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Biopsychosocial Response to the COVID-19 Lockdown in People with Major Depressive Disorder and Multiple Sclerosis

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Sara Siddi, Iago Gine-Vazquez, Raquel Bailón, Faith Matcham, Femke Lamers, Spyridon Kontaxis, Estela Laporta Puyal, Esther Garcia, Gloria Dalla Costa, Ana Isabel Guerrero, Ana Zabalza, Giancarlo Comi, Letizia Leocani, Peter Annas, Matthew Hotopf, Brenda W. J. H. Penninx, Melinda Magyari, Per Sørensen, Xavier Montalban, Grace Lavelle & 22 more Alina Ivan, Carolin Oetzmann, Katie M. White, Sonia Difrancesco, Patrick Locatelli, David C. Mohr, Vaibhav Narayan, Amos Folarin, Richard Dobson, Judith Dineley, Daniel Leightley, Nicholas Cummins, Srinivasan Vairavan, Yatharth Ranjan, Zulqarnain Rashid, Aki Rintala, Giovanni de Girolamo, Antonio Preti, Sara Simblett, Til Wykes, Inez Myin Germeys, Josep Maria Haro

Original languageEnglish
Article number7163
JournalJournal of Clinical Medicine
Issue number23
Published2 Dec 2022

Bibliographical note

Funding Information: The RADAR-CNS project received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 115902. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation program and EFPIA ( This communication reflects the views of the RADAR-CNS consortium and neither IMI nor the European Union and EFPIA are liable for any use that may be made of the information contained herein. The funding body was involved in the design of the study, the collection or analysis of data, and the interpretation of data. Funding Information: Participants in the CIBER site came from the following four clinical communities in Spain: Parc Sanitari Sant Joan de Déu Network services, Institut Català de la Salut, Institut Pere Mata, and Hospital Clínico San Carlos. Participant recruitment in Amsterdam was partially accomplished through, a Dutch online registry that facilitates participant recruitment for neuroscience studies. Ref is funded by ZonMw-Memorabel project no 73305095003, a project in the context of the Dutch Deltaplan Dementie, Gieskes-Strijbis Foundation, the Alzheimer’s Society in the Netherlands and Brain Foundation Netherlands. This paper represents independent research partly funded by the National Institute for Health Research NIHR Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. We thank all the members of the RADAR-CNS patient advisory board for their contribution to the device selection procedures and their invaluable advice throughout the study protocol design. This research was reviewed by a team with experience of mental health problems and their careers who have been specially trained to advise on research proposals and documentation through the Feasibility and Acceptability Support Team for Researchers FAST-R, a free, confidential service in England provided by the National Institute for Health Research Maudsley Biomedical Research Centre via King’s College London and South London and Maudsley NHS Foundation Trust. We thank all GLAD Study volunteers for their participation, and gratefully acknowledge the NIHR BioResource, NIHR BioResource centres, NHS Trusts and staff for their contribution. We also acknowledge NIHR BRC, King’s College London, South London and Maudsley NHS Trust and King’s Health Partners. We thank the National Institute for Health Research, NHS Blood and Transplant, and Health Data Research UK as part of the Digital Innovation Hub Programme. RADAR-MDD will be conducted per the Declaration of Helsinki and Good Clinical Practice, adhering to principles outlined in the NHS Research Governance Framework for Health and Social Care, 2nd edition. This paper was dedicated to the memory of my sister Rita Siddi. Publisher Copyright: © 2022 by the authors.


King's Authors


Background: Changes in lifestyle, finances and work status during COVID-19 lockdowns may have led to biopsychosocial changes in people with pre-existing vulnerabilities such as Major Depressive Disorders (MDDs) and Multiple Sclerosis (MS). Methods: Data were collected as a part of the RADAR-CNS (Remote Assessment of Disease and Relapse—Central Nervous System) program. We analyzed the following data from long-term participants in a decentralized multinational study: symptoms of depression, heart rate (HR) during the day and night; social activity; sedentary state, steps and physical activity of varying intensity. Linear mixed-effects regression analyses with repeated measures were fitted to assess the changes among three time periods (pre, during and post-lockdown) across the groups, adjusting for depression severity before the pandemic and gender. Results: Participants with MDDs (N = 255) and MS (N = 214) were included in the analyses. Overall, depressive symptoms remained stable across the three periods in both groups. A lower mean HR and HR variation were observed between pre and during lockdown during the day for MDDs and during the night for MS. HR variation during rest periods also decreased between pre- and post-lockdown in both clinical conditions. We observed a reduction in physical activity for MDDs and MS upon the introduction of lockdowns. The group with MDDs exhibited a net increase in social interaction via social network apps over the three periods. Conclusions: Behavioral responses to the lockdown measured by social activity, physical activity and HR may reflect changes in stress in people with MDDs and MS. Remote technology monitoring might promptly activate an early warning of physical and social alterations in these stressful situations. Future studies must explore how stress does or does not impact depression severity.

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