Why researchers are worried about chronic stress and Covid-19

Could stress be another pre-existing condition that makes Covid-19 infections worse?

By Lois Parsley for VOX

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The Covid - 19 Stress and Health Study

Spotlight on Gender Report

Report Produced to Coincide with Public Health England (PHE) National Mental Health, Dementia & Neurology Intelligence Network Spotlight on Gender 

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Why are women experiencing greater mental health challenges during the COVID-19 pandemic than men?


The first stage of the COVID-19 stress and health study revealed that in the earliest stages of the pandemic in the UK (April 2020), the emotional impact on women appeared to be much greater than on men, with women reporting much higher levels of stress, anxiety and depression when compared with men (https://www.medrxiv.org/content/10.1101/2020.05.14.20102012v1).


There have been many reports indicating that some of the challenges thrown up by the pandemic (such as precarious employment or unemployment and domestic violence) have been worse for women and these factors could explain these gender differences. However, there may also be psychological and social factors that also play a role. We conducted some additional analyses on the survey responses from April 2020 to examine this question. We focussed on the psychological and social measures which we found to be related to mental health in all participants at wave 1. This included: perceived loneliness, positive mood, worry about COVID-19 and perceived risk of COVID-19 infection.


We analysed responses from 476 men and 2,618 women. We first compared men and women on how lonely they felt, how much positive mood they were experiencing, how worried they were about getting COVID-19 and their perceived risk of acquiring the infection. Women did worse on all these measures. That is, they felt more lonely, experienced less positive mood, believed they were at greater risk of COVID-19 and worried more about this. These differences are shown in figures 1-4.  

We next asked whether these differences  between men and women still existed after taking into consideration how old people were, their ethnic backgrounds and the experience of either positive or negative life events since the start of the pandemic, focussing on events related to finances/employment, health and relationships in particular. 


Our results showed that age, ethnicity and experience of both positive and negative life events were associated with both positive mood and loneliness. But none of these factors accounted for the differences in positive mood and loneliness between men and women. In contrast, age, ethnicity and life events were not related to the differences in perceived risk of COVID-19 between men and women. Finally, being worried about contracting COVID-19 was somewhat associated with age, ethnicity and negative life events. But again, none of these accounted for the differences between men and women in their experience of worry.

In summary, women appear to be experiencing poorer mental health than men during this pandemic and this is largely driven by feeling more lonely, less positive, at greater risk of the disease and being more worried about contracting COVID-19. While some of this is influenced by age, ethnicity and the number and nature of stressful experiences women are experiencing, these factors do not completely account for the differences between men and women that we and others have reported. 

Further research is needed to understand (i) whether these feelings of greater distress are continuing; (ii) what aspects of the pandemic are resulting in greater loneliness, less positive mood and greater worry and perceived risk of the disease in women and (iii) what sorts of interventions are needed to help manage and reduce emotional distress in women.

Figure 1: Illustration of how positive mood scores differed between men and women

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Figure 2: Illustration of how perceived risk scores differed between men and women

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Figure 3: Illustration of how perceived loneliness differed between men and women

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Figure 4: Illustration of how worry about COVID-19 scores differed between men and women

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- End of Report - 

Covid-19 and Cortisol: Your samples just

became really important..

Some of you may have read reports in the news about a study suggesting that cortisol levels are higher in people with COVID-19 compared with those without the disease; and also that the mortality risk from COVID-19 is greater in people with higher levels of cortisol: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30216-3/fulltext


The authors rightly question whether this increase in cortisol is related to the disease itself. However, it is important to acknowledge that cortisol is also influenced by psychological stress, and that stress-related increases in cortisol dysregulate the immune system. As such, the findings raise the intriguing possibility that increased cortisol may not be (or may not only be) a consequence of COVID-19, but may also play a causal role. In theory this could occur in two ways. First, by dysregulating the immune system, cortisol could increase our risk of COVID-19 infection i.e., people with higher levels of the hormone due to the experience of greater stress, may be more likely to become infected. Second, this dysregulation of the immune system may also influence whether people experience asymptomatic/mild disease versus much more severe disease. At present, the main factors associated with severe disease are characteristics that are not amenable to change (e.g.., age, gender, ethnicity). So they don’t offer avenues for modifying the progression or severity of the disease. Cortisol, on the other hand, can be modified by drug treatments as well as psychological and behavioural treatments. Therefore, if cortisol plays a role in disease progression, early intervention to reduce levels of the hormone could, in theory, stall or slow progression of the disease. 

Of course, these findings also tie in with the recent news that dexamethasone may be an effective treatment in some patients with COVID-19: https://www.who.int/news-room/detail/16-06-2020-who-welcomes-preliminary-results-about-dexamethasone-use-in-treating-critically-ill-covid-19-patients Dexamethasone is a synthetic version of cortisol and usually results in a reduction in the body’s production of the hormone. Thus, pulling the findings from the two studies together suggests that the reason dexamethasone works in some patients is because it is dampening down the patient’s overproduction of cortisol. 

Regardless of whether elevated cortisol is a cause or consequence of COVID-19, the increased levels seen in this cohort of patients suggest that it is imperative that we rapidly work towards understanding the role of the hormone not only at the most severe end of the disease, but also examine whether it may also play a role in vulnerability to COVID-19, progression from asymptomatic to severe disease and the role of psychological stress and mental health in these processes. 

Your involvement in the COVID-19 Stress and Health Study will be critical in advancing our understanding in this area. To our knowledge, ours is the largest study in the world to have asked participants to collect hair samples for the measurement of cortisol. So, returning your hair samples to us next month with be vital. Look out for our emails to invite you to complete the survey again and on how to return your hair samples to us.

News from the UK COVID-19 Stress and Health Study: June 2020

The first wave of the study closed on 30th April 2020 with over 3000 people choosing to participate in just under 4 weeks. This phenomenal response from people across the UK has meant that we have already been able to make important contributions to our understanding of how the pandemic has been affecting you.

Our first finding relates to how the first few weeks of ‘lock-down’ have affected people emotionally. What the responses to the survey show is that the levels of stress, anxiety and depression people reported were significantly higher than we normally see in the UK. In fact, findings suggest that 64% of people reported experiencing symptoms of depression and 57% reported symptoms of anxiety, with younger people and women affected the most. These findings are currently being reviewed, but if you are interested in reading the pre-reviewed article (also known as a pre-print) you can find it

here: https://www.medrxiv.org/content/10.1101/2020.05.14.20102012v1

These findings, as well as results relating to the effects on keyworkers and individuals from Black And Minority Ethnic (BAME) backgrounds have, at their request, been shared with Public Health England too.

Invitations to participate in the second phase of the study will be coming out in July 2020 and this will include instructions on how to send your hair samples back to us. Please look out for our emails!

Mental health in the UK during the COVID-19 pandemic: early observations

Findings from from the New Zealand COVID-19 Stress and Health Study

Depression, anxiety and stress during the COVID-19 pandemic: Results from a New Zealand cohort study on mental wellbeing


What did we aim to do?

This studyinvestigated depression, anxiety and stress in New Zealand (NZ) during the first ten weeks of the COVID-19 pandemic. It also looked at psychological and behavioural factors. The results were compared with a similar study in the United Kingdom (UK).


How did we do it? 

Through a mass media campaign, we invited New Zealand adults to complete an online and anonymous survey. This survey asked about depression, anxiety, stress and positive mood. It also looked at health behaviours including smoking, exercise and alcohol consumption. The data were analysed statistically. 


Who participated?

A total of 681 adults aged 18 years or older participated.All lived in New Zealand. Most were female (89%). The average age was 42 years. The youngest was 18 years old and the oldest was 87 years old. Most of the participants (74%) identified as NZ/European and almost half (46%) were keyworkers (essential workers). Almost all (97%) were non-smokers and 20% had clinical riskfactors which put them at increased or greatest risk of COVID-19.


What did we find? 

We found that depression and anxiety in our sample was significantly higher than that of the general population (before the COVID-19 pandemic). People who were younger and most at-risk of COVID-19 were found to have greater depression, anxiety, and stress. Smoking and alcohol consumption were also correlated withincreased anxiety. 


However, we also found that a more positive mood, lower levels of loneliness, and greater exercise protected against depression, anxiety and stress. Owning a pet was also correlated with lower depression and anxiety.


Anxiety and stress were significantly lower in NZ than the UK. The NZ sample also felt less at-risk and worried about COVID-19.


So what can we conclude and what should we do? 

Overall, we can conclude that during the first 10 weeks of the pandemic, the NZ sample had higher depression and anxiety compared with the general population before the pandemic. The NZ sample was less anxious and stressed than the UK sample, which could be because NZ had fewer cases of COVID-19 at this time. We also know that younger people and those most at-risk of COVID-19 reported poorer mental health. Interventions should promote frequent exercise, and reduce loneliness and unhealthy behaviours (smoking and drinking alcohol).


What happens now?

We are currently analysing the follow-up data from the last time point, 10 months after the initial questionnaire. We are also analysing the hair samples that participants sent in for levels of cortisol (a stress hormone).