Depression and anxiety during the two waves of the COVID‐19 pandemic in two large, prospective, aging cohorts in rural and urban India

Background India was severely impacted by both the first and second waves of COVID‐19 in 2020 and 2021. We aimed to estimate proportions of depression and anxiety disorder during both waves, among rural and urban Indians, and to compare depression trends during four distinct periods before and after the pandemic. Method Aging adults (≥45 years) from two, parallel, harmonized cohorts in rural (SANSCOG) and urban (TLSA) sites in India, underwent telephonic assessments for depression (GDS‐7) and anxiety (GAD‐7) during both waves of COVID‐19. Utilizing prior data from depression assessments (GDS‐30) during regular evaluations pre‐ pandemic and during an interim period between the two waves, we compared trends in overall proportions of depression between the two cohorts during four periods: pre‐COVID (684 rural, 317 urban); post‐COVID first wave (733 rural, 297 urban); post‐COVID interim period (458 rural, 204 urban); post‐COVID second wave (611 rural, 305 urban). Result Overall proportion of depression among rural subjects during both waves was 28.8%. Corresponding numbers for anxiety disorder were 5.5% and 3.9%. Among urban subjects, 6.5% and 15.1% were depressed, whereas 1.7% and 0.66% had anxiety disorder, during the first and second waves, respectively. Depression trends during the four periods mentioned above were starkly different between rural and urban Indians. Sub‐analysis of the same subset of rural subjects with pre‐COVID and post‐COVID (both waves) data, revealed that subjects ≥ 65 years and those with comorbidities had significantly higher depression (36.8% vs. 25.3% and 32% vs. 15.7%, respectively) during the first wave only. Conclusion Multi‐fold increase in depression among aging, rural Indians during both waves, with alarmingly high depression among subjects ≥ 65 years and those with comorbidities during first wave, is seriously concerning. Urgent public health measures are needed to address this added mental health burden and prevent further potential adverse consequences.