients participated in this study. The mean total of the KAP score is 12.65 (SD = 2.65), with knowledge section (mean = 7.34 [SD = 2.13]), attitudes section (mean = 2.63 [SD = 0.58]), and practices section (mean = 2.69 [SD = 1.00]). They scored moderately on the MADRS-S (mean = 21.03 [SD = 4.62]) and ISI (mean = 20.25 [SD = 4.62]) but had high GAD-7 scores (mean = 16.8 (SD = 6.27]). From the multiple logistic regression analyses, depressive symptoms of greater severity (MADRS-S 18–34) are significantly associated with more severe insomnia ( P < .001, adjusted OR = 9.101, 95% CI: 3.613–22.924). Furthermore, the high anxiety level is associated with the younger age group ( P = .029, Adjusted OR = 2.274, 95% CI: 1.090–4.746), greater severity of insomnia ( P < .001, Adjusted OR = 22.9, 95% CI: 6.145–85.343), and higher risk of COVID-19 related social media addiction ( P = .011, adjusted OR = 2.637, 95% CI: 1.253–5.550). Conclusion This study demonstrates the high levels of sleep disturbances and anxiety symptoms experienced by outpatients with depression during the COVID-19 pandemic. These are closely linked to the younger age group and at-risk social media addiction related to COVID-19.

Factors associated with insomnia and suicidal thoughts among outpatients, healthcare workers, and the general population in Taiwan during COVID-19 pandemic: a cross-sectional study

“…The insomnia prevalence among outpatients (39.5%) was the lowest among the three populations in the present study. However, one study in Turkey reported that 48.6% of cancer outpatients had insomnia, and another study in Malaysia reported that 80.9% of depression outpatients had insomnia during the pandemic [ 34 , 53 ]. Therefore, differences in the prevalence rates of insomnia may be due to differences in individuals’ underlying medical conditions [ 25 , 26 ].…”

“…Moreover, these studies reported that the prevalence rates for (i) anxiety were 9.5–73.3% (HCWs) and 47% (COVID-19 patients); (ii) depression were 12.5 to 71.9% (HCWs) and 45% (COVID-19 patients); and (iii) sleep problems were 18–32.3% (general population), 31–36% (HCWs), and 34–74.8% (COVID-19 patients). Outpatients may also be vulnerable to mental health issues because of their pre-existing health conditions and higher risk of contracting the virus while attending hospital appointments during the pandemic [ 30 , 33 , 34 ]. However, to the best of the present authors’ knowledge, outpatients have remained an understudied population.…”