Abstract
While the COVID-19 pandemic continues, patients with pre-existing mental disorders are increasingly recognized as a risk group for adverse outcomes. However, data are conflicting and cover only short time spans so far. Here, we investigate the medium-term and peri-lockdown-related changes of mental health outcomes in such patients in a longitudinal study. A cohort of 159 patients comprising all major mental disorders (ICD-10 F0-F9) were interviewed twice with the Goettingen psychosocial Burden and Symptom Inventory (Goe-BSI) to evaluate psychosocial burden, psychiatric symptoms and resilience at the end of the first (April/May 2020) and the second lockdown in Germany (November/December 2020). For the primary outcome “psychosocial burden” ratings also comprised retrospective pre-pandemic (early 2020) and very early states during the pandemic (March 2020). For all diagnostic groups, psychosocial burden varied significantly over time (p < 0.001) with an increase from the pre-pandemic to the initial phase (p < 0.001), followed by a steady decrease across both lockdowns, normalizing in November/December 2020. Female gender, high adjustment disorder symptom load at baseline and psychiatric comorbidities were risk factors for higher levels and an unfavorable course of psychosocial burden. Most psychiatric symptoms changed minimally, while resilience decreased over time (p = 0.044 and p = 0.037). The longitudinal course of psychosocial burden indicates an initial stress response, followed by a return to pre-pandemic levels even under recurrent lockdown conditions, mimicking symptoms of an adjustment disorder. Strategies for proactive, specific and continuous treatment have to address resilience capacities before their depletion in the pandemic aftermath, especially for patients with additional risk factors.
Highlights
As a prolonged global crisis, the continuing COVID-19 pandemic and the associated lockdown measures severely and persistently challenge mental health worldwide
Related to the current pandemic, they were found to exhibit higher COVID-19 infection rates [11, 13], an increased risk of adverse outcomes from COVID-19 [14,15,16], or both [13, 17]. They have been suggested to be susceptible for worsening of their mental health condition in response to pandemic-related stressors, in terms of an exacerbation or relapse of psychopathology or de novo onset of psychiatric symptoms
A total of N = 159 patients treated at the Department of Psychiatry and Psychotherapy, University Medical Center Goettingen were interviewed by telephone with the Goettingen psychosocial Burden and Symptom Inventory (Goe-BSI) both at baseline (T1: 1st lockdown, April/ May 2020,) and at follow-up (T2: 2nd lockdown, November/December 2020,)
Summary
As a prolonged global crisis, the continuing COVID-19 pandemic and the associated lockdown measures severely and persistently challenge mental health worldwide. [1, 11]) Such patients, in addition to pre-existing risk factors (mental disorder as diathesis), may be more adversely affected by current environmental stressors (pandemic and related measures) than healthy individuals. Related to the current pandemic, they were found to exhibit higher COVID-19 infection rates [11, 13], an increased risk of adverse outcomes from COVID-19 [14,15,16], or both [13, 17] They have been suggested to be susceptible for worsening of their mental health condition in response to pandemic-related stressors, in terms of an exacerbation or relapse of psychopathology or de novo onset of psychiatric symptoms
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