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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
Open accessAbstract
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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“Even at this early stage of the global pandemic, there is evidence of significant psychological effects among the general population, which may be more pronounced in certain groups (eg, female, socially stressed, frontline worker, pre-existing psychological disorder) [23,24].”
Qiu, D., Li, Y., Li, L., He, J., Ouyang, F., & Xiao, S. (2021) · European Psychiatry · doi:10.1192/j.eurpsy.2021.24 · Cited by 57
“Hao [101] CC General population 15/109 4 / 32.”
Drissi, N., Ouhbi, S., Idrissi, M. A. J., & Ghogho, M. (2020) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2020.104243 · Cited by 57
Alan, H., Bacaksız, F. E., Şen, H. T., Eskici, G. T., Gümüş, E., & Seren, A. K. H. (2020) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12666 · Cited by 47
Uzunova, G., Pallanti, S., & Hollander, E. (2021) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2021.1887264 · Cited by 53
“…on the Schedule V controlled substances in the U.S., and is reported to cause serious cardiac adverse effects, including heart failure and edoema (Ho et al. 2013) Therefore, its use for management of anxiety in COVID-19 patients, especially in those with pre-existing cardiac conditions or more…”
Bäuerle, A., Graf, J., Jansen, C., Musche, V., Schweda, A., Hetkamp, M., Weismüller, B., Dörrie, N., Junne, F., Teufel, M., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-039646 · Cited by 47
Alsalhe, T. A., Aljaloud, S. O., Chalghaf, N., Guelmami, N., Alhazza, D. W., Azaiez, F., & Bragazzi, N. L. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.570085 · Cited by 49
“, 2020), and suicidal ideation (Hao et al., 2020) have been reported in response to the pandemic spread.”
Acute psychological impact on COVID-19 patients in Hubei: a multicenter observational study
Wang, M., Hu, C., Zhao, Q., Feng, R., Wáng, Q., Cai, H., Guo, Z., Xu, K., Luo, W., Guo, C., et al. (2021) · Translational Psychiatry · doi:10.1038/s41398-021-01259-0 · Cited by 51
Ozamiz-Etxebarria, N., Santamaría, M. D., Munitis, A. E., & Gorrotxategi, M. P. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.02038 · Cited by 46
Al-Shannaq, Y., Mohammad, A. A., & Aldalaykeh, M. (2021) · Heliyon · doi:10.1016/j.heliyon.2021.e06873 · Cited by 52
“This may be explained by the fact that the outbreak of COVID-19 pandemic may have aggravated relapse or intensified existing mental illnesses among people with mental health problems [40].”
Steinmetz, L. C. L., Florio, M. A. D., Leyes, C. A., Fong, S. B., Rigalli, A., & Godoy, J. C. (2020) · Psychology Health & Medicine · doi:10.1080/13548506.2020.1867318 · Cited by 45
New Parents Experienced Lower Parenting Self-Efficacy during the COVID-19 Pandemic Lockdown
Xue, A., Oros, V., Marca-Ghaemmaghami, P. L., Scholkmann, F., Righini-Grunder, F., Natalucci, G., Karen, T., Bassler, D., & Restin, T. (2021) · Children · doi:10.3390/children8020079 · Cited by 35
Rauf, N., Zulfiqar, S., Mumtaz, S., Maryam, H., Shoukat, R., Malik, A., Rowther, A. A., Rahman, A., Surkan, P. J., & Atif, N. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168237 · Cited by 47
“Pandemics have an even greater psychosocial effect on vulnerable populations such as people experiencing poverty [6], those with physical and mental illnesses [7], and pregnant women [8].”
Parental burnout during the COVID‐19 pandemic
Skjerdingstad, N., Johnson, M. S., Johnson, S. U., Hoffart, A., & Ebrahimi, O. V. (2021) · Family Process · doi:10.1111/famp.12740 · Cited by 47
“People with mental disorders are recognized as being severely impacted by the psychosocial effects of the pandemic (e.g. Druss, 2020; Hao et al., 2020; Wang et al., 2020).”
Gündoğan, S. (2022) · The Asia-Pacific Education Researcher · doi:10.1007/s40299-021-00641-2 · Cited by 57
“In addition, it has caused serious negative effects on the mental health of individuals (Arpaci et al., 2021; Cullen et al., 2020; Dubey et al., 2020; Hao et al., 2020; Zhai & Du, 2020).”
Increased airborne transmission of COVID-19 with new variants, Implications for health policies
Rowe, B. R., Canosa, A., Meslem, A., & Rowe, F. (2022) · Building and Environment · doi:10.1016/j.buildenv.2022.109132 · Cited by 46
Scarpelli, S., Zagaria, A., Ratti, P., Albano, A., Fazio, V., Musetti, A., Varallo, G., Castelnuovo, G., Plazzi, G., & Franceschini, C. (2022) · Sleep Medicine · doi:10.1016/j.sleep.2022.07.012 · Cited by 44
Aljaberi, M. A. A., Alareqe, N. A., Alsalahi, A., Qasem, M. A., Noman, S., Uzir, M. U. H., Mohammed, L. A., Abiddine, F. Z. E., Lin, C., Abdallah, A. M., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0277368 · Cited by 49
Han, L., Zhan, Y., Li, W., Xu, Y., Xu, Y., & Zhao, J. (2021) · JMIR Public Health and Surveillance · doi:10.2196/31052 · Cited by 46
Somer, E., Abu‐Rayya, H. M., Schimmenti, A., Metin, B., Brenner, R., Ferrante, E., göçmen, B. S., & Marino, A. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.587455 · Cited by 49
“During the peak of the COVID-19 pandemic, when strict lockdown measures were undertaken, psychiatric patients scored significantly higher than controls on measures of posttraumatic stress, depression, and anxiety (33).”
Burrai, J., Roma, P., Barchielli, B., Biondi, S., Cordellieri, P., Fraschetti, A., Pizzimenti, A., Mazza, C., Ferracuti, S., & Giannini, A. M. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9113787 · Cited by 46
“In contrast, other studies of both non-residential psychiatric patients and the general population have identified higher DASS-21 scores during the COVID-19 lockdown [11,22].”
InfluentialYıldırım, M., & Özaslan, A. (2021) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-021-00515-0 · Cited by 42
Fleischmann, E., Dalkner, N., Fellendorf, F. T., & Reininghaus, E. Z. (2021) · World Journal of Psychiatry · doi:10.5498/wjp.v11.i12.1387 · Cited by 41
Ali, A. M., Alkhamees, A. A., Elhay, E. S. A., Taha, S. M., & Hendawy, A. O. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2021.799812 · Cited by 39
“Available data show worsening in the levels of psychiatric symptoms such as anxiety, depression, stress, insomnia, suicidal ideation, impulsivity, posttraumatic stress symptoms, and dysfunctional eating in patients with preexisting psychiatric disorders during the COVID-19 pandemic (41, 43, 44).”
Milosevic, I., Cameron, D. H., Milanovic, M., McCabe, R. E., & Rowa, K. (2022) · The Canadian Journal of Psychiatry · doi:10.1177/07067437211027319 · Cited by 41
Li, N., Li, S., & Fan, L. (2021) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2021.07.018 · Cited by 52
Zhou, Y., Ding, H., Zhang, Y., Zhang, B., Guo, Y., Cheung, T. C. C., Hall, B. J., Shi, T., Xiang, Y., & Tang, Y. (2021) · Translational Psychiatry · doi:10.1038/s41398-020-01190-w · Cited by 42
Zhang, Y., Wang, S., Ding, W., Meng, Y., Hu, H., Liu, Z., Zeng, X., Guan, Y., & Wang, M. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110253 · Cited by 43
Prosociality and hoarding amid the COVID ‐19 pandemic: A tale of four countries
Tse, D. C. K., Lau, V. W.-Y., Hong, Y., Bligh, M. C., & Kakarika, M. (2021) · Journal of Community & Applied Social Psychology · doi:10.1002/casp.2516 · Cited by 47
“Aside from primary stress associated with the fear of infections, people also suffer from secondary stress, or adversity associated with the pandemic, including shortage of supplies, unemployment, disruptions of daily routines, and lack of access to psychiatric care (e.g., Hao et al., 2020).”
Laranjeira, C., Dixe, M. D. A., VALENTİM, O. M. M. D. S., Charepe, Z. B., & Querido, A. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19010337 · Cited by 44
“The psychological difficulties felt by the population may be due to home confinement, lack of access to psychiatric facilities or inadequate health information [23,24].”
Diotaiuti, P., Valente, G., Mancone, S., Corrado, S., Bellizzi, F., Falese, L., Langiano, E., Vilarino, G. T., & Andrade, A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20075294 · Cited by 44
“Recent studies have found that negative effects on mental health were particularly evident among psychiatric patients [5], individuals with previously diagnosed post-traumatic stress disorder [6], and COVID-19 patients [7], all of whom reported higher levels of anxiety, depression, and stress, as compared to healthy c…”
Changing dynamics of psychoneuroimmunology during the COVID-19 pandemic
Debnath, M., Berk, M., & Maes, M. H. J. (2020) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2020.100096 · Cited by 39
“A recent study reports that COVID-19 has severe negative psychological impact in patients with pre-existing psychiatric conditions and these patients displayed higher risk of developing symptoms of PTSD, depression, anxiety, stress and insomnia (Hao et al., 2020).”
COVID-19 negatively impacts on psychological and somatic status in frontline nurses
Li, J., Su, Q., Li, X., Peng, Y., & Liu, Y. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.07.031 · Cited by 38
Bongelli, R., Canestrari, C., Fermani, A., Muzi, M., Riccioni, I., Bertolazzi, A., & Burro, R. (2021) · Healthcare · doi:10.3390/healthcare9081086 · Cited by 38
Italians on the Age of COVID-19: The Self-Reported Depressive Symptoms Through Web-Based Survey
Balsamo, M., & Carlucci, L. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.569276 · Cited by 41
Trastornos del sueño a consecuencia de la pandemia por COVID-19
Medina, Ó., Araque-Castellanos, F., Ruiz-Domínguez, L.-C., Riaño-Garzón, M., & Bermúdez, V. (2020) · Revista Peruana de Medicina Experimental y Salud Pública · doi:10.17843/rpmesp.2020.374.6360 · Cited by 38
“(26) compararon 76 pacientes con antecedentes de trastornos de ansiedad o depresión con 109 controles sanos pareados por edad y sexo, y encontraron que más de un cuarto de aquellos con antecedentes presentaban mayores puntuaciones totales en el Insomnia Severity Index (ISI) (10,1 vs.”
Martín, J., Padierna, Á., Villanueva, A., & Quintana, J. M. (2021) · International Journal of Clinical Practice · doi:10.1111/ijcp.14607 · Cited by 38
Khuê, P. M., Pham, L. V., Phan, D. T., Tran, T. V., Nguyen, H. C., Nguyen, M. H., Nguyen, H. C., Ha, T. H., Dao, H. K., Nguyen, P. B., et al. (2020) · Frontiers in Nutrition · doi:10.3389/fnut.2020.581043 · Cited by 38
Brimson, J. M., Prasanth, M. I., Malar, D. S., Brimson, S., Thitilertdecha, P., & Tencomnao, T. (2021) · Expert Opinion on Therapeutic Targets · doi:10.1080/14728222.2021.1952987 · Cited by 36
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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