A pandemic toll in frail older adults: Higher odds of incident and persistent common mental disorders in the ELSA-Brasil COVID-19 mental health cohort

Introduction: We aimed to investigate the association of frailty with persistent and incident common mental disorders (CMD) in older adults during the pandemic. Methods: We included 706 older adults who participated in the onsite wave of the ELSA-Brasil study (2017–2019) and the online COVID-19 assessment (May–July 2020). CMD were assessed in both waves by the Clinical Interview Schedule-Revised (CIS-R). Frailty was defined according to the physical phenotype and the Frailty Index. Logistic regression was used to investigate the association of frailty with persistent and incident CMD, adjusted for sociodemographics. Results: Frailty according to both definitions was associated with persistent CMD (Frailty Index: OR = 8.61, 95% CI = 4.08–18.18; physical phenotype: OR = 23.67, 95% CI = 7.08–79.15), and incident CMD (Frailty Index: OR = 2.79, 95% CI = 1.15–6.78; physical phenotype: OR = 4.37, 95% CI = 1.31–14.58). Excluding exhaustion from frailty constructs did not change the association with persistent CMD, but associations with incident CMD were no longer significant. Limitations: Fluctuations in CMD status between assessments were not captured. Conclusion: Frailty status before the COVID-19 outbreak was associated with higher odds of persistent and incident CMD in older adults during the first pandemic wave. Identifying individuals at higher risk of mental burden can help prioritize resource allocation and management.