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      COVID-19-related social support service closures and mental well-being in older adults and those affected by dementia: a UK longitudinal survey

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          Abstract

          Background

          The COVID-19 pandemic has had a major impact on delivery of social support services. This might be expected to particularly affect older adults and people living with dementia (PLWD), and to reduce their well-being.

          Aims

          To explore how social support service use by older adults, carers and PLWD, and their mental well-being changed over the first 3 months since the pandemic outbreak.

          Methods

          Unpaid dementia carers, PLWD and older adults took part in a longitudinal online or telephone survey collected between April and May 2020, and at two subsequent timepoints 6 and 12 weeks after baseline. Participants were asked about their social support service usage in a typical week prior to the pandemic (at baseline), and in the past week at each of the three timepoints. They also completed measures of levels of depression, anxiety and mental well-being.

          Results

          377 participants had complete data at all three timepoints. Social support service usage dropped shortly after lockdown measures were imposed at timepoint 1 (T1), to then increase again by T3. The access to paid care was least affected by COVID-19. Cases of anxiety dropped significantly across the study period, while cases of depression rose. Well-being increased significantly for older adults and PLWD from T1 to T3.

          Conclusions

          Access to social support services has been significantly affected by the pandemic, which is starting to recover slowly. With mental well-being differently affected across groups, support needs to be put in place to maintain better well-being across those vulnerable groups during the ongoing pandemic.

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          Most cited references24

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            The PHQ-9: validity of a brief depression severity measure.

            While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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              The PHQ-9

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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2021
                17 January 2021
                : 11
                : 1
                : e045889
                Affiliations
                [1 ]departmentInstitute of Psychology, Health and Society , University of Liverpool , Liverpool, UK
                [2 ]NIHR ARC NWC , Liverpool, UK
                [3 ]Lancashire Care NHS Foundation Trust , Preston, Lancashire, UK
                [4 ]University College London , London, UK
                [5 ]University of Bradford , Bradford, West Yorkshire, UK
                [6 ]Sefton Older People's Forum , Sefton, UK
                [7 ]Lewy Body Society , Wigan, UK
                [8 ]departmentDepartment of Modern Languages and Cultures , University of Liverpool , Liverpool, UK
                [9 ]SURF Liverpool , Liverpool, UK
                [10 ]EQE Health , Liverpool, UK
                [11 ]Me2U Care , Liverpool, UK
                [12 ]National Museums Liverpool , Liverpool, UK
                [13 ]North West Boroughs Healthcare NHS Foundation Trust , Warrington, UK
                [14 ]Liverpool DAA , Liverpool, UK
                [15 ]departmentBradford Dementia Group , University of Bradford , Bradford, UK
                [16 ]departmentDivision of Health Research , Lancaster University , Lancaster, UK
                [17 ]The Brain Charity , Liverpool, UK
                [18 ]TIDE , Liverpool, UK
                [19 ]departmentFaculty of Health and Wellbeing , University of Central Lancashire , Preston, UK
                Author notes
                [Correspondence to ] Dr Clarissa Giebel; clarissa.giebel@ 123456liverpool.ac.uk
                Author information
                http://orcid.org/0000-0002-0746-0566
                Article
                bmjopen-2020-045889
                10.1136/bmjopen-2020-045889
                7813330
                9791f6ce-4662-4278-b377-9ec26f33e275
                © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/.

                History
                : 27 October 2020
                : 03 January 2021
                : 04 January 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100010329, University of Bradford;
                Funded by: FundRef http://dx.doi.org/10.13039/501100000272, National Institute for Health Research;
                Award ID: ARC NWC
                Funded by: FundRef http://dx.doi.org/10.13039/501100000836, University of Liverpool;
                Award ID: COVID-19 Strategic Research Fund
                Categories
                Public Health
                1506
                2474
                1724
                Original research
                Custom metadata
                unlocked

                Medicine
                dementia,covid-19,mental health,old age psychiatry
                Medicine
                dementia, covid-19, mental health, old age psychiatry

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