Inequalities in Mental Health: Age-related Trends Across Pandemic Phases in Singapore

Abstract

Background In the sphere of mental health, little population wide-scale research has been done in Asia on the pandemic's differential impacts on different sociodemographic groups over time. Methods This study evaluates symptoms of anxiety and depression within different age groups in Singapore across different pandemic phases. Symptoms of depression and anxiety were measured using the Patient Health Questionnaire-4 (PHQ-4), in which higher scores indicate more symptoms and lower scores indicate less. Cross-sectional data from 34,429 individuals aged 18 years and above in Singapore between 27 April 2020 and 27 September 2021 were analyzed. Multivariable logistic and linear regression were performed on PHQ-4 scores over pandemic phases and by age. Findings Overall symptoms of depression and anxiety did not vary significantly across pandemic phases in Singapore. However, compared to Circuit Breaker, younger age groups reported higher PHQ-4 scores as restrictions lifted (ages 18-29: beta (β)=0.59, 95% CI [0.22, 0.97]; ages 30-39: β=0.44, 95% CI [0.08, 0.80]), while older adults reported lower scores (ages 50-59: β=-0.45, 95% CI [-0.80, -0.10]; ages 60 and above: β=-0.38, 95% CI [-0.73, -0.02]). This was associated with more symptoms of anxiety among younger adults, and less symptoms of depression and anxiety among older adults. Interpretation In Singapore, psychological responses to pandemic restrictions may be heterogenous across different age groups and across time. The study can inform policymakers' decisions in distributing mental health resources during a crisis. Funding The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report.