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The Curvilinear Relationship Between the Age of Adults and Their Mental Health in Iran

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The Curvilinear Relationship Between the Age of Adults and Their Mental Health in Iran medRxiv preprint doi: https://doi.org/10.1101/2020.06.11.20128132; this version posted June 12, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-ND 4.0 International license . The curvilinear relationship between the age of adults and their mental health in Iran after its peak of COVID-19 cases Jiyao Chen Associate Professor, Oregon State University, USA Stephen X. Zhang* Associate Professor, University of Adelaide, Australia Yifei Wang Doctoral student, Tongji University, China Asghar Afshar Jahanshahi Associate Professor, Pontificia Universidad Católica del Perú (PUCP), Peru Maryam Mokhtari Dinani Assistant Professor, Alzahra University, Iran Abbas Nazarian Madavani Assistant Professor, Shahid Rajaee Teacher Training University, Iran Khaled Nawaser Assistant Professor, Arvandan Non-profit Higher Education Institute, Iran *Corresponding author: Stephen X. Zhang, [email protected]; Phone: +61 8831 39310; Address: 9-28 Nexus10 Tower, 10 Pulteney St, Adelaide SA 5000, Australia CRediT Author Statement: J. C.: Investigation, Formal analysis, Writing – Original, Writing – Review & Editing S. X. Z.: Conceptualization, Investigation, Methodology, Formal analysis, Writing – Original, Writing – Review & Editing, Supervision Y. W.: Visualization, Writing – Original, Writing – Review & Editing A. A. J.: Investigation (data collection) M. M. D.: Investigation (data collection) A. N. M.: Investigation (data collection) K. N.: Investigation (data collection) Word count: 2524 NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv preprint doi: https://doi.org/10.1101/2020.06.11.20128132; this version posted June 12, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-ND 4.0 International license . The curvilinear relationship between the age of adults and their mental health in Iran after its peak of COVID-19 cases Abstract The emerging body of research on the predictors of mental health in the COVID-19 pandemic has revealed contradictory findings, which prevent effective psychiatry screening for mental health assistance. This study aims to identify the predictors of nonsomatic pain, depression, anxiety, and distress, especially focusing on age as a nonlinear predictor. We conducted a survey of 474 adults in Iran during April 1–10, 2020, when Iran had just passed its first peak of the COVID-19 pandemic with new confirmed cases. We found that Age had a curvilinear relationship with nonsomatic pain, depression, and anxiety. Age was associated with pain, depression, and anxiety disorders negatively among adults younger than 45 years, but positively among seniors older than 70 years. Adults who were female, unsure about their chronic diseases, and exercised less per day were more likely to have mental health issues. This study advances the use of age as an effective predictor by uncovering a curvilinear relationship between individuals’ age and mental health issues by using a sample of adults across a wide spectrum of ages. We hope future research on mental health during COVID-19 pays more attention to nonlinear predictors. Keywords: risk factor; coronavirus; nonlinear predictor; mental health; 2019-nCoV medRxiv preprint doi: https://doi.org/10.1101/2020.06.11.20128132; this version posted June 12, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-ND 4.0 International license . 1. Introduction The COVID-19 pandemic has led to unprecedented disruption to people’s work and life (Zhang et al., 2020b) and triggered widespread mental health issues (Killgore et al., 2020; Xiang et al., 2020). A burgeoning body of research is unveiling the risk factors of mental disorders under the COVID-19 pandemic (i.e. Liu et al., 2020; Meng et al., 2020; Zhang et al., 2020b), however the evidence on individual demographics as predictors has been mixed. For example, some studies have found that age predicts mental disorders negatively (i.e. González- Sanguino et al., in press; Moccia et al., in press; Wang et al., 2020), but other studies have found the relationship between age and mental disorders to be positive (Qiu et al., 2020) or insignificant (Meng et al., 2020; Song et al., 2020; Zhang et al., 2020b). The conflicting evidence prevents the effective identification of the mentally vulnerable during the ongoing COVID-19 pandemic. This study aims to investigate the role of age and other predictors on adults’ nonsomatic pain, depression, anxiety, and distress. In particular, this study does not assume the relationship between age and mental health disorders to be linear and instead examines its second-order term, using a sample of adults across a wide spectrum of age from 20 to 79. Furthermore, this study tests the predictors of individuals’ work situation, exercise hours, and the number of times out of home per day. Finally, following studies that found individuals among both healthcare workers and the general population who were unsure of their COVID-19 infection status had more mental health issues (Jahanshahi et al., 2020; Zhang et al., in press-b), this study tests individuals who were unsure of their chronic diseases as a predictor of mental health issues. These predictors help to further advance the ongoing research on the predictors of mental medRxiv preprint doi: https://doi.org/10.1101/2020.06.11.20128132; this version posted June 12, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-ND 4.0 International license . health issues during the COVID-19 pandemic. The results provide some reconciliation of conflicting findings in this rapidly growing body of literature and provide some new directions for future research to specify risk factors and their boundary conditions to screen people in greater need to prioritize mental healthcare support. 2. Methods 2.1 Context This study was conducted during the COVID-19 outbreak in Iran, one of the worst-hit countries early on. People in Iran faced some unique challenges such as US-led sanctions, an economic slowdown, a lack of medical equipment, and issues in enacting social distancing measures (Aman, 2020). People in Iran suffered from higher distress than people in China during the COVID-19 pandemic (Jahanshahi et al., 2020). 2.2 Data collection Data in this cross-sectional study were collected through an online survey via social media platforms, e.g. Telegram, Instagram and WhatsApp, from April 1 to 10, 2020 in Iran. Iran passed the peak of its COVID-19 pandemic with 3,111 new infection cases on April 2 and had a total of 68,192 confirmed cases and 4,232 deaths of COVID-19 on April 10, 2020. The original survey in English was translated to the official language of Iran (Persian), pretested among 10 professionals in several industries, and approved by Shahid Rajaee Teacher Training University (IR.SSRI.REC.1389.685). Participation was fully voluntary and all participants agreed with their informed consent to complete the survey. We guaranteed the anonymity and strict confidentiality of responses and targeted working adults older than 18 years in Iran. Based on the number of active users in the social media groups, our survey could reach about 980 medRxiv preprint doi: https://doi.org/10.1101/2020.06.11.20128132; this version posted June 12, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-ND 4.0 International license . people. We received 474 usable responses, resulting in a response rate of 48.37%. The participants worked in banking, education, finance, insurance, manufacturing, services, mining, and oil and gas sectors from all 31 provinces of Iran. 2.3 Variables Participants reported their demographic characteristics such as exact age, gender, marital status, and working situation. Participants also reported whether they had chronic diseases (no, unsure, yes), daily exercise hours, and the number of times they left home per day in the past week. The outcome variables included nonsomatic pain, depression, anxiety, and distress. Nonsomatic pain was measured by a three-item including “For the past week I feel I am in agony” (0 = never, rarely, 3 = always; α = 0.75) (Keller and Nesse, 2006). Depression was measured by Patient Health Questionnaire-2 (PHQ-2) (0 = never, rarely, 3 = always; α = 0.77) with the cut-off point of 3. Anxiety was measured by the Generalized Anxiety Disorder-2 scale (GAD-2) (0 = never, rarely, 3 = always; α = 0.76) with the cut-off point of 3 (Kroenke et al., 2009). Distress was measured by K6, the six-item Kessler mental distress scale (0 = never, 4 = almost all of the time, α = 0.90) with the cut-off point of 13 (Kessler et al., 2002). 2.4 Data analysis approach We used Stata 16.0 to summarize the variables and to predict pain by ordinary least squares regression and depression, anxiety, and distress by logistic regression with a 95% confidence level. medRxiv preprint doi: https://doi.org/10.1101/2020.06.11.20128132; this version posted June 12, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
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