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Seniors sit in the hallway following being administered their second dose of the Pfizer COVID-19 vaccine by healthcare workers from Humber River Hospital, inside Caboto Terrace, an independent seniors residence in Toronto on April 1.Cole Burston/Getty Images

Loneliness was the most significant risk factor for depression among older Canadians during the first year of the pandemic, according to the results of a large-scale longitudinal study that followed seniors both before and after COVID-19 spread through the country.

The research is part of a growing treasure trove of data pinpointing risk factors in pandemic mental health that experts say should help governments target health dollars to the Canadians who will struggle most in the aftermath.

“If you only look at mental health in aging populations from a medical viewpoint, you can overlook the social factors that contribute to chronic issues,” said Parminder Raina, the scientific director of the McMaster Institute for Research on Aging, and the lead investigator of the longitudinal study.

The study, which surveyed more than 24,000 Canadians over the age of 50 from before the pandemic to the end of 2020, found that they were twice as likely to experience symptoms of depression after the first lockdown. Forty-three per cent experienced an increasing severity of symptoms as the months went on, which persisted even as the first wave ended and some restrictions were lifted.

That higher rates of symptoms were sustained was a surprising finding, Dr. Raina says, and suggests long-term consequences of the pandemic. “That’s what gives a clue that this was not just a transient thing, it actually has a lasting effect on people,” he said.

The study has highlighted patterns also found in other international research. Having a lower socioeconomic status and more pandemic-related stressors put people at higher risk. Women experienced higher rates of depression than men. Canadians between 50 and 65 fared more poorly than older seniors; researchers theorized this group was more likely to be working, and juggling the needs of both children and aging parents. (The survey did not include residents of long-term care homes.)

As with many COVID-19 surveys, the research, which used a sample of people from the Canadian Longitudinal Study on Aging, found that what put people at higher risk of mental-health issues before the pandemic also tended to make them more vulnerable during it.

The study found that the prevalence of depressive symptoms during the first wave more than doubled in older Canadians with a household income between $100,000 and $150,000, to 19 per cent from about 10 per cent. The increase over the year was smaller among Canadians with an income of less than $50,000, but the overall prevalence was significantly higher. For people whose income was less than $20,000, the prevalence of symptoms was 31 per cent, a number that did not change much during the survey’s time period. As Dr. Raina notes, low-income seniors already had higher rates of depression than those with more financial resources before March 2020.

While seniors living alone had high rates of depression symptoms pre-pandemic, their rates of depression did not increase any more than those with company at home during the first wave. Overall, participants in the study who said they felt lonely, however, were five times more likely to show signs of depression than those who did not. “Loneliness in our country is a serious issue for older people,” said Dr. Raina, and one the pandemic highlighted.

This year, the national survey on aging will collect data from the full sample – about 51,000 people – which will provide answers to a significant research question: What happened after the first 12 months, when the pandemic continued to drag on?

Some research has suggested that while many people initially reported declining mental health, many also showed resilience after several months as they adjusted to the pandemic norm, says Lara Aknin, a social psychologist at Simon Fraser University and the chair of the Lancet’s COVID-19 mental-heath task force. How that overall resilience held up during subsequent waves, and the opening and shutting of society, will require more study. But, Dr. Aknin said, “one clear message from the first year was the exceptional inequality of experience.”

The rate and speed of recovery will come down to each person’s circumstances and experiences, Dr. Rana suggests. “People who have a lot of social stress will probably continue to have poorer outcomes,” he said. “And people who have other resources, they might be able to come back faster.”

Individuals aside, results show the need to focus on poor seniors, those with multiple health issues, and those who feel lonely, the authors write. The trend in worsening symptoms suggests that the mental-health toll of the pandemic “may worsen over the long term in the absence of effective interventions.”

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