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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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“DASS was previously used in research related to SARS (McAlonan et al., 2007) and COVID-19 (Wang et al., 2020a,b).”
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InfluentialAntidepressant Drugs and COVID-19: A Review of Basic and Clinical Evidence
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InfluentialSuicidal Behavior in the First Wave of the COVID-19 Pandemic
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Self-citationWork accidents, climate change and COVID-19
Santurtún, A., & Shaman, J. L. (2023) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2023.162129 · Cited by 16
Chronic kidney disease in the shadow of COVID-19: insights from the bibliometric analysis
Wang, J., Liu, X., Pan, D., Cai, X., Xue, Y., & Huang, J. (2023) · International Urology and Nephrology · doi:10.1007/s11255-023-03706-x · Cited by 17
“Furthermore, several factors, such as age, gender, work status, somatic symptoms, as well as underlying psychiatric and physical illnesses also contributed to this distress [38–41].”
Sabaté, J., Deutsch, D., Melchior, C., Entremont, A., Mion, F., Bouchoucha, M. L., Façon, S., Raynaud, J.-J., Zerbib, F., & Jouët, P. (2021) · Ethics Medicine and Public Health · doi:10.1016/j.jemep.2021.100660 · Cited by 18
Using social media data to assess the impact of COVID-19 on mental health in China
Zhu, Y., Cao, L., Xie, J., Yu, Y., Chen, A., & Huang, F. (2021) · Psychological Medicine · doi:10.1017/s0033291721001598 · Cited by 17
Bonsaksen, T., Skogstad, L., Heir, T., Ekeberg, Ø., Schou‐Bredal, I., & Grimholt, T. K. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18084102 · Cited by 17
“For example, anger, impulsivity, worries about one’s physical health, and suicidality have been shown to be higher among individuals with psychiatric illnesses compared to healthy controls [45].”
Berry, A., Burke, T., & Carr, A. (2021) · International Journal of Clinical Practice · doi:10.1111/ijcp.14941 · Cited by 16
Faraci, P., Bottaro, R., Valenti, G. D., & Craparo, G. (2022) · Psychology Research and Behavior Management · doi:10.2147/prbm.s354083 · Cited by 18
COVID-19 and the Future with Digital Mental Health: Need for Attention to Complexities
MALLA, A. K., & Joober, R. (2020) · The Canadian Journal of Psychiatry · doi:10.1177/0706743720957824 · Cited by 17
Monitoring Depression Trend on Twitter during the COVID-19 Pandemic: Observational Study (Preprint)Preprint
Zhang, Y., Lyu, H., Liu, Y., Zhang, X., Wang, Y., & Luo, J. (2020) · doi:10.2196/preprints.26769 · Cited by 17
The mental health impact of the COVID-19 pandemic: Implications for sub-Saharan Africa.Preprint
Frissa, S., & Semo, B. (2020) · doi:10.31219/osf.io/yq9kn · Cited by 17
Tng, X., Chew, Q. H., & Sim, K. (2020) · Singapore Medical Journal · doi:10.11622/smedj.2020111 · Cited by 17
“6%).(5,6,8,20,22,44,50-65) Although less studied, psychological sequelae were noted in younger individuals such as children and youths (overall anxiety 31.”
InfluentialImmunological Interfaces: The COVID-19 Pandemic and Depression
Perlmutter, A. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.657004 · Cited by 18
“Additionally, patients with preexisting psychiatric diagnoses have been found to experience high rates of psychiatric symptoms including those related to depression in the context of COVID19 lockdown measures, and immunological mechanisms have been proposed as a potential contributor (64).”
Systematic Review on the Mental Health and Treatment Impacts of COVID-19 on Neurocognitive Disorders
Dellazizzo, L., Léveillé, N., Landry, C., & Dumais, A. (2021) · Journal of Personalized Medicine · doi:10.3390/jpm11080746 · Cited by 16
“Overall, the pandemic has brought forth an overall worsening of psychiatric symptoms and greater psychological distress in individuals, particularly the elderly, with mental health needs [8,9].”
Keskin, G. (2022) · Applied Nursing Research · doi:10.1016/j.apnr.2022.151575 · Cited by 17
Korčok, M., Calle, J., Veverka, M., & Vietoris, V. (2022) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2022.2093325 · Cited by 16
“…pandemic is also having a significant impact on the mental health of the public as well as the vulnerable groups, including the elderly (Tsamakis et al. 2021), like health concerns, stress, depression, panic, and sleep disorders represent the psychosocial effects of the pandemics (Hao et al. 2020).”
Ramirez, D., Rufino, K. A., Rech, M., Poa, E., & Patriquin, M. A. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114758 · Cited by 17
Reducing Pediatric Mental Health Boarding and Increasing Acute Care Access.
Ibeziako, P. I., Kaufman, K., Campbell, E., Zou, B., Samsel, C., Qayyum, Z., Caracansi, A., & Ray, A. (2024) · Journal of the Academy of Consultation-Liaison Psychiatry · doi:10.1016/j.jaclp.2024.04.001 · Cited by 15
Bolarinwa, O. A., Olagunju, O. S., Babalola, T. K., & Saeed, B. Q. (2020) · Journal of Public Health Research · doi:10.4081/jphr.2020.1864 · Cited by 17
The Psychological Impact of COVID-19 Pandemic on the Students of Saudi Arabia
Alkhamees, A. A., & Aljohani, M. (2021) · The Open Public Health Journal · doi:10.2174/1874944502114010012 · Cited by 17
Validation of the Korean Version of the COVID-19 Phobia Scale (K-C19PS)
Seong, M., Lee, M., Kim, I., & Kang, M.-R. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18073747 · Cited by 16
“[13] reported that people experience psychological distress in pandemic situations.”
Stafford, O., Berry, A., Taylor, L. K., Wearen, S., Prendergast, C., Murphy, E., Shevlin, M., McHugh, L., Carr, A., & Burke, T. (2021) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2021.37 · Cited by 15
“This study contributes to, and supports, existing research showing that those with an ongoing medical condition are more prone to worry and concern (Wheaton et al. 2012; Özdin & Bayrak Özdin, 2020; Hao et al. 2020).”
Psychosocial Impact of COVID-19 Pandemic in Elderly Psychiatric Patients: a Longitudinal Study
Seethaler, M., Just, S. A., Stötzner, P., Bermpohl, F., & Brandl, E. J. (2021) · Psychiatric Quarterly · doi:10.1007/s11126-021-09917-8 · Cited by 18
“A significant difference between psychiatric patients and healthy controls during the COVID-19 pandemic and higher levels of PTSD, anxiety, depression, stress and insomnia had been shown [41].”
Li, D., Hsu, S., Chou, F. H., Chou, L., Hsieh, K.-Y., Kao, W.-T., Lin, G., Chen, W. J., Liao, C.-H., & Huang, J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18126523 · Cited by 16
“Patients with depressive or anxiety disorder have been reported to demonstrate more serious concerns about their physical health, impulsivity, sleep disturbance, and intense suicidal ideation than healthy controls [28].”
Brewer, G., Centifanti, L. C. M., Caicedo, J. C., Huxley, G., Peddie, C., Stratton, K., & Lyons, M. T. (2021) · Illness Crisis & Loss · doi:10.1177/10541373211023951 · Cited by 18
“Initial research indicates increased symptom severity amongst psychiatric patients during the pandemic and lockdown period (Hao et al., 2020).”
Alrubai, T., Khalil, A. M., Zaki, R., Sinno, L., & Tabbah, S. A. A. A. (2021) · Psycho-Oncology · doi:10.1002/pon.5851 · Cited by 14
“According to the Centers for Disease Control and Prevention (CDC), some groups; in particular, patients diagnosed with cancer, may be more vulnerable to the psychological and mental effects of coronavirus, and they may react more strongly to the stress of this crisis.(9,10) Patients diagnosed with cancer and survivors…”
Increased suicidal ideation in the COVID-19 pandemic: an employee cohort in Japan
Sasaki, N., Kuroda, R., Tsuno, K., Imamura, K., & Kawakami, N. (2021) · BJPsych Open · doi:10.1192/bjo.2021.1035 · Cited by 15
Dai, Z., Wang, H., Xiao, W., Huang, Y., Si, M., Fu, J., Xu, C., Jia, M., Leng, Z., Cui, D., et al. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.09.062 · Cited by 17
“A qualitative study indicated that COVID19 patients regarded COVID-19 infection as a major stress event for them due to high infectivity and potential lethality of COVID-19 infection, in addition, long hours of hospitalization and isolation may lead to their depressive disorders (Hao et al., 2020a).”
Lu, W.-H., Ko, N., Chang, Y., Yen, C., & Wang, P. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17217974 · Cited by 16
“found that people with mental illness may experience more worry, anxiety, and suicidal ideation and develop other mental illnesses than people without mental illness during the COVID-19 pandemic [48].”
Lin, L., Jiang, A., Zheng, Y., Wang, J., & Wang, M. (2021) · Social Work in Public Health · doi:10.1080/19371918.2021.1954127 · Cited by 17
“Furthermore, Hao et al. (2020b) found COVID-19 and psychiatric patients were signifificantly more worried about their health than healthy controls.”
Birgegård, A., Abbaspour, A., Borg, S., Clinton, D. N., Mantilla, E. F., Savva, A., Termorshuizen, J. D., & Bulik, C. M. (2021) · Eating Disorders · doi:10.1080/10640266.2021.1985286 · Cited by 15
“…2020; Carfì et al., 2020) pandemic-related restrictions have also adversely affected mental health in the general population (The Lancet Psychiatry, 2020; Xiong et al., 2020), and may worsen the symptoms in individuals with pre-existing psychiatric illnesses (Gobbi et al., 2020; Hao et al., 2020).”
Fabrazzo, M., Russo, A., Camerlengo, A., Tucci, C., Luciano, M., Santis, V. D., Perris, F., Catapano, F., & Coppola, N. (2021) · Medicina · doi:10.3390/medicina57111244 · Cited by 15
“However, most of the interviewed patients reported no changes or poor/worse physical health status and no increased depression, anxiety and stress [68].”
Duarte-Guerra, L. S., Kortchmar, E., Maraviglia, E. C. S., Costa, T. D. S., Lasmar, C. M., Morin, R. M. R., Grossi, I. O., Villares, J. F., Cremonesi, M. C., Watanuki, H. M., et al. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.02.030 · Cited by 17
Bock, M. M., Graf, T., Woeber, V., Kothgassner, O. D., Buerger, A., & Plener, P. L. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.617941 · Cited by 13
“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.”
Sunjaya, D. K., Paskaria, C., Pramayanti, M., Herawati, D. M. D., & Parwati, I. (2022) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s359530 · Cited by 14
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Teleconsultation Apps in the COVID-19 Pandemic: The Case of Guayaquil City, Ecuador
Perez-Noboa, B., Soledispa-Carrasco, A., Padilla, V. S., & Velásquez, W. (2021) · IEEE Engineering Management Review · doi:10.1109/emr.2021.3052928 · Cited by 14
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Kaggwa, M. M., Bongomin, F., Najjuka, S. M., Rukundo, G. Z., & Ashaba, S. (2021) · International Medical Case Reports Journal · doi:10.2147/imcrj.s301246 · Cited by 14
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Antičević, V., Bubić, A., & Britvić, D. (2021) · Journal of Traumatic Stress · doi:10.1002/jts.22701 · Cited by 18
“In addition to individuals’ responses, the model discusses the contribution of contextual factors involved in coping with traumatic events, such as an individual’s psychiatric history (Hao et al., 2020), prior trauma exposure (Lancee, 2008; Wang et al.”
Tyler, N., Daker‐White, G., Grundy, A. C., Quinlivan, L. M., Armitage, C. J., Campbell, S., & Panagioti, M. (2021) · BJPsych Open · doi:10.1192/bjo.2021.996 · Cited by 14
PSYCHOLOGICAL FACTORS AND CONSEQUENCES OF PSYCHOSOCIAL STRESS DURING THE PANDEMIC
Maruta, N. A., Маркова, М. В., Kozhyna, H. M., Aliieva, T. А., Yuryeva, L., Abdriakhimova, T. B., Пшук, Н. Г., & Skrypnikov, A. M. (2021) · Wiadomości Lekarskie · doi:10.36740/wlek202109126 · Cited by 14
“Despite the undeniable need for isolation and physical distancing, which resist the high contagiousness and pathogenicity of the virus, those factors have a negative impact on mental health [7-10].”
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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