Elevated symptoms of depression and anxiety among family members and friends of critically ill COVID-19 patients - an observational study of five cohorts across four countries

Anikó Lovik^{1

2}, Juan González-Hijón¹, Asle Hoffart^{3

4}, Chloe Fawns-Ritchie^{5

6}, Ingibjörg Magnúsdóttir⁷, Li Lu^{8

9

10}, Anna Bára Unnarsdóttir⁷, Anna K Kähler¹¹, Archie Campbell⁵, Arna Hauksdóttir⁷, Charilaos Chourpiliadis¹, Daniel L McCartney⁵, Edda Björk Thordardóttir^{7

12}, Emily E Joyce¹, Emma M Frans¹¹, Jóhanna Jakobsdóttir⁷, Lill Trogstad¹³, Ole A Andreassen^{9

14}, Per Magnus¹⁵, Sverre Urnes Johnson^{3

4}, Patrick F Sullivan^{11

16}, Thor Aspelund^{7

17}, David J Porteous⁵, Helga Ask^{3

10}, Omid V Ebrahimi^{3

4}, Unnur Anna Valdimarsdóttir^{1

7

18}, Fang Fang¹

Affiliations

¹ Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
² Methodology and Statistics Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands.
³ Department of Psychology, University of Oslo, Oslo, Norway.
⁴ Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway.
⁵ Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland.
⁶ Division of Psychology, University of Dundee, Dundee, Scotland.
⁷ Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
⁸ Health Management and Policy Institute, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
⁹ NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
¹⁰ Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.
¹¹ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
¹² Mental Health Services, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland.
¹³ Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway.
¹⁴ NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
¹⁵ Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
¹⁶ Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill, NC, USA.
¹⁷ The Icelandic Heart Association, Kopavogur, Iceland.
¹⁸ Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.

PMID: 37953992
PMCID: PMC10636287
DOI: 10.1016/j.lanepe.2023.100733

Elevated symptoms of depression and anxiety among family members and friends of critically ill COVID-19 patients - an observational study of five cohorts across four countries

Anikó Lovik et al. Lancet Reg Health Eur. 2023.

. 2023 Sep 4:33:100733.

doi: 10.1016/j.lanepe.2023.100733. eCollection 2023 Oct.

Authors

Affiliations

¹ Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
² Methodology and Statistics Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands.
³ Department of Psychology, University of Oslo, Oslo, Norway.
⁴ Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway.
⁵ Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland.
⁶ Division of Psychology, University of Dundee, Dundee, Scotland.
⁷ Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
⁸ Health Management and Policy Institute, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
⁹ NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
¹⁰ Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.
¹¹ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
¹² Mental Health Services, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland.
¹³ Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway.
¹⁴ NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
¹⁵ Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
¹⁶ Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill, NC, USA.
¹⁷ The Icelandic Heart Association, Kopavogur, Iceland.
¹⁸ Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.

PMID: 37953992
PMCID: PMC10636287
DOI: 10.1016/j.lanepe.2023.100733

Abstract

Background: Little is known regarding the mental health impact of having a significant person (family member and/or close friend) with COVID-19 of different severity.

Methods: The study included five prospective cohorts from four countries (Iceland, Norway, Sweden, and the UK) with self-reported data on COVID-19 and symptoms of depression and anxiety during March 2020-March 2022. We calculated prevalence ratios (PR) of depression and anxiety in relation to having a significant person with COVID-19 and performed a longitudinal analysis in the Swedish cohort to describe temporal patterns.

Findings: 162,237 and 168,783 individuals were included in the analysis of depression and anxiety, respectively, of whom 24,718 and 27,003 reported a significant person with COVID-19. Overall, the PR was 1.07 (95% CI: 1.05-1.10) for depression and 1.08 (95% CI: 1.03-1.13) for anxiety in relation to having a significant person with COVID-19. The respective PRs for depression and anxiety were 1.15 (95% CI: 1.08-1.23) and 1.24 (95% CI: 1.14-1.34) if the patient was hospitalized, 1.42 (95% CI: 1.27-1.57) and 1.45 (95% CI: 1.31-1.60) if the patient was ICU-admitted, and 1.34 (95% CI: 1.22-1.46) and 1.36 (95% CI: 1.22-1.51) if the patient died. Individuals with a significant person with hospitalized, ICU-admitted, or fatal COVID-19 showed elevated prevalence of depression and anxiety during the entire year after the COVID-19 diagnosis.

Interpretation: Family members and close friends of critically ill COVID-19 patients show persistently elevated prevalence of depressive and anxiety symptoms.

Funding: This study was primarily supported by NordForsk (COVIDMENT, 105668) and Horizon 2020 (CoMorMent, 847776).

Keywords: Anxiety; COVID-19; Cross-country study; Depression; Significant person.

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Conflict of interest statement

AL received a grant from the Fredrik and Ingrid Thuring Foundation. DLM is a part-time employee of Optima Partners Ltd. EMF received payment for keynote lecture from Astra Zeneca. HA received a grant from the Research Council of Norway. PFS received a grant from the Swedish Research Council (Vetenskapsrådet, award D0886501) and is a consultant and shareholder Neumora Therapeutics for work not directly related to the topics of this paper. OAA received grants from NordForsk (Grant 105668) and the European Union’s Horizon2020 Research and Innovation Programme (Grant 847776; CoMorMent) for the current project and received grants from NIH NIMH, the Research Council of Norway, the South-East Regional Health Authority, Horizon2020, Stiftelsen Kristian Gerhard Jebsen, consulting fees from Biogen, Cortechs.ai and Milken, payment or honoraria from Janssen, Lundbeck and Sunovion, and reports patent Intranasal Administration, US20160310683 A1, participation on DSMB 21 board as PI, and stock options with Cortechs.ai. UAV received grants from NordForsk (Grants 138929 and 105668). FF received grants from NordForsk, the Swedish Research Council for Health, Working Life and Welfare, the Horizon2020 programme, Swedish Research Council, Swedish Cancer Society, US CDC, US NIH, and the European Research Council. The other authors declare no conflict of interest.

Figures

**Fig. 1**
Depressive (top) and anxiety (bottom) symptoms and COVID-19 incidence across cohorts over the entire study period, stratified by infection of a significant person. COVID-19 incidence is defined as the average number of confirmed cases per week per 100,000 persons in the 2 weeks prior to participant's response to the survey. Dotted blue line represents trend with 95% confidence interval.

**Fig. 2**
Prevalence ratio (PR) and 95% confidence interval (CI) of depressive (left) and anxiety (right) symptoms in relation to having a significant person with COVID-19.

**Fig. 3**
Prevalence ratio (PR) and 95% confidence interval (CI) of depressive (left) and anxiety (right) symptoms in relation to having a significant person with COVID-19, analysis by disease severity.

**Fig. 4**
Time trends of the monthly prevalence of depressive (left) and anxiety (right) symptoms among individuals with or without a significant person with COVID-19 (top) and by the disease severity of COVID-19 (bottom) in the Swedish Omtanke2020 cohort.

See this image and copyright information in PMC

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Elevated symptoms of depression and anxiety among family members and friends of critically ill COVID-19 patients - an observational study of five cohorts across four countries

Affiliations

Elevated symptoms of depression and anxiety among family members and friends of critically ill COVID-19 patients - an observational study of five cohorts across four countries

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Research Materials