Evaluating the Association Between COVID-19 and the Risk of Anxiety and Depression Among Bedford, MA Residents - Laura Nash Bedford Board of Health

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Evaluating the Association Between COVID-19 and the Risk of Anxiety and Depression Among Bedford, MA Residents - Laura Nash Bedford Board of Health
Evaluating the Association Between
COVID-19 and the Risk of Anxiety
and Depression Among Bedford,
MA Residents
Laura Nash
Bedford Board of Health
Evaluating the Association Between COVID-19 and the Risk of Anxiety and Depression Among Bedford, MA Residents - Laura Nash Bedford Board of Health
Bedford, MA
●   Middlesex County: 1.612 million
●   Bedford: 14,123
Evaluating the Association Between COVID-19 and the Risk of Anxiety and Depression Among Bedford, MA Residents - Laura Nash Bedford Board of Health
Bedford Census Demographics
 ●   Race & Ethnicity
      ○ 77.4% White
      ○ 15% Asian
      ○ 4.1% Black/African American
      ○ 3.2% Hispanic/Latinex
 ●   Education:
      ○ High school graduate or higher: 96.8%
      ○ Bachelor degree or higher: 71.8%
 ●   Median income: $128,354
 ●   Percentage in poverty: 2.9%
Evaluating the Association Between COVID-19 and the Risk of Anxiety and Depression Among Bedford, MA Residents - Laura Nash Bedford Board of Health
Mental Health Impact Survey
 ●   Mental health already proved to be a growing issue in Bedford, MA
 ●   A recent report published from the Centers for Disease Control and Prevention found that adults who
     were experiencing symptoms with similar characteristics to anxiety and depression from August
     2020 to February 2021 increased from 36.4% to 41.5% (Vahratian et al., 2021)
 ●   What was COVID-19’s effect like on Bedford residents?
       ○ Are they at an increased risk of anxiety and depression?
Evaluating the Association Between COVID-19 and the Risk of Anxiety and Depression Among Bedford, MA Residents - Laura Nash Bedford Board of Health
Evaluating the Association Between COVID-19 and the Risk of Anxiety and Depression Among Bedford, MA Residents - Laura Nash Bedford Board of Health
Evaluating the Association Between COVID-19 and the Risk of Anxiety and Depression Among Bedford, MA Residents - Laura Nash Bedford Board of Health
Anxiety & Self-Rated Mental Health

                               Self-Rated Mental Health

                               New/Worsening Symptoms
                               with Similar Characteristics
                               to Anxiety
Findings
  ●     Prevalence: 30.3%
          ○ Of respondents experiencing symptoms similar to Anxiety
  ●     Statistically significant?

> table(SympAnx, MHCov)
                              MHCov
SympAnx          1 2 3 4 5
   1                          23 31 32 8 2
   2                          3 9 13 8 9
   3                          1 0 2 0 0
> prop.table(table(SympAnx,MHCov),1)
                              MHCov
SympAnx         1     2     3    4      5
   1                          0.23958333 0.32291667 0.33333333 0.08333333 0.02083333
   2                          0.07142857 0.21428571 0.30952381 0.19047619 0.21428571
   3                          0.33333333 0.00000000 0.66666667 0.00000000 0.00000000
> chisq.test(table(SympAnx,MHCov),correct = FALSE)

                Pearson's Chi-squared test

data: table(SympAnx, MHCov)
X-squared = 25.351, df = 8, p-value = 0.001355
Depression & Self-Rated Mental Health

                               Self-Rated Mental Health

                               New/Worsening Symptoms
                               with Similar Characteristics
                               to Depression
Findings
   ●     Prevalence: 26.2%
           ○ Of respondents experiencing symptoms similar to Depression
   ●     Statistically significant?

 > table(SympDep,MHCov)
                              MHCov
 SympDep          1 2 3 4 5
                  1           24 31 35 7 2
                  2           3 8 9 9 8
                  3           0 1 3 0 1
 > prop.table(table(SympDep,MHCov),1)
                                                  MHCov
 SympDep           1    2    3      4      5
    1                          0.24242424 0.31313131 0.35353535 0.07070707 0.02020202
    2                          0.08108108 0.21621622 0.24324324 0.24324324 0.21621622
    3                          0.00000000 0.20000000 0.60000000 0.00000000 0.20000000
 > chisq.test(table(SympDep,MHCov),correct = FALSE)

                 Pearson's Chi-squared test

 data: table(SympDep, MHCov)
 X-squared = 29.67, df = 8, p-value = 0.0002417
Additional Analysis: Income
Income
> income = 99
                                                    ●   Codes:
> income[Income
Takeaways

●   Data collected parallels assumptions that increased outreach and education is needed within the
    community in order to meet increased needs for treating mental health conditions
●   While the pandemic is ongoing, data suggests that COVID-19’s effect on an individual’s well-being has
    been significant and will continue to pose an issue to public health officials for the foreseeable future
●   Limitations
      ○ Sample size
      ○ Tick survey
      ○ Confidentiality concerns
      ○ Incomplete answers
Was your mental health negatively impacted during the
pandemic? If so, explain your thoughts below.
●   “Yes, I was so isolated and anxious”
●   “Yes… [But] not in a lasting kind of way… I hope”
●   “Stress of juggling needs for [children]”
●   “Short fuse; Sadness”
●   “Unable to adjust from working from home”
●   “Hard to pay bills”
●   “I got fired from my job and drank and smoked in my bed for eight months”
●   “I found myself annoyed and sometimes angered at people who complained about restrictions”
●   “I feel like my support structures are weaker”
●   “I lacked the confidence in how I was communicating with others and became angry with myself for
    not doing better to communicate”
What would you like the Town of Bedford to do moving forward
to promote mental health?
●   “Educate community about resources”
●   “Provide information publicly (through local new - both paper and web based) as to signs of
    depression and how to seek help for those in need”
●   “Promote outdoor abilities-sidewalks, bike lanes, park space”
●   “Offer fun activities like town gathering meditations, yoga, mindfulness etc. A way for everyone to
    come back together again”
●   “Continued support of social/emotional learning at schools/ resources for parents- (webinars this
    past year were helpful)”
●   “More anonymity when getting town services”
●   “Promotion of fun and easy activities to safely bring more happiness and connection and
    community back into our lives”
Thank you!
Questions?
1

Evaluating the Association Between COVID-19 and the Risk of Anxiety and Depression Among

                                 Bedford, MA Residents

                             Laura Nash, Boston University

                                Bedford Board of Health
2

Abstract

Introduction: The COVID-19 pandemic caused staggering rates of unemployment, unstable
housing, and financial hardships for many Americans. As a result, the pandemic has had profound
effects on mental health (a person’s psychological, emotional, and social well-being). However, the
extent to which the pandemic has affected the residents of Bedford, MA is unknown. With an
abundance of mental health services and programs in place, the Board of Health (BOH) sought to
understand if there was an association between risk factors for anxiety and depression and mental
health changes during the pandemic.

Methods: After meeting with key stakeholders, the BOH deemed that a town-wide mental health
assessment was necessary to assess how to improve the systems in place. Using a mixed methods
approach for the survey, it was distributed via social media platforms, news outlets, and newspaper
advertisements. The survey was open for two weeks, gathering information through Google Forms.
Information was then re-coded through Microsoft Excel, and uploaded into R Studio for Chi-square
tests of independence.

Results: On July 26th, 2021, 141 participants had completed the survey. However, 8 were excluded
from the analysis for not being Bedford residents. Of the 133 Bedford residents surveyed over the
course of two weeks, 26.2% of respondents reported new or worsening symptoms with similar
characteristics to depression and 30.3% of respondents reported new or worsening symptoms with
similar characteristics to anxiety. Chi-square tests of independence revealed that self-rated mental
health during the pandemic varied significantly among those with new or worsening symptoms of
depression and anxiety (p=0.0002 and p=0.001, respectively).

Discussion: Data regarding the risk of developing anxiety and depression during the COVID-19
pandemic had not been analyzed in Bedford prior to this survey. Although the sample size was a
limitation to the study, data collected parallels the BOH’s assumptions that increased outreach and
education is needed within the community in order to meet increased needs for treating mental
health conditions. While the pandemic is on-going, data suggests that COVID-19’s effect on an
individual’s well-being has been significant and will continue to pose an issue to public health
officials for the foreseeable future.
3

                                            Background

       Before the height of the COVID-19 pandemic, mental health within the town of Bedford,

MA was already posing to be an issue to health officials. A 2019 mental health needs assessment

revealed that 80% of survey respondents indicated one or more symptoms corresponding to a mental

health condition. In addition, the most common concerns that residents voiced was that more

education on the services offered in town needed to be offered, despite the fact that the town of

Bedford houses exemplary channels for mental health services. Many residents also cited that there

was a disconnect between the knowledge of these services and actual community outreach.

       In the coming time, the onset of the COVID-19 pandemic set back any progress that had

been made in regards to improving community outreach efforts. The pandemic brought profound

changes in the way people lived their day-to-day lives. More people found themselves jobless, food

insecure, and unsure about what the future would hold. A recent report published from the Centers

for Disease Control and Prevention found that adults who were experiencing symptoms with similar

characteristics to anxiety and depression from August 2020 to February 2021 increased from 36.4%

to 41.5% (Vahratian et al., 2021). Researchers went on to insinuate that social distancing, quarantine,

and lockdown protocols had significant contributions to the rise in these numbers. On a national

level these numbers had been increasing, but would they parallel local numbers too? To date, this

question remains ambiguous. However, in an attempt to answer this question, the Bedford Board of

Health sought to understand if there was an association between risk factors for anxiety and

depression and mental health changes during the pandemic.
4
                                               Methods

       The Bedford Mental Health Impact survey was developed as a continuation of 2019 Mental

Health Needs Assessment, taking into account recommendations and new questions needing to be

answered. The survey was reviewed by the Community Health Nurse, Director of Health and Human

Services, and Community Social Worker. After five rounds of revisions, 29 questions were

developed asking participants questions about demographics, self-rated health conditions, and daily

habits. Once the survey had been finalized, it had been transferred to Google Forms and opened to

the public on July 19th. For a total of 14 days the survey had been opened, and on August 2nd the

survey was closed. It is important to note that the survey could not be submitted until all of the

required fields were completed.

       Since the survey had been designed for Bedford residents, respondents who had answered

“no” to question two—which had asked whether or not the participant lived or attended school in the

town of Bedford—they would be disqualified from the final data analysis. Questions three through

eight asked participants to disclose anonymous information about demographics such as gender, age,

ethnicity, education, employment, and income. Question nine asked respondents whether or not they

had been experiencing symptoms with similar characteristics to depression. If answered yes, the

respondent would move on to question ten. If no, the respondent moved to question eleven, asking
5
whether or not they had been experiencing symptoms with similar characteristics to anxiety. If yes,

the respondent moved to question twelve. If no, the participant moved on to question thirteen.

Questions thirteen through eighteen asked respondents questions regarding self-rated mental health

changes and knowledge of town services. Question nineteen asked whether or not the person knew

of any mental health services in Bedford. If yes, move to question twenty. If not, skip to question

twenty-one. Questions twenty-one through twenty-five prompted participants to indicate the extent

to which they agreed or disagreed with each statement. Questions twenty-six and twenty-seven

sought to understand what changes Bedford residents had seen in their daily lives as a result of the

pandemic. Lastly, questions twenty-eight and twenty-nine were left as open-ended questions to see

what the town of Bedford could do to make residents feel more confident and comfortable in their

ability to use town services as well as to suggest improvements to the town on how to proceed in

such events in the future.

       When the survey was ready to be distributed among the town, an email was sent to the

town’s mailing list, distributed in the Bedford MinuteMan, and on the town’s social media page.

                                               Results

       As of August 2nd, 2021 a total of 141 participants had completed the survey. Eight

respondents had indicated that they had not lived or attended school in the town of Bedford and were

excluded from the final data analysis. On the first day of being opened, 77 people had completed the

survey. By the end of the first week, 115 respondents had completed the survey and in the following

week the survey had been completed by an additional 26 people.

Table 1.
 Demographic                 Value                                 Frequency (n =        Percentage
                                                                   141)

 Gender                      Male                                           35                   24.8%
6

                 Female                             99    70.2%
                 Gender queer                        1     0.7%
                 Prefer not to say/self-describe     6     4.3%

Age              Under 18                            1     0.7%
                 18 - 29                             2     1.4%
                 30 - 39                            18    12.8%
                 40 - 49                            23    16.3%
                 50 - 59                            27    19.1%
                 60+                                66    46.8%
                 Prefer not to answer                4     2.8%

Race/Ethnicity   White                              118   83.7%
                 Hispanic/Latinex                     5    3.5%
                 Black/African American               1    0.7%
                 Asian/Pacific Islander               6    4.6%
                 Indian-American                      1    0.7%
                 Prefer not to say                   10    7.1%

Education        Less than a high school diploma     1     0.7%
                 High school degree or equivalent   15    10.6%
                 Associate’s degree                  2     1.4%
                 Bachelor’s degree                  43    30.5%
                 Master’s degree                    58    41.1%
                 Doctorate                          16    11.3%
                 Prefer not to say                   7     4.3%

Employment       Full-time (40+ hours/week)         55    39.0%
                 Part-time (
7

                               $100,000 - $114,999                             11                    7.8%
                               $115,000+                                       55                   39.0%
                               Prefer not to say                               49                   34.8%

       As seen above, Table 1 described the demographics of the 141 respondents who completed

the survey. Female respondents (70.2%), those over the age of 60 (46.8%), white residents (83.7%),

those with a Master’s degree (41.1%), full-time employees (39.0%), and those making over

$115,000 (39.0%) were the most common answers to the demographic questions listed in the survey.

Figure 1.

       Figure 1 represents whether or not survey respondents had reported new or worsening

symptoms with similar characteristics to depression. Those symptoms were including, but not

limited to: little interest in doing activities, feeling down or hopeless, trouble sleeping or eating,

fatigue, trouble concentrating, and/or feeling bad about oneself. A majority of respondents had

indicated that they had not experienced these feelings, however, over a quarter of participants had

indicated that they had been in fact experiencing these symptoms.

Figure 2.
8

       Figure 2 represents whether or not survey respondents had reported new or worsening

symptoms with similar characteristics to anxiety. Those symptoms were including, but not limited

to: feeling nervous or on edge, not being able to control worrying, trouble relaxing, restlessness,

irritability, and/or being afraid something awful might happen. A majority of respondents had

indicated that they had not experienced these feelings, however, over 31.4% of participants had

indicated that they had been in fact experiencing these symptoms.

Data Analysis

       On August 2nd, 2021 the Bedford Mental Health Impact survey was closed to the public. The

information was collected via Google Forms and downloaded and uploaded into Google Excel. Once

in Excel, in order to give the text values numeric values, the Count If function was used for

seventeen of the twenty-nine questions. Once saved, the new document was then uploaded into R

Studio to generate descriptive statistics (see Table 1) and conduct Chi-square tests of independence

when appropriate.

       The aim of the assessment was to examine the potential association between risk factors for

anxiety and depression and mental health changes during the pandemic. To examine this question,

two questions were developed in conjunction with the town’s Community Social Worker which

were common screening questions that are used to determine whether or not one might be at risk of

developing anxiety or depression (see Figures 1 & 2). These screening questions were analyzed with
9
a self-rating system to determine mental health changes during the height of the pandemic. In R

studio, prevalence ratios were computed to determine what percentage of respondents had indicated

new or worsening symptoms of depression and anxiety. 30.3% of participants had indicated that they

had presented symptoms of anxiety and 26.2% of participants had indicated that they had presented

symptoms of depression. Given this insight, upon further data analysis, a Chi-square test of

independence revealed that mental health changes during the pandemic were statistically significant

with regards to anxiety (p-value = 0.001, X-squared = 25.35, df = 8) and depression (p-value =

0.0002, X-squared = 26.97, df = 8).

                                             Discussion

       Overall, risk factors for anxiety and depression were associated with mental health changes

during the COVID-19 pandemic. However, the results from this data analysis cannot be

generalizable to the entire population of Bedford, MA. The number of respondents who completed

the survey were overwhelmingly female, over the age of sixty-five, and retired, which is not very

similar to the demographics within the town itself: around 17% of Bedford, MA residents are over

the age of 65 and around 52% of the population is female (U.S. Census Bureau. n.d.).

       Furthermore, there are several possible explanations that may have impacted this result. First,

the temporal relationship between risk factors for anxiety and depression and the pandemic are

unclear. It is unknown whether or not these symptoms had already manifested within individuals

before COVID-19 became a global phenomenon. Plus, it is possible that factors such as stress,

financial constraints, daily habits, and other extraneous factors may have led to an overestimate of

the true association between risk factors for anxiety and depression and the pandemic. Moreover,

misclassification of responses may have been present within the study. Certain words including, but

not limited to anxiety and depression, had non-specific and broad definitions that to many may have
10
been misleading. Perhaps it would have been beneficial to include technical definitions for these

words, as they are a health state, not a feeling. Lastly, recall bias may have been present within the

study, as participants were asked to recall feelings, emotions, and daily habits from well over a year

ago and sometimes this information can be hard to remember.

       Despite the limitations of this study, the results revealed that there was an association

between the risk factors for anxiety and depression and mental health changes during the pandemic.

They also indicate that on a local level, public health officials may begin to see an increase in the

amount of people needing mental health services. In turn, it is unknown whether or not many

municipalities have such services in place to meet this demand. For the time being, it is important

that health departments and boards of health alike generate an effective outreach campaign to enable

residents within each town to learn more about services offered at a free or low cost. With the two

open-ended questions at the end of the survey, a common theme among the responses was that

residents wished to see more community outreach and perhaps more community building

opportunities. In other words, this might look like mindfulness classes, group exercises, and other

recreational activities, which might be a salient way to foster trust between the community and

health officials. Yet, although the pandemic is on-going, it is evident that confronting these health

disparities and creating strong support systems is urgently needed as the consequences of

deteriorating mental health in various populations will create greater issues for the overall well-being

of the community in the coming time.
11
                                      References

U.S. Census Bureau QuickFacts: Bedford town, Middlesex County, Massachusetts. (n.d.).

    Retrieved August 10, 2021, from

    https://www.census.gov/quickfacts/fact/table/bedfordtownmiddlesexcountymassachusetts/R

    HI225219

Vahratian, A. et al. (2021). Symptoms of Anxiety or Depressive Disorder and Use of Mental

    Health Care Among Adults During the COVID-19 Pandemic—United States, August

    2020–February 2021. MMWR. Morbidity and Mortality Weekly Report, 70.

    https://doi.org/10.15585/mmwr.mm7013e2
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