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Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry
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This study aimed to assess and compare the immediate stress and psychological impact experienced by people with and without psychiatric illnesses during the peak of 2019 coronavirus disease (COVID-19) epidemic with strict lockdown measures. Seventy-six psychiatric patients and 109 healthy control subjects were recruited from Chongqing, China and completed a survey on demographic data, physical symptoms during the past 14 days and a range of psychiatric symptoms using the Impact of Event Scale-Revised (IES-R), Depression, Anxiety and Stress Scale (DASS-21) and Insomnia Severity Index (ISI). IES-R measures PTSD symptoms in survivorship after an event. DASS-21 is based on tripartite model of psychopathology that comprise a general distress construct with distinct characteristics. The mean IES-R, DASS-21 anxiety, depression and stress subscale and ISI scores were higher in psychiatric patients than healthy controls (p < 0.001). Serious worries about their physical health, anger and impulsivity and intense suicidal ideation were significantly higher in psychiatric patients than healthy controls (p < 0.05). More than one-third of psychiatric patients might fulfil the diagnostic criteria post-traumatic stress disorder (PTSD). More than one-quarter of psychiatric patients suffered from moderately severe to severe insomnia. Respondents who reported no change, poor or worse physical health status and had a psychiatric illness were significantly more likely to have higher mean IES-R, DASS depression, anxiety and stress subscale scores and ISI scores (p < 0.05). This study confirms the severity of negative psychological impact on psychiatric patients during the COVID-19 epidemic with strict lockdown measures. Understanding the psychological impact on psychiatric patients during the COVID-19 pandemic has the potential to provide insight into how to develop a new immunopsychiatry service. Further research is required to compare pro-inflammatory cytokines between psychiatric patients and healthy controls during the pandemic.
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“Evidence suggests that this disease has psychological consequences on healthcare workers, students, psychiatric patients and general workers, especially for COVID-19 patients [4–13].”
From Mindfulness-based online intervention on mental health and quality of life among COVID-19 patients in China: an intervention design (2021) · cites this paper as [7]
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“So far, data clearly indicate disproportional consequences of the COVID-19 pandemic (16–18), even a potentially increased suicide risk (18), and an increase of adversities (19) in patients suffering from mental health disorders.”
From Radical Acceptance of Reality: Putting DBT®-A Skill Groups Online During the COVID-19 Pandemic: A Qualitative Study (2022) · cites this paper as [18]
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Health-Related Quality of Life and its Associated Factors in COVID-19 Patients
Arab‐Zozani, M., Hashemi, F., Safari, H., Yousefi, M., & Ameri, H. (2020) · Osong Public Health and Research Perspectives · doi:10.24171/j.phrp.2020.11.5.05 · Cited by 168
Rogowska, A. M., Павлова, Ю., Kuśnierz, C., Ochnik, D., Боднар, І., & Petrytsa, P. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9113494 · Cited by 179
Alsolais, A., Alquwez, N., Alotaibi, K., Alqarni, A. S., Almalki, M., Alsolami, F. J., Almazan, J. U., & Cruz, J. P. (2021) · Journal of Mental Health · doi:10.1080/09638237.2021.1922636 · Cited by 161
“Previous studies have investigated the negative impact of the COVID-19 pandemic on the psychological health of the population (Hao et al., 2020; Tan et al., 2020).”
COVID-19: The Hidden Impact on Mental Health and Drug Addiction
Chiappini, S., Guirguis, A., John, A. M., Corkery, J., & Schifano, F. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00767 · Cited by 150
“High risk of mental illness was previously identified in individuals with existing or history of mental illnesses (1, 9, 12, 14, 19), but also vulnerable categories might be considered the elderly (>80 years old), children/adolescents, individuals from deprived areas, peri-natal women and BAME (Black, Asian and minori…”
van der Velden, P. G., Hyland, P., Contino, C., von Gaudecker, H., Muffels, R. J. A., & Das, M. (2021) · PLoS ONE · doi:10.1371/journal.pone.0245057 · Cited by 163
“[15] revealed that non-psychotic psychiatric patients had higher COVID-19 related PTSD symptoms, and higher anxiety, depression, and stress symptom levels than the healthy control group.”
Buizza, C., Bazzoli, L., & Ghilardi, A. (2022) · Adolescent Research Review · doi:10.1007/s40894-022-00192-7 · Cited by 149
Pandemics and pre-existing mental illness: A systematic review and meta-analysis
Neelam, K., Duddu, V., Anyim, N., Neelam, J., & Lewis, S. W. (2020) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2020.100177 · Cited by 147
Preoperative staging of extrahepatic bile duct cancer with intraductal ultrasonography.
Tamada, K., Ido, K., Ueno, N., Kimura, K., Ichiyama, M., & Tomiyama, T. (1995) · PubMed · Cited by 148
Loneliness and Problematic Internet Use during COVID-19 Lock-Down
AlHeneidi, H. H., AlSumait, L., Alsumait, D. S. F., & Smith, A. P. (2021) · Behavioral Sciences · doi:10.3390/bs11010005 · Cited by 146
Multiple Neuroinvasive Pathways in COVID-19
Bougakov, D., Podell, K., & Goldberg, E. (2020) · Molecular Neurobiology · doi:10.1007/s12035-020-02152-5 · Cited by 142
Mental health crisis under COVID-19 pandemic in Hong Kong, China
Zhao, S. Z., Wong, J. Y. H., Luk, T. T., Wai, A. K. C., Lam, T. H., & Wang, M. P. (2020) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2020.09.030 · Cited by 133
“The simple measures we used for mental health symptoms have limited the clinical implications and more rigorous measurements were warranted (Hao et al., 2020).”
Vuillier, L., May, L., Greville-Harris, M., Surman, R., & Moseley, R. L. (2021) · Journal of Eating Disorders · doi:10.1186/s40337-020-00362-9 · Cited by 140
Neuropsychiatric aspects of COVID-19 pandemic: A selective review
Dinakaran, D., Manjunatha, N., Kumar, C. N., & Suresh, B. M. (2020) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2020.102188 · Cited by 136
Impact of the COVID ‐19 pandemic – a mental health service perspective
Byrne, A., Barber, R., & Lim, C. H. (2021) · Progress in Neurology and Psychiatry · doi:10.1002/pnp.708 · Cited by 131
Le, X. T. T., Dang, A. K., Toweh, J., Nguyen, Q. N., Le, H. T., Toàn, Đ. T. T., Phan, H. B. T., Nguyen, T. T., Pham, Q. T., Ta, N. T. K., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00824 · Cited by 128
Self-citationPhiri, P., Ramakrishnan, R., Rathod, S., Elliot, K., Thayanandan, T., Sandle, N., Haque, N., Chau, S. W. H., Wong, O. W. H., Chan, S. S. M., et al. (2021) · EClinicalMedicine · doi:10.1016/j.eclinm.2021.100806 · Cited by 137
Chen, R., Liang, S., Peng, Y., Li, X., Chen, J., Tang, S., & Zhao, J. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110219 · Cited by 136
Stress and Symptom Burden in Oncology Patients During the COVID-19 Pandemic
Miaskowski, C. A., Paul, S. M., Snowberg, K. E., Abbott, M., Borno, H. T., Chang, S. M., Chen, L. M., Cohen, B., Hammer, M. J., Kenfield, S. A., et al. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.08.037 · Cited by 122
COVID-19 in Portugal: exploring the immediate psychological impact on the general population.
Paulino, M., Dumas-Diniz, R., Brissos, S., Brites, R., Alho, L., Simões, M. R., & Silva, C. F. (2021) · Psychology, Health & Medicine · doi:10.1080/13548506.2020.1808236 · Cited by 124
“…al., 2020a; Y. Zhang & Ma, 2020), possibly triggered by the increase in cases, stress on healthcare workforce, confinement at home or in health facilities, lack of psychiatric services, exhaustive media coverage, and poor health information (Tan et al., 2020; Hao et al., 2020, Tran et al. 2020a).”
Ye, B., Wu, D., Im, H., Liu, M., Wang, X., & Yang, Q. (2020) · Children and Youth Services Review · doi:10.1016/j.childyouth.2020.105466 · Cited by 123
The community psychosocial burden during the COVID-19 pandemic in Indonesia
Megatsari, H., Laksono, A. D., Ibad, M., Herwanto, Y. T., Sarweni, K. P., Geno, R. A. P., & Nugraheni, E. (2020) · Heliyon · doi:10.1016/j.heliyon.2020.e05136 · Cited by 133
“However, in general, the Note: * P < 0.05; ** P < 0.01; *** P < 0.001. results of this study are in line with the previous research which found the severity of negative psychological impacts on psychiatric patients during the COVID-19 epidemic due to strict lockdown measures (Hao et al., 2020).”
InfluentialHossain, M. M., Rahman, M., Trisha, N. F., Tasnim, S., Nuzhath, T., Hasan, N. T., Clark, H., Das, A., McKyer, E. L. J., Ahmed, H. U., et al. (2021) · Heliyon · doi:10.1016/j.heliyon.2021.e06677 · Cited by 125
“Also, people with chronic mental disorders may have been disproportionately affected during this pandemic who may have lost access to care and other services [100].”
The Influence of the COVID-19 Pandemic on Social Anxiety: A Systematic Review
Kindred, R., & Bates, G. W. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20032362 · Cited by 149
“However, this is common across mental health conditions because they predispose individuals with clinical vulnerability to negative mental health outcomes [94,95].”
Psychological distress in outpatients with lymphoma during the COVID-19 pandemic
Romito, F., Dellino, M., Loseto, G., Opinto, G., Silvestris, E., Cormio, C., Guarini, A., & Minoia, C. (2020) · Frontiers in Oncology · doi:10.3389/fonc.2020.01270 · Cited by 113
Do, B. N., Tran, T. V., Phan, D. T., Nguyen, H. C., Nguyen, T. T. P., Nguyen, H. C., Ha, T. H., Dao, H. K., Trinh, M. V., Do, T. V., et al. (2020) · Journal of Medical Internet Research · doi:10.2196/22894 · Cited by 121
“In addition, the pandemic itself and social distancing measures have had negative impacts on psychological health [18,19] and health-related behavior (eg, unhealthy eating habits and behaviors, less physical activity, and more smoking [20-23] and drinking to cope amid the COVID-19 pandemic [24]).”
Mechili, E. A., Saliaj, A., Kamberi, F., Girvalaki, C., Peto, E., Patelarou, A. E., Bucaj, J., & Patelarou, E. (2020) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12672 · Cited by 114
Lu, X., & Lin, Z. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.759974 · Cited by 138
Robillard, R., Daros, A. R., Phillips, J. L., Porteous, M., Saad, M., Pennestri, M.-H., Kendzerska, T., Edwards, J. D., Solomonova, E., Bhatla, R., et al. (2021) · The Canadian Journal of Psychiatry · doi:10.1177/0706743720986786 · Cited by 112
“To our knowledge, only one previous study featured a case-control design where participants with and without psychiatric conditions were age- and gender-matched.(17) They reported worse psychological outcomes in those with psychiatric conditions, but since there was no pre-outbreak estimate, the portion of psychiatric…”
Hung, T. M., Nong, V. M., Nguyen, C. T., Dong, K. P., Hoa, N. T., Doan, T. T., Thu, N. D., Nguyen, T. H. T., Do, T. V., Co, D. X., et al. (2020) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s280749 · Cited by 111
Baenas, I., Caravaca‐Sanz, E., Granero, R., Sánchez, I., Riesco, N., Testa, G., Vintró‐Alcaraz, C., Treasure, J., Jiménez‐Murcia, S., & Fernández‐Aranda, F. (2020) · European Eating Disorders Review · doi:10.1002/erv.2771 · Cited by 102
“Hao et al. (2020) found higher levels of concerns about their physical health, anger, anxiety, depression, impulsivity and intense suicidal ideation stress in psychiatric patients in comparison with healthy controls during COVID-19 confinement.”
Increasing Cybercrime Since the Pandemic: Concerns for Psychiatry
Monteith, S., Bauer, M., Alda, M., Geddes, J. R., Whybrow, P. C., & Glenn, T. (2021) · Current Psychiatry Reports · doi:10.1007/s11920-021-01228-w · Cited by 131
Amin, M. A., Muzareba, A. M., Chowdhury, I. U., & Khondkar, M. (2023) · Journal of Financial Services Marketing · doi:10.1057/s41264-022-00197-2 · Cited by 152
“However, perceived benefits and perceived barriers are not included in this research since these two variables are less likely to determine consumers’ motives to use MPA (Hao et al. 2020; Sreelakshmi and Prathap 2020).”
Pappa, S., Athanasiou, N., Sakkas, N., Patrinos, S., Sakka, E., Barmparessou, Z., Tsikrika, S., Adraktas, A., Pataka, A., Migdalis, I., et al. (2021) · doi:10.20944/preprints202102.0194.v1 · Cited by 100
“Finally, the lack of information about the baseline mental health status and previous history in the sample represents an important limitation given that subjects with previous mental health problems exposed to COVID-19 pandemic-related stress and/or infection may experience a higher mental health burden [62].”
For the Greater Good? The Devastating Ripple Effects of the Covid-19 Crisis
Schippers, M. C. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.577740 · Cited by 105
Deng, C.-H., Wang, J.-Q., Zhu, L.-M., Liu, H.-W., Guo, Y., Peng, X., Shao, J., & Xia, W. (2020) · Journal of Medical Internet Research · doi:10.2196/21301 · Cited by 100
“According to the DASS-21, depression, anxiety, and stress could be observed in various populations during the outbreak of COVID-19 in China, which lasted for at least 4 weeks [15]; these populations included the general population [21], general workforce [23], psychiatric patients [24], and health care professionals […”
Solé, B., Verdolini, N., Amoretti, S., Montejo, L., Rosa, A. R., Hogg, B., García‐Rizo, C., Mezquida, G., Bernardo, M., Martínez‐Arán, A., et al. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.11.099 · Cited by 100
Wang, C., López-Núñez, M. I., Pan, R., Wan, X., Tan, Y., Xu, L., Choo, F., Ho, R., Ho, C. S. H., & García, M. E. A. (2021) · JMIR Formative Research · doi:10.2196/27818 · Cited by 98
“DASS-21 and IES-R have been previously used in COVID-19 research [3,17,24,33].”
Self-citationMonitoring Depression Trends on Twitter During the COVID-19 Pandemic: Observational Study
Zhang, Y., Lyu, H., Liu, Y., Zhang, X., Wang, Y., & Luo, J. (2021) · JMIR Infodemiology · doi:10.2196/26769 · Cited by 125
“For individuals with mental disorders, their need is amplified; the study by Hao et al [12] suggests that, during the pandemic, psychiatric patients reported more moderate to severe anger and impulsivity as well as concerns about their physical health, as opposed to the healthy controls, and that ideal remote mental h…”
Banerjee, D., Vaishnav, M., Rao, T. S., Raju, M., Dalal, P., Javed, A., Saha, G., Mishra, K. K., Kumar, V., & Jagiwala, M. P. (2020) · Indian Journal of Psychiatry · doi:10.4103/psychiatry.indianjpsychiatry_1002_20 · Cited by 96
“Indian Journal of Psychiatry Volume 62 (Supplement 3), September 2020 S345 existing psychiatric conditions might be at increased risk for the infection due to lack of supervision and inadequate compliance to precautionary measures.[9] Most studies done till date are online surveys that have used non-specific tools to…”
Silva, L., Seguro, C. S., de Oliveira, C. G. A., Santos, P. O. S., de Oliveira, J. C. M., Filho, L. F. M. D. S., Júnior, C. A. D. P., Gentil, P., & Rebelo, A. C. S. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.565291 · Cited by 101
“Limited knowledge about COVID-19, lack of update on COVID-19, duration of home confinement, poor physical health and physical symptoms, lack of access to healthcare, lack of activity, uncertainty regarding the economic scenario and health systems can increase anxiety and depression (3, 6, 10, 11).”
Confirming validity of The Fear of COVID-19 Scale in Japanese with a nationwide large-scale sample
Midorikawa, H., Aiba, M., Lebowitz, A., Taguchi, T., Shiratori, Y., Ogawa, T., Takahashi, A., Takahashi, S., Nemoto, K., Arai, T., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0246840 · Cited by 100
“Some reports suggest that people with mental illness are more likely to have mental health problems during the COVID-19 epidemic [61, 62].”
Hull, M., Parnes, M., & Jankovic, J. J. (2021) · Neurology Clinical Practice · doi:10.1212/cpj.0000000000001082 · Cited by 101
“During the initial peak of the pandemic in China, patients previously diagnosed with depression and anxiety disorders reported an increase in symptoms of post-traumatic stress disorder (PTSD), anxiety, depression, and insomnia.(4) In a series of four consecutive patients admitted for new onset of reactive psychosis du…”
Metadata
- Authors
- Hao, F., Tan, W., Jiang, L., Zhang, L., Zhao, X., Zou, Y., Hu, Y., Luo, X., Jiang, X., McIntyre, R. S., Tran, B., Sun, J., Zhang, Z., Ho, R., Ho, C., & Tam, W.
- Affiliations
- First People's Hospital of Chongqing (CN)
- National University of Singapore (SG)
- Army Medical University (CN)
- University Health Network (CA)
- Johns Hopkins University (US)
- Huaibei Normal University (CN)
- National University Health System (SG)
- Corresponding author
- Ho, Roger
- ORCID
- Venue
- Brain, Behavior, and Immunity
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 87
- Pages
- 100-106
- ISSN
- 0889-1591 (ISSN-L)
- PMC
- PMC7184991
- OpenAlex
- W3020448761
- Cited by
- 968
- References
- 43
- Citations by year
- 2026: 6 · 2025: 27 · 2024: 65 · 2023: 107 · 2022: 257 · 2021: 332 · 2020: 171
- FWCI
- 86.61
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Brain Behavior and Immunity (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Rare & Special e-Zone (The Hong Kong University of Science and Technology) (submittedVersion)
- Funders
- Vingroup Innovation Foundation
- National University of Singapore (VINIF.2020.Covid19.DA07, R-722-000-004-731)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- COVID-19 pandemic, lockdown, psychiatric patients, psychiatric symptoms, post-traumatic stress disorder, insomnia, depression, anxiety, stress, suicidal ideation, immunopsychiatry, physical health status, inflammatory cytokines
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adult, Anxiety, Anxiety Disorders, Mental Disorders, China, Depression, Female, Health Status, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Pneumonia, Viral, Psychoneuroimmunology, Surveys and Questionnaires, Stress Disorders, Post-Traumatic, Stress, Psychological, Case-Control Studies, Coronavirus, Coronavirus Infections, Pandemics
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