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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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InfluentialYang, Y., Xiao, Y.-N., Liu, Y.-L., Li, Q., Shan, C., Chang, S., & Jen, P. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18041421 · Cited by 29
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Mental Violence: The COVID-19 Nightmare
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Self-citationPsychological Responses According to Gender during the Early Stage of COVID-19 in Spain
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InfluentialAnxiety and Depression during COVID-19 Pandemic among Medical Students in Nepal
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“Therefore, our results confirm a reduction in the use of mental health services [80,81].”
Li, W., Zhao, N., Yan, X., Xu, X., Zou, S., Wang, H., Li, Y., Du, X., Zhang, L., Zhang, Q., et al. (2022) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/08919887221078559 · Cited by 29
Self-citationMak, I. L., Wan, E. Y. F., Wong, T. K. T., Lee, W. W. J., Chan, E. W., Choi, E. P. H., Chui, C. S. L., Ip, M., Lau, W. C. S., Lau, K. K., et al. (2022) · Public health reviews · doi:10.3389/phrs.2022.1604121 · Cited by 30
“A single-center study in China in patients with hip fractures found an increase in injury to hospitalization time, surgery wait time, and time of discharge after surgery compared to the previous year [127].”
The three frontlines against COVID-19: Brain, Behavior, and Immunity
Wang, S.-C., Su, K., & Pariante, C. M. (2021) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2021.01.030 · Cited by 29
Satran, C., Saleh, O. A., Mashiach‐Eizenberg, M., & Bord, S. (2021) · Ethnicity and Health · doi:10.1080/13557858.2021.1899139 · Cited by 28
Lambrichts, S., Vansteelandt, K., Crauwels, B., Obbels, J., Pilato, E., Denduyver, J., Ernes, K., Maebe, P., Migchels, C., Roosen, L., et al. (2021) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13334 · Cited by 25
Almaghrebi, A. H. (2021) · Journal of Taibah University Medical Sciences · doi:10.1016/j.jtumed.2021.04.010 · Cited by 27
“Other negative psychological effects included increased anxiety and depressive symptoms, post-traumatic stress disorder, and relapses.(37) Further, the risk of suicide is 3e12 times higher in these patients than in non-clinical populations.”
Kim, M. J., Paek, S. H., Kwon, J. H., Park, S., Chung, H.-J., & Byun, Y.-H. (2022) · Children · doi:10.3390/children9020151 · Cited by 30
“One study shows that people with a psychiatric history have more impulsive and suicidal thoughts than healthy people after COVID-19 [36], which is consistent with the results of this study.”
Irisson-Mora, I., Salgado-Cordero, A. M., Reyes-Varón, E., Cataneo‐Piña, D. J., Fernández-Sánchez, M., Buendía-Roldán, I., & Salazar-Lezama, M. Á. (2022) · PLoS ONE · doi:10.1371/journal.pone.0273041 · Cited by 28
“Several reports described a great burden of psychiatric symptoms such as insomnia [37], anxiety, post-traumatic stress symptoms [38] and mood disorders [39] in patients affected by COVID-19 on the acute phase.”
Schützwohl, M., & Mergel, E. (2020) · Psychiatrische Praxis · doi:10.1055/a-1202-2427 · Cited by 26
Lakra, V., Itrat, A., Jagadheesan, K., & Danivas, V. (2020) · Indian Journal of Psychiatry · doi:10.4103/psychiatry.indianjpsychiatry_852_20 · Cited by 26
“Although the symptoms remained almost similar, the severity was significantly high.[6] Further, studies have noted differential effects of the pandemic and quarantine – patients with anxiety and mood disorders presenting with much higher perceived stress and somatic symptoms whereas it made little impact on patients h…”
Depressive Symptoms, Anxiety Disorder, and Suicide Risk During the COVID-19 Pandemic
Pera, A. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.572699 · Cited by 21
de Neira, M. D., Blasco-Fontecilla, H., Murillo, L. G., Pérez-Balaguer, A., Mallol, L., Buratti, A. F., del Sol, P., & Palanca, I. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.557508 · Cited by 25
“In view of the severity and length of the COVID-19 pandemic situation, future studies should confirm our initial results on the analysis of the demand of adolescent mental health services (16).”
Psychological support in general population during the COVID-19 lockdown in France: Needs and access
Alleaume, C., Verger, P., Peretti‐Watel, P., & the COCONEL Group (2021) · PLoS ONE · doi:10.1371/journal.pone.0251707 · Cited by 27
“Depression and anxiety symptoms should therefore be clinically verified [24].”
Hakkenbrak, N. A. G., Loggers, S. A. I., Lubbers, E., de Geus, J., van Wonderen, S. F., Berkeveld, E., Mikdad, S., Giannakopoulos, G. F., Ponsen, K. J., Bloemers, F. W., et al. (2021) · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine · doi:10.1186/s13049-021-00942-x · Cited by 30
Raffagnato, A., Iannattone, S., Tascini, B., Venchiarutti, M., Broggio, A., Zanato, S., Traverso, A., Mascoli, C., Manganiello, A., Miscioscia, M., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18189880 · Cited by 27
“For instance, a case-control study [13] conducted in February 2020 in China compared a group of 76 psychiatric patients with 109 healthy subjects; results highlighted significantly higher levels of anxiety, depression, stress, suicidal thoughts, and insomnia in the first group.”
Correlates of Non-suicidal Self-Injury in Adolescent Psychiatric Patients in China
Zhang, J.-J., Liu, Y.-D., Zhang, H., Huang, Z., Wang, F., Yang, J.-J., Wang, S., Jia, F., & Hou, C.-L. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.864150 · Cited by 29
“Furthermore, a study conducted during COVID-19 pandemic suggest that psychiatric patients were at higher levels of symptoms of depression (53).”
Nakhaee, H., Bayati, R., Rahmanian, M., Jolfayi, A. G., Zangiabadian, M., & Rakhshanderou, S. (2022) · PLoS ONE · doi:10.1371/journal.pone.0267423 · Cited by 25
Experiences of Persons With Serious Mental Illness During the COVID-19 Pandemic
Dickerson, F., Katsafanas, E., Newman, T., Origoni, A. E., Rowe, K. C., Squire, A., Ziemann, R. S., Khushalani, S., & Yolken, R. H. (2021) · Psychiatric Services · doi:10.1176/appi.ps.202100130 · Cited by 26
Implication of coronavirus pandemic on obsessive-compulsive-disorder symptoms
Sulaimani, M. F., & Bagadood, N. H. (2020) · Reviews on Environmental Health · doi:10.1515/reveh-2020-0054 · Cited by 21
Krystal, J. H., Alvarado, J., Ball, S. A., Fortunati, F., Hu, M., Ivy, M. E., Kapo, J. M., Olson, K. D., Rohrbaugh, R. M., Sinha, R., et al. (2020) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2020.11.005 · Cited by 25
Phone-based outpatients’ follow-up in mental health centers during the COVID-19 quarantine
Gentile, A., Torales, J. C., O’Higgins, M. G., Figueredo, P., Castaldelli-Maia, J. M., Berardis, D. D., Petito, A., Bellomo, A., & Ventriglio, A. (2020) · International Journal of Social Psychiatry · doi:10.1177/0020764020979732 · Cited by 26
“…other authors have described a worsening of psychopathological symptoms during the COVID-19 quarantine among those subjects affected by pre-existing mental disorders (Chevance et al., 2020; Cortese et al., 2020; Fernandez-Aranda, 2020; Garriga, 2020; Hao et al., 2020; Iancu et al., 2005; Kozloff”
Ferreira, F. D. O., Lopes-Silva, J. B., Siquara, G. M., Manfroi, E. C., & de Freitas, P. M. (2021) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2021.1897595 · Cited by 27
“The pandemic has led to a generalized state of anxiety, depression, and stress, but people with mental health conditions could be more prone to being influenced by these emotional responses due to a higher susceptibility to stress (Hao et al., 2020).”
The Experiences of COVID-19 Patients in Intensive Care Units: A Qualitative Study
Kürtüncü, M., Kurt, A., & Arslan, N. (2021) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228211024120 · Cited by 27
“The testimonies of patients reported in other studies show a respect for how the healthcare team met their physiological and psychological needs and thankfulness for their high sensitivity in providing care (Hao et al., 2020; Luo et al., 2020; Sun et al., 2020).”
Personality and Lockdown: A Study on Italian Undergraduates During the COVID-19 Pandemic
Biondi, S., Casale, S., Burrai, J., Mazza, C., Cavaggioni, G., Ferracuti, S., Giannini, A. M., & Roma, P. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.622366 · Cited by 26
“(14), instead, studied the psychological impact of the COVID-19 pandemic in China on psychiatric patients and healthy controls.”
Danenberg, R., Shemesh, S., Bitan, D. T., Maoz, H., Saker, T., Dror, C., Hertzberg, L., & Bloch, Y. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.08.020 · Cited by 25
“The pandemic carries mental health consequences, especially for people with previous mental health difficulties (Liu et al., 2020; Hao et al., 2020).”
Alkathiri, M. A., Almohammed, O. A., Alqahtani, F., & AlRuthia, Y. S. (2022) · Psychology Research and Behavior Management · doi:10.2147/prbm.s350931 · Cited by 25
“Moreover, individuals with a pre-existing or family history of mental illness were more likely to have adverse mental health outcomes during the COVID-19 pandemic.(32,33) There is a paucity of research addressing the impact of COVID-19 on mental health in Saudi Arabia.”
Hofer, A., Schurr, T. A., Plattner, B., Chernova, A., Conca, A., Fronthaler, M., Häring, C., Holzner, B., Huber, M., Marksteiner, J., et al. (2022) · Schizophrenia · doi:10.1038/s41537-022-00225-z · Cited by 25
“As previously shown by Hao et al.8, our results therefore point to a particularly negative impact of the pandemic on nonpsychotic individuals with a pre-existing psychiatric disorder.”
Pourhashemi, S., Asadi, M. A. Z., Boroughani, M., & Azadi, H. (2022) · Environmental Science and Pollution Research · doi:10.1007/s11356-022-23982-x · Cited by 25
“The closer the surface below the curve is to 1, the more accurate the zoning map will be (Hao et al. 2020).”
Si, M.-Y., Xiao, W.-J., Pan, C., Wang, H., Huang, Y.-M., Lian, J., Mak, W. W. S., Leng, Z.-W., Su, X.-Y., Tang, Q.-P., et al. (2021) · Infectious Diseases of Poverty · doi:10.1186/s40249-021-00836-1 · Cited by 24
Alharbi, A. (2022) · Cureus · doi:10.7759/cureus.21965 · Cited by 24
“However, the preponderance of studies reported results consistent with this study or higher rates of depression among those with a history of mental illness [36-40].”
Clinical characteristics of coronavirus disease 2019 in patients aged 80 years and older
Dang, J., Zhu, G., Yang, Y., & Zheng, F. (2020) · Journal of Chinese Integrative Medicine · doi:10.1016/j.joim.2020.07.002 · Cited by 25
“In recent months, numerous studies have looked at how COVID-19 has affected specific populations, such as psychiatric patients [5], healthcare workers [3,6], and the general working population [7].”
Kassir, G., Hayek, S. E., Zalzale, H., Orsolini, L., & Bizri, M. (2021) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2021.1900872 · Cited by 25
“Similarly, individuals with mental illness have expressed elevated scores on depression, anxiety, and trauma-related scales (Hao et al. 2020).”
Lam, C. S., Yu, B. Y., Cheung, D. S. T., Cheung, T. C. C., Lam, S. C., Chung, K., Ho, F. Y., & Yeung, W. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168444 · Cited by 24
“People with psychiatric illnesses reportedly suffered from higher severity of stress, anxiety, insomnia, and depression, and they were more worried about their physical health than those without existing mental problems [32].”
Huang, S., Wang, D., Zhao, J., Chen, H., Ma, Z., Pan, Y., Liu, X., & Fan, F. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114653 · Cited by 26
Adibi, A., Tardeh, S., & Mozafari, A. (2023) · International Journal of Preventive Medicine · doi:10.4103/ijpvm.ijpvm_507_21 · Cited by 24
“[25] 2020 cross‐sectional South India 132 19 Hao et al.[26] 2020 cross‐sectional China 185 13 Son et al.”
McGowan, I. W., Fisher, N., Havens, J., & Proudlock, S. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03571-x · Cited by 23
“In China, Hao et al. (2020) [8] surveyed 76 people currently in treatment for a mental health problem and 109 without.”
Public awareness and anxiety during COVID-19 epidemic in China: A cross-sectional study
Liu, Y., Li, P., Lv, Y., Hou, X., Rao, Q., Tan, J., Gong, J., Chao, T., Liao, L., & Cui, W. (2021) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2021.152235 · Cited by 25
“The study found that serious worries about physical health, anger and impulsivity, and intense suicidal ideation were significantly higher in patients under psychiatric treatment compared with healthy individuals [12].”
Timming, A. R., French, M. T., & Mortensen, K. (2021) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2021.100152 · Cited by 23
Health literacy, resilience and perceived stress of migrants in Israel during the COVID-19 pandemic
Zlotnick, C., Dryjańska, L., & Suckerman, S. (2021) · Psychology and Health · doi:10.1080/08870446.2021.1921177 · Cited by 24
“Psychiatric patients and individuals with chronic diseases reported more symptoms (Hao et al., 2020; Tee et al., 2020).”
The effect of COVID-19 lockdown on psychiatric admissions: role of gender
Davies, M., & Hogarth, L. (2021) · BJPsych Open · doi:10.1192/bjo.2021.927 · Cited by 23
“11”
Bell, C., Williman, J. A., Beaglehole, B., Stanley, J., Jenkins, M., Gendall, P. J., Rapsey, C. M., & Every‐Palmer, S. (2021) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674211034317 · Cited by 24
“Early in the pandemic, crosssectional studies from China (Hao et al., 2020), Italy (Iasevoli et al., 2020), Australia (Van Rheenen et al., 2020), the United States and Canada (Asmundson et al., 2020), and Denmark (Rohde et al., 2020) consistently reported higher rates of anxiety, depression and…”
InfluentialDeep graph neural network-based prediction of acute suicidal ideation in young adults
Choi, K., Kim, S., Kim, B.-H., Jeon, H., Kim, J.-H., Jang, J., & Jeong, B. (2021) · Scientific Reports · doi:10.1038/s41598-021-95102-7 · Cited by 22
Lazzaroni, E., Invernizzi, R., Fogliato, E., Pagani, M., & Maslovaric, G. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.701381 · Cited by 38
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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