COVID-19: Disruptions to physical activity emerged as a leading risk factor for depression during the pandemic

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The United States spends more than $200 billion every year in efforts to treat and manage mental health. The onset of the coronavirus pandemic has only deepened the chasm for those experiencing symptoms of depression or anxiety. This breach has also widened, affecting more people.

New research from Carnegie Mellon University, University of Pittsburgh and University of California, San Diego found that 61% of surveyed university students were at risk of clinical depression, a value twice the rate prior to the pandemic. This rise in depression came alongside dramatic shifts in lifestyle habits.

The study documents dramatic changes in physical activity, sleep and time use at the onset of the COVID-19 pandemic.

Disruptions to physical activity emerged as a leading risk factor for depression during the pandemic. Importantly, those who maintained their exercise habits were at significantly lower risk than those who experienced the large declines in physical activity brought on by the pandemic.

While physical activity resumed in early summer, mental well-being did not automatically rebound. The results of the study are available online in the February 10 issue of the Proceedings of the National Academy of Sciences.

“There is an alarming rise in the rate of anxiety and depression among young adults, especially among college students,” said Silvia Saccardo, assistant professor in the Department of Social and Decision Sciences at CMU and senior author on the paper. “The pandemic has exacerbated the mental health crisis in this vulnerable population.”

Saccardo and her colleagues, Osea Giuntella, Kelly Hyde and Sally Sadoff, examined data gathered from 682 college students who used a smartphone app and a Fitbit wearable tracker for spring 2019, fall 2019 and spring 2020.

Their results show large disruptions in physical activity, sleep and computer/phone screen time and social interaction, alongside large declines in well-being. This data set spans the onset of social isolation during the early months of the pandemic, offering an insight into the factors that exacerbated mental health disorders in this age group.

“We used this unique dataset to study what factors are predictive of changes in depression,” said Saccardo. “[In the dataset,] we can see that mental health gets worse as the semester progresses, but it is dramatically worse in 2020 compared to the previous cohort.”

The team found that participants who maintained healthy habits prior to the pandemic—scheduled physical active and an active social life—were at a higher risk for depression as the pandemic continued.

The researchers point to a decline in physical activity as the leading risk factor for diminished mental health. However, restoration of physical activity was not met with a rebound in mental well-being.

“We randomized a group of individuals to receive incentive to exercise. While our short intervention increased physical activity among this group, it did not have an impact on mental health. These results open up a lot of opportunities for future research,” said Saccardo. “It is an interesting puzzle for future studies to understand why we do not see a symmetric relationship between the resumption of physical activity and mental health.”

This research documents how COVID-19 has generated large disruptions in mental well-being among college students, a vulnerable population.

“The results are generalizable to the young adult population, a highly exposed group which has exhibited rising depression rates over the last decades and was dramatically exposed to the disruptions caused by the current epidemic,” said Giuntella, assistant professor of economics at Pitt. “We need more work to understand whether similar trends were observed in other age groups.”


Exercise routine change is associated with prenatal depression scores during the COVID-19 pandemic among pregnant women

The COVID-19 pandemic has impacted the health and livelihoods of people around the world [1]. However, certain countries have been hit harder than others, with the United States exhibiting the highest prevalence and mortality estimates globally. As of November 16, 2020, 54,563,236 people living in the U.S. are estimated to have been infected with the novel coronavirus SARS-CoV-2, while 246,526 are thought to have died from the resulting disease COVID-19 [1].

Within the U.S., certain populations appear to be at higher risk for negative COVID-19 disease outcomes, including pregnant women. Although the specific effects of COVID-19 on pregnancy are still being tested, some researchers argue pregnant women are generally at higher risk for viral respiratory illness [2]. Moreover, other studies indicate that COVID-19 may be associated with an elevated risk for intensive care unit admission, placental injury, pre-eclampsia, preterm birth, low birth weight, and even maternal death [3–6]. These recent findings led the CDC to add pregnancy as a risk factor for severe COVID-19 outcomes on June 25, 2020 [7].

In addition to potentially being at an elevated risk for poor COVID-19 health outcomes, the CDC cautions that pregnant women may feel increased stress or anxiety during the pandemic [7]. The physical distancing and “stay at home” orders implemented by many local governments to slow the spread of SARS-CoV-2 are thought to increase feelings of anxiety and isolation, especially among already vulnerable populations [8].

Pregnancy-associated physiological changes have been clearly linked with increased depression risk, such that 1 in 8 women in the U.S. have been estimated to experience postpartum depression symptoms [9]. These depression-related symptoms include fatigue, changes to appetite or sleep, crying more often than usual, withdrawing from loved ones or the baby, feelings of anger, sorrow, hopelessness, worthlessness, or restlessness, and suicidal ideology [9].

Recent evidence suggests that maternal depression symptomatology has become even more common during the COVID-19 pandemic [8, 10].

Specifically, one study comparing mental health among pregnant women/new mothers before and after the onset of the pandemic found that rates of clinical depression and moderate to high anxiety significantly increased with the onset of the pandemic [8]

. These changes appear to be directly linked with the disruptions to daily routines, social isolation, and fears of developing COVID-19, highlighting the need for increased maternal health screening and treatment [8]. Other factors, including increased COVID-19-related financial stress or changes to working plans in pregnancy have also been associated with increased depression [11, 12].

Given the probable exposure of offspring to any psychotropic medications taken by the mother during pregnancy or breastfeeding [13], the identification of non-pharmaceutical treatments to reduce maternal depression is of great interest. One such alternative treatment may be maintaining a regular exercise routine throughout pregnancy and the postpartum period, which has been shown to both prevent and help treat depression symptoms among women able to safely engage in moderate to vigorous physical activity [13–20].

Regular exercise has been linked with several beneficial effects, including improved body satisfaction [21], reduced physical discomfort [22], feelings of physical control despite somatic changes linked with pregnancy [23, 24], and improved mood through the release of endorphins and neurotransmitters [23, 25].

It has therefore been recommended by the American College of Obstetricians and Gynecologists that pregnant women without medical contraindications engage in at least 150 minutes of moderate-intensity aerobic activity every week, divided into 30 minutes intervals most days of the week [26]. Yet, many pregnant women do not exercise at the recommended levels, due in large part to fatigue, time constraints (e.g., work and childcare), and pregnancy-related physical limitations (e.g., back pain, swelling, and joint pain) [27, 28].

Differences are also apparent by location, with pregnant women living in urban areas exhibiting significantly higher levels of moderate physical activity compared to those living in rural areas, likely due in part to increased access to fitness centers [29, 30].

Regardless of location, the benefits of exercise during pregnancy appears to be especially relevant during the COVID-19 pandemic, with women who reported at least 150 min of moderate intensity exercise exhibiting significantly lower scores for both anxiety and depression compared to those who exercised less [8]. Yet the direct effects of the pandemic on exercise regimens among pregnant women has not been fully explored.

For instance, within the United States, shelter in place orders were implemented to some extent across nearly all states throughout the spring of 2020 [31]. It therefore seems likely that many women’s exercise routines have been disrupted by the pandemic, especially in metro areas (e.g., due to fitness centers and parks closing or a fear of viral exposure while exercising outside in a densely populated area).

Conversely, women in less densely populated areas may feel safer going outside to engage in physical activities. However, the association between geographic location and the likelihood of reporting pandemic-related exercise changes has yet to be directly assessed. To the best of our knowledge, no other study has directly tested these relationships during the COVID-19 pandemic. In other words, it is not clear if reported pandemic-related changes in exercise routines are significantly associated with depression risk, and whether geographic location may influence the likelihood of these exercise disruptions.

We therefore use data drawn from the COVID-19 and Reproductive Effects (CARE) study–an online survey of pregnant women living in the U.S. which assesses how the COVID-19 pandemic has affected pregnant women’s wellbeing–to test the following two hypotheses:

Whether reported exercise routine change during the COVID-19 pandemic was significantly associated with participant depression score.
Whether the likelihood of reporting pandemic-related changes in exercise routine significantly differed between women living in a metro area and those in a non-metro area.

reference link: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243188


More information: Osea Giuntella et al, Lifestyle and mental health disruptions during COVID-19, Proceedings of the National Academy of Sciences (2021). DOI: 10.1073/pnas.2016632118

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