In a recent study posted to the medRxiv* pre-print server, researchers investigated the impact of the coronavirus disease 2019 (COVID-19) pandemic on anxiety, depression, and mental well-being of adults with neurodevelopmental disorders (NDDs) in the United Kingdom (UK).

Background

It is important to assess the disproportionate effect of anxiety, depression, and poor mental well-being on people with NDDs, including attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), for provisioning support. Further, it could help better manage mental health recovery programs for those most impacted by such mental health issues during the pandemic.

About the study

In the present study, researchers retrieved longitudinal data of 3,058 adults with NDDs from the Avon Longitudinal Study of Parents and Children (ALSPAC) study. The ALSPAC study is ongoing, and its core population comprises 14,541 pregnant women and 13,988 children.

The researchers analyzed mental health data from the participants at ages 21, 23, and 25 before the pandemic and 27 to 28 during the COVID-19 pandemic.

Further, the researchers used the generalized anxiety disorder assessment-7 (GAD-7) to measure anxiety symptoms at age 21, and the Warwick-Edinburgh mental well-being scale (WEMWBS) for mental well-being at age 23. The former was a seven-item questionnaire, with higher values indicating more anxiety symptoms, whereas the latter was a 14-item questionnaire, with lower values indicating poorer mental well-being. Likewise, 13-items short mood and feelings questionnaire (SMFQ) measured depression symptoms at age 25, with higher values indicating more depression. The summation of all symptom scores helped the researchers generate a continuous measure for each scale.

The researchers also asked all 25-year-old ALSPAC participants with high ADHD symptoms to complete the self-rated five-item strengths and difficulties questionnaire (SDQ). Likewise, all 25-year-old ALSPAC participants with high ASD symptoms completed the self-rated autism-spectrum quotient (AQ).

More importantly, the team used multi-level mixed-effects models to assess the changes in mental health in individuals with ADHD and ASD. These models account for associations between repeated mental health measures in the same individual, allowing maximizing of samples without imputing missing data.

The researchers sent three questionnaires, including SMFQ, GAD-7, and WEMWBS, to all the study participants aged 27 to 28 between i) April and May 2020, ii) May and July 2020, and iii) December 2020 to January 2021. These time points corresponded with the periods of national lockdown in the UK.

Additionally, they investigated variations in the distribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in individuals with ASD/ADHD using a Chi-squared test. They relied on self-reported incidences of suspected or confirmed COVID-19 at the third time point when the UK witnessed another national lockdown between December 2020 and January 2021. The team also determined whether the frequency of financial difficulties, losing a job, illness/injury, or death of someone close to the participant during the pandemic varied in patients with ASD/ADHD.

In their sensitivity analyses, the researchers performed additional adult anxiety-related disorders (SCAARED) test among all 25-year-old study participants to establish a correlation between GAD7-measured anxiety at age 21 and 25. They also repeated mental health analyses using different cut-off points for ADHD and ASD.

Study findings

There were 386 and 79 25-year-old individuals with high ADHD and broadly defined ASD. Patients with broadly defined ADHD were more likely to experience the death of a close one or financial difficulties during the COVID-19 pandemic, with an odds ratio (OR) of 1.33 and 1.34, respectively. The patients with both ADHD and ASD also showed higher depression, anxiety, and poor mental well-being throughout the study period.

The prevalence of anxiety increased in patients with ADHD and ASD to a greater extent. It surged from 21% to 42% and 26% to 47% from pre-pandemic time to the third COVID-19 timepoint in patients of ADHD and ASD, respectively. Notably, scores of all the GAD-7 items indicated worse anxiety symptoms during the pandemic in those with and without ADHD.

Conversely, symptoms of depression diminished, particularly in females with ASD. Accordingly, eight of 13 SMFQ items indicated less severe depression symptoms during the pandemic. From the pre-pandemic timepoint to the third COVID-19 timepoint, the prevalence of depression fell from 45% to 33% and 61% to 42% in those with ADHD, and ASD, respectively. Across the same timeframe, symptoms of poor mental well-being increased from 34% to 49% and 42% to 60% in patients with ADHD and ASD, respectively.

Overall, females with ADHD/ASD consistently had the poorest mental health, and males had the best. The authors also observed an association between GAD-7 and SCAARED test results, with Spearman’s rank-order correlation coefficient (r)=0.54.

Conclusions

Taken together, the study findings demonstrated a higher risk of poor mental health among patients of NDDs during the COVID-19 pandemic. Risk factors, such as financial difficulties and apprehension of the death of a close one, were also higher in those with NDDs. While anxiety increased, mental well-being decreased in young adults with ASD and ADHD. On the other hand, depressive symptoms diminished in ADHD patients and female patients with ASD.

To conclude, the current study remarkably captured mental health changes in NDD patients at different stages of national lockdowns in the UK using multi-level models and maximizing each sample to include all available data.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Written by

Neha Mathur

Neha is a digital marketing professional based in Gurugram, India. She has a Master’s degree from the University of Rajasthan with a specialization in Biotechnology in 2008. She has experience in pre-clinical research as part of her research project in The Department of Toxicology at the prestigious Central Drug Research Institute (CDRI), Lucknow, India. She also holds a certification in C++ programming.