Abstract
BackgroundThe coronavirus disease (COVID-19) pandemic, a global health crisis, has resulted in widespread socioeconomic restrictions including lockdown, social distancing, and self-isolation. To date, little is known about the psychological impact of the COVID-19 pandemic and lockdown on patients with bipolar disorder as a particularly vulnerable group.MethodsAn online survey was conducted in Austria at two points of measurement (T1 April 2020 during the first lockdown vs. T2 May 2020 at post-lockdown). The sample comprises 20 patients with bipolar disorder (mean age = 49.4 ± 15.6 years) and 20 healthy controls (mean age = 32.7 ± 9.6 years). A 2 × 2 factorial design to compare two time points (T1 vs. T2) and two groups (patients vs. healthy controls) was used. Main outcome measures included the Brief Symptom Inventory-18 (BSI-18) and a (non-validated and non-standardized) assessment to determine COVID-19 fears and emotional distress due to social distancing. Multiple linear regression analyses were used to assess the longitudinal association of COVID-19 fears/emotional distress due to social distancing during lockdown (T1) and psychological symptoms after lockdown (T2).ResultsAt T1, results demonstrated higher scores in BSI-18 subscales depression, anxiety and global severity index as well as emotional distress due to social distancing in bipolar patients compared to controls. There was a significant time x group interaction in the BSI-18 subscale somatization showing a decreasing trend in patients with BD compared to controls. No time effects in BSI-18 subscales or COVID-19 fears/emotional distress due to social distancing were observed. Regression analyses showed that COVID-19 fears during lockdown predicted somatization, only in patients.ConclusionsThere was a connection between the lockdown measures and somatization symptoms observed in patients. When the first steps of easing the social restrictions in May 2020 took place, somatization decreased only in the bipolar compared to the control group. Higher COVID-19 fears during lockdown predicted later symptoms at post-lockdown. Long-term impacts of the COVID-19 pandemic need further investigations to improve current therapeutic approaches and prevent fears and distress during lockdown in individuals with bipolar disorder in times of crisis.
Highlights
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which can cause the novel coronavirus disease (COVID-19) and its consequences, represent a global health crisis, and the whole world has experienced a state of emergency
No one had tested positive for COVID-19, no one lived together with someone who tested positive for COVID-19, and no one was put under quarantine at the time of testing or before
Results from repeated measures Analysis of covariance (ANCOVA) controlling for age, sex, education, and employment Bipolar disorder (BD) bipolar disorder, Brief Symptom Inventory-18 (BSI-18) brief symptom inventory-18, GSI global severity index, M mean, SD standard deviation showing higher scores in the patients group compared to controls
Summary
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which can cause the novel coronavirus disease (COVID-19) and its consequences (e.g., quarantine, lockdown, and social distancing), represent a global health crisis, and the whole world has experienced a state of emergency The COVID-19 pandemic is leading directly or indirectly to extraordinary challenges for mental health services (Fatke et al 2020; Rajkumar 2020). Insecurity, confusion, emotional isolation, and stigma may affect mental health and well-being (Pfefferbaum and North 2020). Emotional responses to the COVID-19 pandemic can result in relapse or worsening of an already existing psychiatric disorder because of high susceptibility to stress compared with the general population (Pérez-Fuentes et al 2020). The coronavirus disease (COVID-19) pandemic, a global health crisis, has resulted in widespread socioeconomic restrictions including lockdown, social distancing, and self-isolation. Little is known about the psychological impact of the COVID-19 pandemic and lockdown on patients with bipolar disorder as a vulnerable group
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