Depression and Anxiety in Long-Term Care Residents During the COVID-19 Pandemic: The Influence of Telehealth Availability, Cognitive Status, and Trauma History

OBJECTIVES

The present study investigates the impact of disrupted mental health services during the COVID-19 pandemic on depression and anxiety symptoms in long-term care (LTC) residents.

METHODS

The study examined clinical data from 5,645 residents who received at least two psychological services in a long-term care (LTC) or assisted living (AL) setting between March 2019 and March 2021. A series of multiple regressions were run to explore the effects of the COVID-19 shutdown on depression and anxiety symptoms while examining the effects of COVID-19-related facility closure and facility telehealth capabilities. Follow-up regression analyses explored the impact of cognitive impairment and positive trauma history on depression and anxiety symptoms.

RESULTS

Post-COVID levels of anxiety and depression were higher for residents with higher levels of pre-COVID anxiety and depression. The interaction between facility closure and availability of telehealth services and trauma history predicted self-report anxiety symptoms. Clinician-observed anxiety symptoms were predicted by cognitive impairment. Residents with a history of trauma had an increase in self-reported anxiety symptoms.

CONCLUSIONS

Telehealth appeared to mitigate anxiety during the pandemic for residents with higher pre-COVID anxiety.

CLINICAL IMPLICATIONS

For those individuals with severe anxiety, results suggest the importance of ensuring that mental health services are available to mitigate symptoms via telehealth when infection control disrupts the usual delivery of treatment.

Effects of the COVID-19 Pandemic on Anxiety Symptoms in Long Term Care Residents: A multilevel Growth Curve Analysis

Objectives

The coronavirus disease 2019 (COVID-19) pandemic has negatively impacted the mental health functioning of older adults residing in long-term care (LTC) settings. This study examines the impact of the lockdown on anxiety symptoms over time in LTC residents.

Design

Secondary data analysis was conducted on clinical data obtained with permission from a large behavioral health company that provides behavioral health services in long-term care (LTC) and assisted living (AL) facilities.

Setting and Participants

Data was obtained from 1149 adults (mean age 72.37, 70% female) in in LTC and AL facilities across the United States who were receiving psychological services one year prior, and one year after, the COVID-19 pandemic lockdown.

Methods

Changes in anxiety (measured using a clinician rating scale) over time before and after the pandemic were assessed using Latent Growth Curve modeling with psychiatric diagnosis, psychiatric medication and demographic factors included as covariates.

Results

Anxiety severity decreased over time before and after the onset of the COVID-19 pandemic. While pandemic level factors such as facility closure and telehealth availability did not affect anxiety over time, individual treatment factors such as OCD diagnosis, initial anxiety severity, bipolar disorder diagnosis, and prescriptions for anxiolytic and antipsychotic medications affected the trajectory of anxiety during the pandemic.

Conclusions and Implications

These results demonstrate that individual covariates such as diagnosis, symptom severity and medication use impacted the trajectory of anxiety symptoms before and during the COVID-19 pandemic more strongly than pandemic related circumstances (facility closure, telehealth availability). The impact of the COVID-19 pandemic may be better observed through treatment-relevant variables, rather than pure symptom severity. In preparation for future pandemics or other large-scale disasters potentially impacting service delivery, facilities should continue to prioritize continuity of care or a timely resumption of services attending to individual treatment factors.

Effectiveness of supported employment for veterans with spinal cord injuries: results from a randomized multisite study

OBJECTIVE

To examine whether supported employment (SE) is more effective than treatment as usual (TAU) in returning veterans to competitive employment after spinal cord injury (SCI).

DESIGN

Prospective, randomized, controlled, multisite trial of SE versus TAU for vocational issues with 12 months of follow-up data.

SETTING

SCI centers in the Veterans Health Administration.

PARTICIPANTS

Subjects (N=201) were enrolled and completed baseline interviews. In interventional sites, subjects were randomly assigned to the SE condition (n=81) or the TAU condition (treatment as usual-interventional site [TAU-IS], n=76). In observational sites where the SE program was not available, 44 subjects were enrolled in a nonrandomized TAU condition (treatment as usual-observational site [TAU-OS]).

INTERVENTIONS

The intervention consisted of an SE vocational rehabilitation program called the Spinal Cord Injury Vocational Integration Program, which adhered as closely as possible to principles of SE as developed and described in the individual placement and support model of SE for persons with mental illness.

MAIN OUTCOME MEASURES

The primary study outcome measurement was competitive employment in the community.

RESULTS

Subjects in the SE group were 2.5 times more likely than the TAU-IS group and 11.4 times more likely than the TAU-OS group to obtain competitive employment.

CONCLUSIONS

To the best of our knowledge, this is the first and only controlled study of a specific vocational rehabilitation program to report improved employment outcomes for persons with SCI. SE, a well-prescribed method of integrated vocational care, was superior to usual practices in improving employment outcomes for veterans with SCI.