With over 6.26 million cases and 375,000 deaths in just five months, the COVID-19 pandemic has caused great fear and devastation in many parts of the world. Many studies show that, generally, there has been an accompanying increase in fear, anxiety, and depressive symptoms during this period. Now, a new study published on the online preprint server medRxiv* in May 2020 shows that patients with a history of mental ill-health often underwent a worsening of their symptoms with the onset of the pandemic.
An earlier study by the same team of international researchers showed that psychological conditions, depression, and post-traumatic stress disorder were more common in people who already had mental disorders. Moreover, it found that those individuals whose conditions were self-perceived to have become aggravated because of the pandemic were more likely to be psychologically disturbed, overall, to be infected, and to have a psychiatric relapse, as well as to have suicidal ideas.
Mental ill-health requires considerable healthcare resources, and have a significant death rate, disability number, and more reduced productivity. Against this background, the pandemic has caused the burden on these resources to increase significantly, with extra care being required for frontline healthcare workers, psychiatric patients, and the people in general. As a result, it is essential that the groups in greatest need of psychiatric services be identified.
The Study to Identify Worsening of Psychiatric Health
The current study is aimed at analyzing different groups of mental health patients to evaluate the impact of COVID-19 on them.
Using an online questionnaire that was placed online for 15 consecutive days from March 29, 2020, by April 14, 2020, the researchers extracted data dealing with only those groups which had a history of psychiatric ill-health – a total of 2,734 patients.
They then looked at those patients above 18 years, who reported a decline in their mental health. They adjusted the reports of worse psychiatric health for various factors like:
- demographic factors;
- social conditions, satisfaction with interventions taken by employer or state during this period
- personality factors like optimism, extroversion, family conditions like working at home, home isolation, having one or more pets, how much social contact was present, exercise;
- prior history of trauma or mental ill-health;
- and COVID-19-linked factors like knowing someone nearby at work or home who became sick or died from COVID-19.
They looked specifically for risk factors and factors that indicated a resilient personality, to predict if the psychiatric condition would worsen or not.
The researchers then tested another cohort of 318 patients from an independent practice during this period during the pandemic to verify their results.
Worsening of Mental Health Among Those with Psychiatric Disorders
Among the 2,734 patients, the most significant number of responses was from the USA, at over 850, with the next four countries at a level of below 250 each. The highest percentage of self-reported aggravation of symptoms was among Canadians, at 81%, and Pakistan, with 72%.
However, the survey results were skewed with almost 80% of responses from females, living in urban areas, and with higher educational attainments. Most of them were working or studying from home or isolated at home with family or others.
Just over half and two-thirds of the responses expressed satisfaction with the response of the government or employer to the pandemic. Half reported less than 15 minutes daily of exercise. Two-thirds said they were spending more time on social media, less with family and friends even virtually, and the vast majority said they were feeling out-of-control to some extent.
The self-reports of decline in mental health were verified against the compared scores from the questionnaires and indices used in both groups, those with and without worsening psychiatric health. As reported, all scores were higher in the first group, and patient distribution, along with the score graphs, also followed their self-reported change/no change in mental condition.
Psychiatric Patients at Highest Risk
The adjusted analysis showed that the highest odds of worsening of mental health (90%) were linked to a feeling of loss of control. Being female, a lack of interaction with others, and dissatisfaction with state response to the outbreak was linked to a 70%, 56%, and 31% increase in the odds of worsening of the psychiatric condition.
Factors that prevented such worsening included the freedom to share concerns with those close to the patient, normal usage of social media, and having a realistic view of conditions.
The validation study was also skewed, with almost 72% being females and 82% having a major depressive disorder. About 44% of patients had new clinical symptoms, mostly sleep disturbances. Almost half the patients needed a new mode of treatment or adjustment in the current therapy, according to the clinician’s evaluation.
Overall, the study showed that the pandemic had a substantial effect on psychiatric patients globally, with at least half the patients in 8 of 12 countries in the study reporting that their psychiatric condition had worsened. The factors that tended to worsen the psychiatric disorder at this time were also identified, as were the risk factors underlying this change.
The patients’ reports of worse mental health were validated with their scores on self-scored validated patient scales used to evaluate depression, PTSD risk, and general mental disturbance. These findings are strengthened by the clinical study showing that over half of the patients had new findings and needed treatment adjustments during the pandemic period.
The study’s strengths include a large sample size, a large number of countries, the use of 11 different languages for generalizability, and direct collection of data at the pandemic’s peak, with a particular endpoint and validation by an independent clinical study.
Of course, it has limitations such as the non-randomized nature of the sample, the online nature of the survey, which could exclude a large part of the population who do not have access to equal resources.
The Implications of the Study
The study shows the vulnerability of this group of people to adverse impacts from the pandemic. The findings can “provide the insight necessary to improve mental health systems. Health systems can become better equipped to address the concerns of this population, mitigate the risk of further mental deterioration, and reduce the prevalence of suicidal ideation.”
In addition, the study shows that women are at higher risk, both because of the increased prevalence of such conditions as depression and anxiety, and the gender disparity in the violence and abuse they face during the pandemic. The latter can be traced partly to increased risk of economic insecurity, reduced mobility, fewer health services, and social isolation. Hence, say the investigators, “Governments and public health experts should recognize the needs of women and women with psychiatric diseases to counter the vulnerability and risk they face.”
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information