New research from the University of Toronto has revealed the mental health toll of the COVID-19 pandemic on older adults with peptic ulcer disease (PUD), a painful condition in which gastric sores develop in the lining of the stomach or upper portion of the small intestine.

The researchers examined a subsample of older adults from the Canadian Longitudinal Study on Aging, a national dataset of older Canadians. The sample consisted of 1,140 older adults with PUD, of whom 689 had a pre-pandemic history of depression and 451 had no history of depression. By using longitudinal data, the researchers were able to compare the mental health trajectories of those with and without a history of depression.  The article was published this week in PLOS ONE.

Among older adults with PUD and no lifetime history of depression, approximately 1 in 8 (13.0%) developed depression for the first time during the COVID-19 pandemic. These numbers were substantially higher when compared to depression levels before the pandemic (2015-2018).

“Although individuals with peptic ulcers were already known to be vulnerable to depression, our findings show that the pandemic severely exacerbated this vulnerability,” said lead author Esme Fuller-Thomson, Professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work (FIFSW) and director of the Institute for Life Course & Aging (ILCA). “COVID-19 introduced many unforeseen stressors for people with chronic health conditions, such as higher levels of stress and lower levels of physical activity and social support, which may contribute to their worsening mental health.”

When the analysis was limited to those who had a lifetime history of depression, approximately 1 in 2 (46.6%) experienced recurrent or persistent depression during the pandemic.

“One of the major risk factors for depression in later life is having a previous history of depressive episodes,” said co-author Hannah Dolhai, a former research assistant at the ILCA. “Older adults with a history of depression who also had to navigate challenges with managing their chronic illness during the pandemic are a vulnerable subpopulation of Canadians.”

The researchers also identified several risk factors for depression among those with PUD, such as experiencing difficulty accessing healthcare.

“We found that individuals who reported challenges with healthcare access during the pandemic had a higher risk for depression. It’s important to think about the potential cascading mental health consequences of the healthcare restrictions that occurred during COVID-19,” said co-author Andie MacNeil, a research assistant at the FIFSW and Institute for Life Course and Aging. “While the shift towards telemedicine helped maintain healthcare continuity for many individuals, it is not always accessible or preferable for some patients”

Other risk factors for depression among older adults with PUD included feeling lonely at the beginning of the pandemic and experiencing functional limitations.

“Loneliness is a well-established risk factor for depression. For many older adults, the physical distancing limitations early in the pandemic meant increased time alone and declines in social support. Although these guidelines were important to protect the health of Canadians, they can also had unintended mental health consequences. It is important to find ways to foster social connection even when staying apart,” said co-author Grace Li, PhD candidate in the Sociology Department at the University of Victoria.

Co-author Ying Jiang, Senior Epidemiologist at the Public Health Agency of Canada points out that previous research on the relationship between PUD and depression has highlighted how symptoms like chronic pain can severely disrupt functional status and dramatically reduce quality of life in patients. “It is unsurprising that this relationship persisted into the pandemic, and that those with reduced functional status faced a higher risk of depression,” Jiang said.

Women were also found to have a higher risk of depression when compared to men.

“During the pandemic, many women experienced increased household labour and caregiving responsibilities due to school closures and restrictions in other community services, like older adult day programs. This exacerbation of gender-role stress may have impacted the mental health of many women,” said co-author Margaret de Groh, Scientific Manager at the Public Health Agency of Canada.

“By drawing attention to those with the highest risk for depression, we hope our findings will help inform targeted screening and intervention. Many older adults may still need mental health support in the post-COVID era,” said Fuller-Thomson.