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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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Ariccio, S., & Theodorou, A. (2024) · Journal of Environmental Psychology · doi:10.1016/j.jenvp.2024.102334 · Cited by 3
The effects of the SARS-CoV-2 pandemic on self-reported interoception and mental health
Biotti, F., Barker, M., Carr, L., Pickard, H., Brewer, R., & Murphy, J. (2025) · PLoS ONE · doi:10.1371/journal.pone.0314272 · Cited by 2
Pinucci, I., Tedeschi, F., Serra, R., Patanè, M., Acartürk, C., Andriani, D., Bryant, R. A., Burchert, S., Caggiu, G., Campos, D., et al. (2025) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-025-02944-x · Cited by 2
Re-testing the psychometric properties of the Fear of COVID-19 Scale (FCV-19s)
Garcia, L. L. (2022) · Journal of Nursing Education and Practice · doi:10.5430/jnep.v13n1p55 · Cited by 2
Outpatient psychiatric service utilization during the Covid-19 pandemic
Shirzad, F., Shati, M., Mortazavi, S. S., Gholamzad, S., Ahmadkaraji, S., Pazhooyan, M., Saeedi, N., Hashemi, R., Shirdel, S., & Salehi, M. (2022) · Middle East Current Psychiatry · doi:10.1186/s43045-022-00234-9 · Cited by 2
Use of anxiolytics and hypnotic drugs during COVID-19 pandemic: The literature review
Trajkovski, T., & Marić, N. P. (2022) · Medicinski podmladak · doi:10.5937/mp73-35916 · Cited by 2
“A possible reason for woman preponderance is a higher prevalence of risk factors known to intensify during a pandemic such as pre-existing depressive and anxiety disorders (33, 34).”
Al-Jadidi, S., Alharrasi, M., Kassim, N. M., Alkalbani, A., Muthukrishnan, A., & Al-Shukaili, A. K. (2022) · Malaysian Journal of Medicine and Health Sciences · doi:10.47836/mjmhs.18.5.16 · Cited by 2
Joung, J., & Shin, S. (2023) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20230110-01 · Cited by 2
Yüce, Z., & Şimşek, N. (2023) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.1079919 · Cited by 2
Yamanaka, Y., Yoshiuchi, K., Kubo, C., Fukudo, S., Japanese Society of Psychosomatic Medicine, Kusumi, I., Sato, K., Ebana, S., Kawai, K., Takeuchi, T., et al. (2023) · BioPsychoSocial Medicine · doi:10.1186/s13030-023-00279-0 · Cited by 2
“Prior psychiatric diagnoses, such as depression and anxiety, may predict the development of adverse psychological symptoms associated with lockdown [6, 7].”
Healthcare providers as patients: COVID-19 experience
Mutair, A. S. A., Woodman, A., Alhasawi, A. I., Ambani, Z., Bazroun, M. I. A., Alahmed, F. S., Defensor, M. A., Saha, C., & Aljarameez, F. (2023) · PLoS ONE · doi:10.1371/journal.pone.0289131 · Cited by 2
Mental health-related presentations to a tertiary emergency department during the COVID-19 pandemic
Lim, E. G., How, A. E. H., Lee, J. Z. H., Ganti, S., & Omar, E. B. (2023) · Singapore Medical Journal · doi:10.4103/singaporemedj.smj-2022-103 · Cited by 2
“[23] 24-26] This study is not without limitations.”
Khalkhali, M., Zarvandi, P., Mohammadpour, M., Alavi, S. M. K., Khalkhali, P., & Farrahi, H. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05742-y · Cited by 2
Liu, Y., Su, Y., & Li, X. (2024) · PsyCh Journal · doi:10.1002/pchj.782 · Cited by 2
“Apart from anxiety, depression and stress, a large proportion of psychiatric patients also suffered from moderately severe to severe insomnia along with potential post-traumatic stress disorder (PTSD) (Hao et al., 2020).”
Post, F., Schurr, T. A., Frajo-Apor, B., Tutzer, F., Schmit, A., Plattner, B., Conca, A., Fronthaler, M., Häring, C., Holzner, B., et al. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.116064 · Cited by 2
Jones, S. B., Ko, H., Gatto, A. J., Kablinger, A. S., Sharp, H. D., Cooper, L. D., Tenzer, M. M., O’Brien, V. C., & McNamara, R. S. (2024) · Journal of Patient-Reported Outcomes · doi:10.1186/s41687-024-00802-z · Cited by 2
“…with COVID-19 have been shown to have a disproportionate impact on individuals with preexisting mental health diagnoses, people of color, and those in low to middle income countries, the use of tele-health and telepsychiatry has been shown to decrease the impacts of pandemic stressors [13, 26, 27].”
Almurshidi, A. H., Bridi, R. M., & Hosani, N. A. (2021) · Papers in Applied Geography · doi:10.1080/23754931.2021.1950039 · Cited by 2
“It is worth noting that for the respondents of the study by Hao et al. (2020), the impact of the pandemic on mental health does not correspond with an increase in alcohol consumption.”
Pokharel, R., Shah, T., Lama, S., Karki, A., & Shrestha, E. (2022) · Journal of Mental Health · doi:10.1080/09638237.2021.2022634 · Cited by 2
“A study in China among psychiatric patients found increased DASS-21 scores during lockdown (Hao et al., 2020).”
Mental Health Day Hospitals and Lockdown Due to COVID-19 in Spain
Sánchez-Guarnido, A. J., Lucena, V., Torrent, A., Bosa, L., Martinez-López, V., Cuartiles-Berenguer, A., & Batalla, I. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.769015 · Cited by 2
Role of Media in Depression to The Viewers Watching Covid 19 Related News
Ullah, A., Khan, A. M., & Siraj, M. (2022) · Journal of Accounting and Finance in Emerging Economies · doi:10.26710/jafee.v8i2.2267 · Cited by 2
“Several empirical studies concluded that epidemics not only increased the risk of mortality but also led to unbearable mental health problems among the people (Duan & Zhu, 2020; Hao et al., 2020; Tan et al., 2020; Wang et al., 2021; Xiao, 2020).”
Gambaran Gejala Klinis dan Gangguan Psikologis Pasien Positif Covid-19 di Kota Pontianak
Setiawati, L., Windi, M. M., Tambunan, M. B., & Suawarni, L. (2021) · Media Publikasi Promosi Kesehatan Indonesia (MPPKI) · doi:10.56338/mppki.v4i3.1621 · Cited by 2
Suicide in the context of infodemic during COVID-19 pandemic: A global perspective
Shoib, S., Armiya’u, A. Y., Das, N., Hussaini, S. S., Ahmed, E. M. S., & Chandradasa, M. (2022) · Annals of Medicine and Surgery · doi:10.1016/j.amsu.2022.104070 · Cited by 2
“The COVID-19 pandemic has created widespread worry, anxiety, and suffering in the general public and especially among persons with psychiatric problems [12].”
Clinical features of mental disorders during the pandemic of a new coronavirus infection
Tyuvina, N. A., Vysokova, V. O., Efremova, E. N., & Lavrinenko, O. V. (2022) · Neurology neuropsychiatry Psychosomatics · doi:10.14412/2074-2711-2022-4-75-81 · Cited by 2
Depressive and anxious symptomatology in a Lebanese sample during the COVID-19 outbreak
Assi, M., Maatouk, I., & Jaspal, R. (2021) · International Journal of Health Promotion and Education · doi:10.1080/14635240.2021.1950561 · Cited by 2
“As previous research has revealed much higher levels of anxiety and depression in patients with a diagnosed mental health condition (Hao et al. 2020), participants with a diagnosed mental health disorder were excluded from further analysis, resulting in a sample of 157 people.”
Social Media Creating Resilient Communities During COVID-19: India, Bangladesh & Pakistan
Saha, A. (2021) · Risk, systems and decisions · doi:10.1007/978-3-030-77344-1_21 · Cited by 2
Badanapurkar, A., Nelson, D., Alabdulla, M., Reagu, S. M., Woodruff, P. W. R., Varghese, S., Aly, S. M., & Haddad, P. M. (2021) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12810 · Cited by 2
Bloch, Y., Shemesh, S., Grossman‐Giron, A., Maoz, H., Cohenmehr, E., Hertzberg, L., Nitzan, U., & Bitan, D. T. (2022) · Psychiatry Research Communications · doi:10.1016/j.psycom.2022.100027 · Cited by 2
“Based on recent literature demonstrating that the fear of covid-19 among psychiatric patients is as severe as in the general population (Liu et al., 2020; Hao et al., 2020; Gonzalez-Blanco et al., 2020), we hypothesized that both groups would exhibit similar levels of “fear of covid-19”.”
InfluentialPredicting the role of coping factors on pandemic-related anxiety
Askari, I., Wenglorz, L., Gajewski, F. J., Jänner, M., Vetter, A., Askari, A., Askari, S., Balázsy, Z., Bramer-Ugur, S., Reinermann, D., et al. (2022) · Current Psychology · doi:10.1007/s12144-022-03188-7 · Cited by 3
“Possible explanations arise when considering the Social Solidarity Scale.”
InfluentialLucidi, S., Iannattone, S., Mallardo, F., Spoto, A., & Lorio, R. (2022) · PubMed Central · doi:10.36131/cnfioritieditore20220403 · Cited by 2
Saeieh, S. E., Mahmoodi, Z., Rajati, F., & Salehi, L. (2022) · Medical Journal of the Islamic Republic of Iran · doi:10.47176/mjiri.36.106 · Cited by 2
Publications on COVID-19 from Vietnam during 2020 and 2021: A bibliometric analysis
Nguyen, V. L., Luong, D., & Pham, H. (2022) · European Science Editing · doi:10.3897/ese.2022.e83724 · Cited by 1
Sood, M., Chadda, R., Shukla, T., Patel, R., Ratra, D., Mohan, M., & Singh, S. P. (2022) · World Social Psychiatry · doi:10.4103/wsp.wsp_88_20 · Cited by 2
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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