Impact of COVID-19 on loneliness, mental health, and health service utilisation: a prospective cohort study of older adults with multimorbidity in primary care

Samuel Yeung Shan Wong; Dexing Zhang; Regina Wing Shan Sit; Benjamin Hon Kei Yip; Roger Yat-nork Chung; Carmen Ka Man Wong; Dicken Cheong Chun Chan; Wen Sun; Kin On Kwok; Stewart W Mercer

doi:10.3399/bjgp20X713021

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Impact of COVID-19 on loneliness: A medical student's perspective
Sarina Rana and Jaclyn Yizhen Tan

Published on: 16 November 2020

Published on: (16 November 2020)

Impact of COVID-19 on loneliness: A medical student's perspective
Sarina Rana, Medical Student, University College London (UCL)
Other Contributors:
Jaclyn Yizhen Tan, Medical Student, University College London (UCL)
We read with great interest the paper written by Wong et al., which attempted to identify the pandemic’s impact on elderly’s mental health.¹ We acknowledge the importance of identifying risk factors of mental health deterioration, but highlight the article’s shortfalls.

The study did not account for method bias associated with the De Jong Gierveld Loneliness Scale, a unidimensional measure of loneliness that uses negative-word association in the 6-item scale to determine an elder’s mental state. This causes method effects that skew results towards a negative outlook, depicting higher levels of loneliness in a vulnerable population that already experience higher levels of low mood and loneliness.² Using the original 11-item scale with periodic telephone follow-ups during the peak and aftermath of the pandemic would provide a more reliable picture of the impact of lockdown.

Aside from social isolation, one must consider the psychological impact of additional comorbidities and social factors that went undetected due to the lack of medical consultations and social support. This includes financial hardship and distress from the concurrent political unrest - confounding factors that were unaccounted for.

In addition, there was no justification for the increase in missed appointments during the pandemic. Plausible reason...
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We read with great interest the paper written by Wong et al., which attempted to identify the pandemic’s impact on elderly’s mental health.¹ We acknowledge the importance of identifying risk factors of mental health deterioration, but highlight the article’s shortfalls.

The study did not account for method bias associated with the De Jong Gierveld Loneliness Scale, a unidimensional measure of loneliness that uses negative-word association in the 6-item scale to determine an elder’s mental state. This causes method effects that skew results towards a negative outlook, depicting higher levels of loneliness in a vulnerable population that already experience higher levels of low mood and loneliness.² Using the original 11-item scale with periodic telephone follow-ups during the peak and aftermath of the pandemic would provide a more reliable picture of the impact of lockdown.

Aside from social isolation, one must consider the psychological impact of additional comorbidities and social factors that went undetected due to the lack of medical consultations and social support. This includes financial hardship and distress from the concurrent political unrest - confounding factors that were unaccounted for.

In addition, there was no justification for the increase in missed appointments during the pandemic. Plausible reasons include fear of getting infected and lack of accessibility to the GP practice in terms of transportation or escorts. Such issues could be mitigated by teleconsultations but bring about limitations in conducting physical examinations as well as technical challenges for the elderly.³

Identifying and addressing factors impacting psychosocial health in a multimorbid population is particularly important during the COVID-19 pandemic. More studies need to be carried out to supplement current literature, and key policies should be in place to prevent the rise of poor mental health. Although telehealth consultations are a step forward, there are practical issues that need to be considered.

References

1. Wong, S., Zhang, D., Sit, R et al. Impact of COVID-19 on loneliness, mental health, and health service utilisation: a prospective cohort study of older adults with multimorbidity in primary care. Br J Gen Pract 2020, 70(700): e817-e824. doi: 10.3399/bjgp20X713021.

2. Tomás, J., Pinazo-Hernandis, S., Donio-Bellegarde, M., Hontangas, P. Validity of the de Jong Gierveld Loneliness Scale in Spanish older population: competitive structural models and item response theory. Eur J Ageing 2017, 14(4): 429-437.

3. Greenhalgh T, Vijayaraghavan S, Wherton J, et al. Virtual online consultations: advantages and limitations (VOCAL) study. BMJ Open 2016, 6:e009388. doi: 10.1136/bmjopen-2015-009388.

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Competing Interests: None declared.