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. Frailty was defined according to the physical phenotype and Frailty Index in the wave. Logistic regression was used to investigate the association of frailty with persistent and incident CMD, adjusted for sociodemographics. Results: Frailty according to both definitions were associated with persistent CMD (Frailty Index: OR = 8.61, 95 % CI = 4.08-18.18; physical phenotype: OR = 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). The exclusion of exhaustion (that overlaps with psychiatric symptoms) from the frailty constructs did not change the association between frailty and persistent CMD, although the associations with indent CMD were no longer significant. Conclusion: Frailty status before the COVID-19 outbreak was associated with higher odds of persistent and incident CMD in older adults during the pandemic first wave. Identifying individuals at higher risk of mental burden can help prioritize resources allocation and management.

Claudia Szlejf, Claudia Kimie Suemoto, Alessandra Carvalho Goulart, Itamar De Souza Santos, Pedro Starzynski Bacchi, Daniel Fatori, Lais Boralli Razza, Maria Carmen Viana, Paulo Andrade Lotufo, Isabela Martins Benseñor, Russowsky Brunoni