Depression trajectories during the COVID-19 pandemic: a secondary analysis of the impact of cognitive-appraisal processes

• Published in: Journal of patient-reported outcomes 2023-07, Vol.7 (1), p.67-15, Article 67
• Main Authors: Schwartz, Carolyn E., Borowiec, Katrina, Rapkin, Bruce D.
• Format: Article
• Language: English
• Subjects: Appraisal; Chronic illness; Cognition; COVID; COVID-19; COVID-19 - epidemiology; COVID-19 and patient-reported outcomes; Depression; Depression - epidemiology; General population; Humans; Longitudinal Studies; Medicine; Medicine & Public Health; Mental depression; Pandemics; Quality of Life; Quality of Life Research; Response shift
• ISSN: 2509-8020; 2509-8020
• DOI: 10.1186/s41687-023-00600-z

Purpose This study characterized depression trajectories during the COVID pandemic and investigated how appraisal and changes in appraisal over time related to these depression trajectories. Methods This longitudinal study of the psychosocial impact of the COVID-19 pandemic included 771 people with data at three timepoints over 15.5 months. The depression index was validated using item-response-theory methods and receiver-operating-characteristic curve analysis. The Quality of Life (QOL) Appraisal Profile v2 Short-Form assessed cognitive-appraisal processes. Sequence analysis characterized depression-trajectory groups, and random effects models examined appraisal main effects, appraisal-by-group, and appraisal-by-group-by-time interactions. Results Sequence analysis generated six trajectory groups: Stably Well (n = 241), Stably Depressed (n = 299), Worsening (n = 79), Improving (n = 83), Fluctuating Pattern 1 (No–Yes–No; n = 41), and Fluctuating Pattern 2 (Yes–No–Yes; n = 28). While all groups engaged in negative appraisal processes when they were depressed, the Stably Depressed group consistently focused on negative aspects of their life. Response-shift effects were revealed such that there were differences in the appraisal-depression relationship over time for standards of comparison and recent changes for the Stably Depressed, and in health goals for those Getting Better. Conclusion The present work is, to our knowledge, the first study of response-shift effects in depression. During these first 15.5 pandemic months, group differences highlighted the connection between negative appraisals and depression, and response-shift effects in these relationships over time. Egregious life circumstances may play a lesser role for the Stably Depressed but a greater role for people who have transient periods of depression as well as for those with improving trajectories (i.e., endogenous vs. reactive depression). How one thinks about QOL is intrinsically linked to mental health, with clear clinical implications.