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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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Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17051729 · Cited by 9,923 · cited 4×
“DASS was previously used in research related to SARS (McAlonan et al., 2007) and COVID-19 (Wang et al., 2020a,b).”
InfluentialSelf-citationValidation of the Insomnia Severity Index as an outcome measure for insomnia research
Bastien, C. (2001) · Sleep Medicine · doi:10.1016/s1389-9457(00)00065-4 · Cited by 8,067
Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., McIntyre, R. S., Choo, F. N., Tran, B., Ho, R., Sharma, V. K., et al. (2020) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2020.04.028 · Cited by 2,571 · cited 4×
“DASS was previously used in research related to SARS (McAlonan et al., 2007) and COVID-19 (Wang et al., 2020a,b).”
InfluentialSelf-citationHo, C. S., Chee, C. Y., & Ho, R. C. (2020) · Annals of the Academy of Medicine, Singapore · doi:10.47102/annals-acadmedsg.202043 · Cited by 1,699 · cited 1×
“Further research is required to evaluate the effectiveness of these psychoneuroimmunity preventive strategies to enhance resilience (Ho et al., 2020).”
Self-citationChew, N. W. S., Lee, G. K. H., Tan, B. Y. Q., Jing, M., Goh, Y., Ngiam, N. J. H., Yeo, L. L. L., Ahmad, A., Ahmed Khan, F., Napolean Shanmugam, G., et al. (2020) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2020.04.049 · Cited by 1,650 · cited 1×
“Nevertheless, the COVID-19 pandemic has a sudden and massive impact on health care infrastructure, transportation, daily activity, freedom of movement, and distribution of medical resources globally (Gautam and Sharma, 2020; Joob and Wiwanitkit, 2020; Simpson and Katsanis, 2020).”
Self-citationPsychological impact of the COVID-19 pandemic on health care workers in Singapore
Tan, B. Y. Q., Chew, N. W. S., Lee, G. K. H., Jing, M., Goh, Y., Yeo, L. L. L., Zhang, K., Chin, H.-K., Ahmad, A., Khan, F. A., et al. (2020) · Annals of Internal Medicine · doi:10.7326/m20-1083 · Cited by 1,279
Self-citationLi, Z., Ge, J., Yang, M., Feng, J., Qiao, M., Jiang, R., Bi, J., Zhan, G., Xu, X., Wang, L., et al. (2020) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2020.03.007 · Cited by 1,223
Self-citationLee, S. M., Kang, W. S., Cho, A.-R., Kim, T., & Park, J. K. (2018) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2018.10.003 · Cited by 1,112
Liu, Y., Ho, R. C.-M., & Mak, A. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.08.003 · Cited by 948
Self-citationOsimo, E. F., Pillinger, T., Rodriguez, I. M., Khandaker, G. M., Pariante, C. M., & Howes, O. D. (2020) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2020.02.010 · Cited by 937
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Impact of COVID-19 pandemic on mental health in the general population: a systematic review
Xiong, J., Lipsitz, O., Nasri, F., Lui, L. M. W., Gill, H., Phan, L., Chen-Li, D., Iacobucci, M., Ho, R., Majeed, A., et al. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.08.001 · Cited by 5,204
“T also reported an increase in psychological distress in the general population, persons with pre-existing mental disorders, as well as in healthcare workers (Hao et al., 2020; Tan et al., 2020; Wang et al., 2020b).”
Self-citationHow mental health care should change as a consequence of the COVID-19 pandemic
Moreno, C., Wykes, T., Galderisi, S., Nordentoft, M., Crossley, N., Jones, N., Cannon, M., Correll, C. U., Byrne, L., Carr, S., et al. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30307-2 · Cited by 1,840
Luo, M., Guo, L., Yu, M., Jiang, W., & Wang, H. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113190 · Cited by 1,615
Epidemiology of mental health problems in COVID-19: a review
Hossain, M. M., Tasnim, S., Sultana, A., Faizah, F., Mazumder, H., Zou, L., McKyer, E. L. J., Ahmed, H. U., & Ma, P. (2020) · F1000Research · doi:10.12688/f1000research.24457.1 · Cited by 1,113
The impact of the COVID-19 pandemic on suicide rates
Sher, L. (2020) · QJM: An International Journal of Medicine · doi:10.1093/qjmed/hcaa202 · Cited by 1,047
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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