The Association of Delayed Care With Depression Among US Middle-Aged and Older Adults During the COVID-19 Pandemic: Cross-sectional Analysis.

Abstract

BACKGROUND\nDuring the Coronavirus Disease 2019 (COVID-19) pandemic, the depression level among US adults has significantly increased. Age disparity in depression during the pandemic was also reported in recent studies. Delay or avoidance of medical care is one of the collateral damages caused by the COVID-19 pandemic and it can lead to increased morbidity and mortality.\n\n\nOBJECTIVE\nThe present study aims to assess the prevalence of depression and delayed care among US middle-aged adults and older adults during the pandemic, as well as investigate the association of delayed care with depression among those two age groups.\n\n\nMETHODS\nThis cross-sectional study used the 2020 Health and Retirement Study (HRS) COVID-19 Project (Early, Version 1.0) data. Univariate analyses, bivariate analyses, and binary logistic regression were applied. US adults older than 46 years old were included. Depression was measured by Composite International Diagnostic Interview Short Form (CIDI-SF). Delayed care was measured by four items: delayed surgery, delayed seeing a doctor, delayed dental care, and other delayed care.\n\n\nRESULTS\nMore than half of participants were older than 65 years old (58.23%) and 274 participants (8.75%) had depression during the pandemic. Delayed dental care was positively associated with depression among both middle-aged adults (OR=2.05, 95%CI=1.04-4.03, P<0.05) and older adults (OR=3.08, 95%CI=1.07-8.87, P<0.05). Delayed surgery was positively associated with depression among older adults (OR=3.69, 95%CI=1.06-12.90, P<0.05). Self-reported pain was positively related to depression among both age groups. Middle-aged adults who reported higher education level (some college of above) or worse self-reported health had higher likelihood to have depression. While perceived more loneliness was positively associated with depression among older adults, financial difficulty was positively associated with depression among middle-aged adults.\n\n\nCONCLUSIONS\nThis study found that depression among middle-aged and older adults during the pandemic was also prevalent. The study highlighted the collateral damage of the COVID-19 pandemic by identifying the association of delayed surgery and dental care with depression during the pandemic. Although surgery and dental care cannot be delivered by telehealth, telehealth services can still be provided to address patients concern on delayed surgery and dental care. Moreover, the implementation of tele-mental health services is also needed to address mental health symptoms among US middle-aged and older adults during the pandemic. Future research that uses more comprehensive measurements for delayed care is needed to decipher the path through which delayed care is associated with depression.\n\n\nCLINICALTRIAL