Stress, Personality, Attachment, and Coping Strategies During the COVID-19 Pandemic: The STERACOVID Prospective Cohort Study Protocol.

Background: Due to the lockdown linked to the COVID-19 pandemic, the French National Authority for Health has recommended reinforced follow-up of psychiatric patients, with particular attention to people over 65 years. Cross-sectional studies reported an increased risk of anxiety, depression, and suicide during this period. Older people with psychiatric disorders are at higher risk of developing severe COVID-19 and worsening their psychiatric symptoms. Objective: The main objective is to evaluate the link between coping strategies and the onset of post-traumatic stress disorder (PTSD) after lockdown. The secondary objective is to assess the psychological factors influencing lockdown experiences such as personality, attachment type, or coping strategies. Method/Design: this is a multicenter cohort study including 117 patients followed up by phone in two French geriatric psychiatry units. Sociodemographic variables, psychiatric diagnoses, lockdown conditions, coping strategies, anxiety, and depressive symptoms reported during the first lockdown will be collected retrospectively from the medical file. A first prospective assessment including personality traits, attachment type, and traumatic life events will be conducted at 12 months (T1). Follow-up visits assessing anxious-depressive symptoms and PTSD will be made 18 (T2) and 24 months (T3) after the first lockdown. The primary outcome measure is PTSD symptoms. Secondary outcomes measures are coping strategies, generalized anxiety, anxiety about the COVID-19 pandemic, and quality of life. Discussion: This study aims to determine if the type of coping strategies usually employed have an impact on the onset of PTSD after a lockdown period. It will also determine if these coping strategies are influenced by other factors such as sociodemographic variables, lockdown conditions, particular personality traits, attachment type, and traumatic life events. This study could help identify factors associated with a poorer experience of lockdowns and pandemic crisis in elderly patients followed in a psychiatric center, and guide support in future similar situations. Trial Registration: ClinicalTrials.gov: http://clinicaltrials.gov/show/NCT04760795, Registered 18 February 2021.

Anxiety, depression and coping evolution during the Covid-19 pandemic in older people with psychiatric diseases / Anxiété, dépression et évolution du coping durant la pandémie de Covid-19 dans une population de patients âgés avec troubles psychiatriques

Introduction: Lockdown over the Covid-19 pandemic might have had a major impact on people's mental health. The present longitudinal study was aimed to explore the impact of the two first lockdowns on anxious and depressive symptoms of older subjects suffering from psychiatric disorders and to highlight their strategies to cope with the stress induced by these lockdowns. Methods: Twenty-one outpatients from psychogeriatric units benefited from a follow-up visit phone. They filled out questionnaires assessing their anxious (GAD-7) and depressive (Mini-GDS) symptomatology and a questionnaire about their coping strategies (Brief COPE). Results: The depressive symptomatology significantly decreased between the 1st lockdown and the second assessment 9 months later with a GDS score significantly decreasing from 1.7 ± 1.2 to 0.9 ± 1.0. Conversely, anxiety remained stable with a mean GAD-7 score from 6.2 ± 5.1 to 6.3 ± 4.4. Furthermore, coping strategies were correlated with both depressive symptomatology and anxiety. At the same time, coping strategies focused on emotional support, acceptance, selfdistraction, and expression of feeling during the first lockdown had shifted 9 months later towards positive reframing and problem-solving strategies (active coping and planification) with a significant increase of active coping. Conclusion: The study showed that during the Covid-19 pandemic and its lockdown, older subjects with psychiatric disorders were able to engage coping strategies and to mitigate their depressive symptomatology and these coping strategies were flexible according to the context.

Contexte: Le confinement durant la pandémie de Covid-19 a eu un impact majeur sur la santé mentale. Cette étude longitudinale réalisée durant la pandémie avait pour objectif d'évaluer l'impact des deux premiers confinements sur les symptômes anxieux et dépressifs de sujets âgés avec troubles psychiatriques, et de mettre en évidence leurs stratégies d'adaptation pour faire face au stress. Méthodes: Vingt et un patients de psychogériatrie ont bénéficié d'un suivi en téléconsultation. Ils ont renseigné des questionnaires mesurant leur symptomatologie anxieuse (GAD 7) et dépressive (Mini-GDS), et leurs stratégies de coping. Résultats: La symptomatologie dépressive a significativement diminué entre le premier confinement et l'évaluation réalisée neuf mois plus tard (avec respectivement : scores à la Mini-GDS à 1,7 = 1,2 et 0,9 ± 1,0, p = 0,01). En revanche, le niveau d'anxiété ne s'est pas modifié (avec respectivement score GAD7 à 6,2 ± 5,1 et 6,3 ± 6,4, p = 0,4). Par ailleurs, des corrélations significatives entre certaines stratégies de coping, la dépression et l'anxiété ont été observées. Les stratégies de coping centrées sur le soutien émotionnel lors du premier confinement ont évolué vers des stratégies orientées sur la résolution de problème neuf mois plus tard. Ainsi, l'étude a montré que durant cette période de confinement et de pandémie de Covid-19, des sujets âgés ont pu mobiliser des stratégies de coping et atténuer leur symptomatologie dépressive et que ces stratégies ont été modulables selon le contexte.

Anxiety symptoms during COVID-19 in older adults with psychiatric disorders.

Objective: During the COVID-19 pandemic, older people and patients with psychiatric disorders had an increased risk of being isolated. The French National Authority for Health has recommended a reinforced follow-up of these patients. Cross-sectional studies reported an increased risk of developing anxiety and depression during pandemic. The aim of our study was to identify factors associated with higher anxiety during the pandemic in older patients with psychiatric disorders. Methods: STERACOVID is a multicenter cohort study with 117 patients followed-up by phone in two French geriatric psychiatry units. In this work, we used cross-sectional data from a prospective follow-up conducted between January and May 2021. Results: We found that coping strategies, personality, and living conditions were associated with general anxiety (GA) level during the pandemic period. Higher GA was associated with less positive thinking coping strategy, more avoidance strategies, a lower level of extraversion, a higher level of neuroticism, more time spent watching the news, a higher feeling of loneliness, and a lack of physical contact. Findings: Our study identified factors associated with a poorer experience of pandemic crisis. Special attention should be paid to patients with a high level of neuroticism and a high feeling of loneliness. Support could aim to help patients use more functional strategies: reducing avoidance strategies and increasing positive thinking. Finally, reducing time watching news could also be an interesting prevention perspective. Clinical trial registration: clinicaltrials.gov, identifier NCT04760795.

Predictive performance of four frailty screening tools in community-dwelling elderly.

BACKGROUND: This study compares the performance of four frailty screening tools in predicting relevant adverse outcome (disability, institutionalization and mortality) in community-dwelling elderly. METHODS: Our study involved a secondary analysis of data from the FréLE cohort study. We focused on the following four frailty screening tools: the abbreviated Comprehensive Geriatric Assessment (aCGA), the Groningen Frailty Indicator (GFI), the Vulnerable Elders Survey-13 (VES-13) and the Fried scale. We used the Barberger-Gateau scale to assess disability. For comparison, we determined the capacity of these tools to predict the occurrence of disability, institutionalization or death using the receiver operating characteristic (ROC) curve. We also determined the threshold at which an optimal balance between sensitivity and specificity was reached. Odds ratios (ORs) were calculated to compare the risk of adverse outcome in the frail versus non-frail groups. RESULTS: In total, 1643 participants were included in the mortality analyses; 1224 participants were included in the analyses of the other outcomes (74.5% of the original sample). The mean age was 77.7 years, and 48.1% of the participants were women. The prevalence of frailty in this sample ranged from 15.0% (Fried) to 52.2% (VES-13). According to the Barberger-Gateau scale, 643 (52.5%) participants were fully independent; 392 (32.0%) were mildly disabled; 118 (9.6%) were moderately disabled; and 71 (5.8%) were severely disabled. The tool with the greatest sensitivity for predicting the occurrence of disability, mortality and institutionalization was VES-13, which showed sensitivities of 91.0%, 89.7% and 92.3%, respectively. The values for the area under the curve (AUC) of the four screening tools at the proposed cut-off points ranged from 0.63 to 0.75. The odds (univariate and multivariate analysis) of developing a disability were significantly greater among the elderly identified as being frail by all four tools. CONCLUSION: The multivariate analyses showed that the VES-13 may predict the occurrence of disability, mortality and institutionalization. However, the AUC analysis showed that even this tool did not have good discriminatory ability. These findings suggest that despite the high number of frailty screening tools described in the literature, there is still a need for a screening tool with high predictive performance.