Behaviours to prevent anxiety and depression during the pandemic

The COVID-19 pandemic and the situation of lockdown may increase anxiety and depressive symptoms in the population. Various organisations have provided recommendations for tackling these symptoms, but as this is the first time we have experienced a global pandemic with these characteristics, most recommendations are based on studies of different experiences of isolation. For example, individual isolation experienced by prisoners, or studies on the psychological well-being of populations that have been through events such as natural disasters. Until now, no study has investigated which behaviours may protect against the impacts on psychological well-being during the current situation.

To add evidence to this field, the Psychiatry and Psychology Department for Adults at Hospital Clínic de Barcelona and the August Pi i Sunyer Biomedical Research Institute (IDIBAPS), carried out a major survey amongst the Spanish adult population two weeks after quarantine was established across the whole country. The survey was carried out anonymously through an online questionnaire, through the Hospital Clínic system, and was disseminated through social media. It included socio-demographic and work-related questions such as age range, if they had dependants to take care of, such as children, amount of remote and in-person work, perceived risk of losing work related to the pandemic, etc. It also included questions about the risk of relatives catching or being seriously affected by COVID-19.

Furthermore, participants were asked to assess the frequency of various behaviours during the last two weeks. These include following a routine; talking to family and friends; doing physical exercise; following a healthy, balanced diet; drinking plenty of water; reading news about COVID-19 very frequently; practising hobbies; spending time outside or doing relaxing activities such as listening to music, practising yoga, or gardening.

In total, 5,545 people participated in the survey. Of these, surveys with inaccurate answers were discarded, which left a total of 4,399 respondents whose levels of anxiety and depression could be analysed, as well as behaviours to tackle them. Of the surveyed women, 73%displayed symptoms of anxiety or depression. Symptoms were mild in the majority of cases, although 10% did display serious symptoms of one of these two conditions.

As for behaviours shown to havea protective effect against these symptoms, it was observed that following a healthy diet and not reading news about COVID-19 too often were the best predictors of lower levels of anxiety.

Other behaviours seen to reduce levels of anxiety were making the most of lockdown to practice hobbies, and not to talking to family or friends too often.

As for depression, following a healthy diet, maintaining a routine, not reading news about COVID-19 too often, practising hobbies and spending time outside were the best predictors of lower levels of depressive symptoms.

Other behaviours such as physical exercise, drinking water regularly or doing relaxing activities were not shown to reduce anxiety or depression.

Personal factors associated with greater anxiety and depressive symptoms were the risk of losing employment, having symptoms of COVID-19 without a diagnosis or having received mental health treatment for at least three months at some point during the person’s life. Having children or dependants was associated with increased symptoms of anxiety.

Although the survey had a large number of participants, which makes it more reliable, it also had some limitations. Firstly, this type of study, known as cross-sectional studies, is used to detect associations, but the direction of these associations cannot be determined. In other words, it could be that practising hobbies leads to a reduction in the levels of depressive symptoms, but the inverse could also be true: people with fewer depressive symptoms may be more likely to practice hobbies.

Longitudinal studies (which not only observe participants at a specific moment, but also at different time intervals) would be necessary to clarify these relationships.

Secondly, the study uses a sample in which women aged 35-44 are over-represented, and men and people over 75 years of age are under-represented in relation to the general Spanish population. This limitation is relevant as, at least in this survey, the presence of symptoms largely depended on age and sex (they were much more common in women). Nevertheless, the objective of the study was to identify the behaviours that may help to tackle these symptoms.

Despite these limitations, this study suggests that some very simple behaviours may protect against anxiety and depressive symptoms during the pandemic and the lockdown caused by COVID-19. These are behaviours that can be easily recommended by health organisations or healthcare professionals, as well as political representatives, to guide the public during the exceptional circumstances we are experiencing at the moment.

Source: Dr Eduard Vieta, Clinical Institute of Neuroscience, Hospital Clínic de Barcelona and Dr Joaquim Raduà, Image of Disorders Related to Mood and Anxiety (IMARD) research group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS).