The psychopathological impact of the SARS-CoV-2 epidemic on subjects suffering from different mental disorders: An observational retrospective study

Which Factors Are Associated With Comorbid Psychiatric Conditions in Patients Affected by Substance Use Disorders? The Impact of COVID-19 Pandemic on Dual-Diagnosis Subjects

OBJECTIVE

To investigate demographic/cinical variables associated to dual diagnosis and the psychological reaction of dual-diagnosis patients to COVID-19 pandemic.

METHODS

Information was collected at the Addiction Service of Monza, Italy. The Impact of Event Scale-Revised (IES-R), a self-report questionnaire measuring the subjective response to a traumatic event, was administered. Univariate analyses and binary logistic regression were performed. IES-R scores were compared between groups defined by qualitative variables through one-way analyses of variance (ANOVA).

RESULTS

118 outpatients were included, 48.3% with dual diagnosis. Alcohol use disorder and being female were associated to dual diagnosis. IES-R scores were significantly higher in the dual-diagnosis group, especially for personality disorders (PDs). IES-R scores were higher in patients taking treatment for substance use disorder (SUD).

CONCLUSIONS

Females and alcohol abusers were at-risk subjects for dual diagnosis. Patients with SUD and PDs may benefit from additional support, especially when traumatic life events occur.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04694482.

Depression and stress levels in patients with different psychiatric disorders during concurrent early-phase COVID-19 pandemic and earthquake in Croatia

BACKGROUND

While Croatia shared COVID-19 pandemic with other countries, its capital area was also hit by a 5.6 magnitude earthquake. The simultaneous impact of these two disasters on psychiatric patients is largely unknown, and we addressed those knowledge gaps.

METHODS

The cross-sectional study was conducted during the pandemic's first peak, in the aftermath of earthquake, by telephonic survey. Measurements included the Patient Health Questionnaire-9, the Perceived Stress Scale and the semi-structured interview to evaluate the impact of pandemic stress and earthquake. Overall 396 patients with depression and/or anxiety disorders (DAD), 229 participants with schizophrenia spectrum disorders (SSD) and 205 healthy controls were enrolled.

RESULTS

Both patient groups had higher depression and stress levels than controls, independent of sex, age and the presence of somatic comorbidity. After controlling for the same covariates, patient groups had higher COVID-19- and earthquake-related fears than controls. In patients with DAD, both fears were greater than among SSD patients. When comparing the two fears, the fear from earthquake was higher in DAD and control groups, whereas in SSD patients there was no such difference.

CONCLUSIONS

Patients with DAD were the most vulnerable group during disasters, while earthquake seems to be associated with more fear than the pandemics, at least in DAD patients and healthy individuals. Future longitudinal studies should determine if early psychological support might alleviate stress levels after disasters and prevent further worsening of mental health, particularly among DAD patients.

The Impact of the COVID-19 Pandemic on Binge Eating Disorder: A Systematic Review

The aim of this systematic review was to synthesise the impact of the COVID-19 pandemic on binge eating disorder (BED) the new onset and course. Inclusion criteria: original articles and BED diagnosis; and the main outcomes: relationships between the COVID-19 pandemic and the new onset/clinical changes in BED, and specific results for BED. Exclusion criteria: mixed/inaccurate diagnoses and articles not written in English. We searched four databases and one registry until 5 May 2023. The quality appraisal was conducted using the Effective Public Health Practice Project (EPHPP) tool. Twelve studies with 4326 participants were included. All studies were observational with nine cross-sectional and three longitudinal. Four of the included studies investigated new-onset BED, while eight examined the BED clinical course of patients with a previous diagnosis. With the exception of one study, the available literature indicates both an increase in BED diagnoses and a clinical worsening during COVID-19. Major limitations include study quality (weak-to-moderate) and high heterogeneity in terms of pandemic phase, population, geographical areas, and psychometric tools. Our findings indicate that BED patients are particularly vulnerable to events characterised by social distancing and over-worry, and should be, therefore, carefully monitored. Further studies are needed to corroborate our findings, implement preventive strategies, and promote personalised treatments. PROSPERO registration number: CRD42023434106.

Mental health in Europe during the COVID-19 pandemic: a systematic review

The COVID-19 pandemic caused immediate and far-reaching disruption to society, the economy, and health-care services. We synthesised evidence on the effect of the pandemic on mental health and mental health care in high-income European countries. We included 177 longitudinal and repeated cross-sectional studies comparing prevalence or incidence of mental health problems, mental health symptom severity in people with pre-existing mental health conditions, or mental health service use before versus during the pandemic, or between different timepoints of the pandemic. We found that epidemiological studies reported higher prevalence of some mental health problems during the pandemic compared with before it, but that in most cases this increase reduced over time. Conversely, studies of health records showed reduced incidence of new diagnoses at the start of the pandemic, which further declined during 2020. Mental health service use also declined at the onset of the pandemic but increased later in 2020 and through 2021, although rates of use did not return to pre-pandemic levels for some services. We found mixed patterns of effects of the pandemic on mental health and social outcome for adults already living with mental health conditions.

Comparing the emotional impact of the UK COVID-19 lockdown in very preterm and full-term born children: a longitudinal study

Introduction

The COVID-19 pandemic has caused a global mental health crisis, especially for those individuals who are vulnerable to stress and anxiety due to pre-existing mental health problems. This study aimed to understand the emotional impact of the COVID-19 lockdown on children who were born very preterm (VPT, <32 weeks' gestation), as they are vulnerable to mental health difficulties and are at increased risk of developing psychiatric problems during childhood compared to their full-term-born counterparts.

Methods

The parents of 32 VPT children (mean age = 8.7) and 29 term-born controls (mean age = 8.8), who had previously taken part in a study of brain development and psychopathology following VPT birth, completed an online modified version of the Coronavirus Health and Impact Survey (CRISIS). The emotional impact of the COVID-19 lockdown on the child and the parent, measured by the CRISIS, was studied in relation to pre-existing mental health, assessed with the parent-rated Strengths and Difficulties Questionnaire (SDQ), evaluated before the CRISIS completion (mean time gap 15 months). Linear regression model comparisons were conducted to study the effects of COVID-19-related stressors on children's and parents' behavior, relationships and mental health.

Results

There were no significant group differences in pre-existing SDQ internalizing/externalizing symptoms, child's emotions or parent's emotions during the COVID-19 lockdown. However, higher pre-existing internalizing symptoms in VPT children were associated with greater lockdown-related emotional problems and worries (simple slope = 1.95, p < 0.001), whereas this was not observed in term-born children.

Conclusion

Our results suggest that VPT children with pre-existing internalizing problems may be more vulnerable to the negative impact of certain societal and familial stressors, such as social restrictions during the national COVID-19 lockdown periods. Further rigorous studies are therefore needed to assess the severity of increased risks for this particularly vulnerable group in the context of potentially stressful life changes and adjustments.

Self-selection biases in psychological studies: Personality and affective disorders are prevalent among participants

Respondents select the type of psychological studies that they want to participate in consistence with their needs and individual characteristics, which creates an unintentional self-selection bias. The question remains whether participants attracted by psychological studies may have more psychological dysfunctions related to personality and affective disorders compared to the general population. We investigated (N = 947; 62% women) whether the type of the invitation (to talk about recent critical or regular life events) or the source of the data (either face-to-face or online) attracts people with different psychopathology. Most importantly, participants who alone applied to take part in paid psychological studies had more symptoms of personality disorders than those who had never before applied to take part in psychological studies. The current results strongly translate into a recommendation for either the modification of recruitment strategies or much greater caution when generalizing results for this methodological reason.

First access to mental health services during COVID-19 pandemic: A multicenter study

BACKGROUND

The impact of the COVID-19 pandemic on mental health is complex and affects a broad segment of the population. Several studies indicate that depressive, anxious and post-traumatic symptoms are common in people exposed to SARS-Cov2.

METHODS

458 subjects were recruited during their first consultation in outpatient psychiatric services between June 2020 and October 2021. Post-traumatic, depressive and anxious symptoms were assessed using the Impact of Event Scale-Revised (IES-R), the Beck Depression Inventory Scale-second edition (BDI-II), and  the Self Rating Anxiety Scale (SAS). A specific set of questions was developed, with the aim of evaluating socio-demographic variables and work, environmental and personal characteristics related to the pandemic.

RESULTS

Prevalence rates of clinically significant depressive, anxious and post-traumatic symptoms were 57.6%, 63.5% and 54.8%, respectively. Female gender, worsening of relationship status and financial consequences due to the pandemic were the conditions most strongly associated with the presence of psychopathology.

LIMITATION

The cross-sectional design of the study doesn't allow an evaluation over time of the sample. No assumption of causality can be made due to the lack of pre-pandemic assessments for the investigated variables.

CONCLUSIONS

The impact of the pandemic involves depressive, anxious and post-traumatic dimensions. The investigated psychopathology correlates with several variables expressing the personal and environmental changes that occurred in the population due to the COVID-19 emergency. The study is multicentric and the recruitment of participants was held in a clinical setting, providing a realistic picture of the consequences of the pandemic in clinical practice within mental health services.

Have the COVID-19 outbreak and related restrictions affected the right to mental health of people with severe mental health conditions?

The Coronavirus disease (COVID-19) outbreak, and the restrictions implemented by governments to limit its public health impact, may have determined a reduction of the right to mental health of people with severe mental health conditions, that is a limitation to adequate, human, and value-based mental healthcare, with rising inequalities in comparison with the general population. This systematic review was, therefore, conducted to collate evidence on the impact of the pandemic period on the mental health of individuals with pre-existing severe mental health conditions. Of 3,774 retrieved citations, we selected 21 studies meeting the inclusion criteria. The majority of the included studies assessed trends in psychological symptoms over the pandemic period, then arguing that symptoms worsened for a number of reasons, including the risk of contracting the virus, the disruption of mental health services, and the feelings of loneliness and isolation associated with the restriction measures. Even though studies provided somewhat contradictory results, the majority of evidence indicates that people with pre-existing mental health conditions were more likely to report greater self-isolation distress, anxiety, depression, COVID-19-related perceived stress, and were more likely to voluntarily self-isolate than those without a mental health condition. These findings appeared to suggest that a combination of factors related to the pandemic itself and to the prevention and mitigation strategies were responsible for a reduction of the right to mental health of people with mental health conditions, with increased inequalities in comparison with the general population.

The effect of the COVID-19 pandemic on health behavior and psychopathology in patients with psychotic disorders

In our study we aimed to investigate the effect of the pandemic period on disease severity, medication adherence, suicidal behavior, physical health and health behavior in patients with psychotic disorders. 255 patients with any of the diagnoses of Schizophrenia, Schizoaffective Disorder, Delusional Disorder, Bipolar Disorder with psychotic features and Major Depressive Disorder with psychotic features were included, 200 were assessed by telephone and 55 face-to-face. The patient's sociodemographic status, cigarette-alcohol use, physical diseases, body weight, suicidal behaviors, and the effects of the pandemic period on general health were assessed. Clinical global impression scale(CGI) and modified medication adherence scale(MMS) were also administered. We showed that the MMS scores of the patients significantly decreased compared to the pre-pandemic period. In our study, suicidal behavior and decrease in medication adherence during the pandemic period were found to be correlated with higher scores of CGI- Severity and Improvement Scale. Our study is one of the few studies that addresses the effects of the pandemic period on patients with psychotic disorders. The results show that the pandemic period is associated with an increase in negative health behavior and clinical worsening in patients with psychotic disorders. In order to confirm these findings, more research is needed in this area.

Perceived empowerment and the impact of negative effects of the COVID-19 pandemic on the quality of life of persons with severe mental illness

Purpose

Beyond its direct effects on physical health the COVID-19 pandemic has been shown to have negative effects on the living situation of people with severe mental illness (SMI). To date, there has been little research on resilience factors preventing people with SMI from experiencing negative effects of the COVID-19 pandemic.

The objective of this study was to investigate the role of perceived empowerment (PE) as a resilience factor, preventing people with SMI from experiencing negative effects of the COVID-19 pandemic on daily living.

Methods

We investigated negative effects of the COVID-19 pandemic on daily living in 931 persons with SMI at two times within six month between June 2020 and Mai 2021. To take into account the longitudinal structure of the data we applied mixed effects regression analyses and longitudinal path models.

Results

A majority of participants experienced negative effects of the COVID-19 pandemic on several dimensions of daily living. Negative effects increased with rising levels of illness-related impairment but decreased as the level of PE rose. While negative effects of the COVID-19 pandemic at follow-up were negatively associated with overall subjective quality of life baseline, PE was negatively associated with the negative impact of the pandemic and positively with quality of life.

Conclusion

Patients with SMI need support to reduce negative effects of the COVID-19 pandemic on their quality of life. The promotion of PE could help strengthen resilience in this target group.

Trial registration

German Clinical Trial Register, DRKS00019086, registered on 3 January 2020. (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00019086).

Comparing the COVID-19-related PTSD symptoms between psychiatric patients and healthy subjects: an observational retrospective study from Northern Italy

COVID-19 pandemic had a great impact on mental health, both in the general population and psychiatric patients. Little is known about the difference between these two populations in perceiving the pandemic as a traumatic event. The aim of the study was to compare psychiatric patients and healthy controls (HC) in terms of change over time of post-traumatic (PTSD) symptoms. Demographic and clinical variables were collected. Impact of Event Scale Revised (IES-R) scores were registered at T1 as lockdown period (March-April 2020) and T2 as restarting (May-June 2020). Descriptive analyses and linear regression models were performed. A total of 166 outpatients and 57 HC were recruited. Time (F = 15.76; p < 0.001) and diagnosis (F = 4.94; p < 0.001) had a significant effect on the change of IES-R scores, which resulted T1 > T2 (p < 0.001), except for subjects affected by Obsessive-Compulsive Disorder (OCD). Overall, IES-R scores were < in patients than in HC (p = 0.02), particularly in the schizophrenia (SKZ) subgroup (p < 0.001). IES-R scores of subjects with personality disorders (PDs) resulted to be > HC, although not statistically significant. The lockdown period was perceived as more traumatic than the reopening phase by both groups, with the exception of OCD patients, probably because of the clinical worsening associated with the urge of control against risks of contamination. Overall, HC reported more PTSD symptoms than psychiatric patients did, particularly SKZ ones. PD patients, in contrast, may be more vulnerable to PTSD symptoms probably as a result of poor coping skills. Together with OCD patients, subjects with PDs may need closer monitoring during the different phases of the pandemic. Trial Registration: ClinicalTrials.gov Identifier: NCT04694482.

Unrealistic pessimism and obsessive-compulsive symptoms during the COVID-19 pandemic: Two longitudinal studies

Objective

Unrealistic pessimism (UP) is an aspect of overestimation of threat (OET) that has been associated with obsessive‐compulsive disorder/symptoms (OCD/OCS). During the COVID‐19 pandemic, UP may have played an important role in the course of OCD. To investigate the relationship, we conducted two longitudinal studies assuming that higher UP predicts an increase in OCS.

Method

In Study 1, we investigated UP in the general population (N = 1,184) at the start of the pandemic asking about overall vulnerability to infection with SARS‐CoV‐2 and UP regarding infection and outcome of severe illness. Further, OCS status (OCS+/−) was assessed at the start of the pandemic and 3 months later. In Study 2, we investigated UP in individuals with OCD (N = 268) regarding the likelihood of getting infected, recovering, or dying from an infection with SARS‐CoV‐2 at the start of the pandemic and re‐assessed OCS 3 months later.

Results

In Study 1, UP was higher in the OCS+ compared to the OCS− group, and estimates of a higher overall vulnerability for an infection predicted a decrease in OCS over time. UP regarding severe illness predicted an increase in symptoms over time. In Study 2, UP was found for a recovery and death after an infection with SARS‐CoV‐2, but not for infection itself.

Conclusions

Exaggeration of one’s personal vulnerability rather than OET per se seems pivotal in OCD, with UP being associated with OCD/OCS+ as well as a more negative course of symptomatology over the pandemic in a nonclinical sample.

Practitioner points

Unrealistic optimism, a bias common in healthy individuals, is thought to be a coping mechanism promoting well‐being in the face of danger or uncertainty.

The current study extends findings that its inversion, unrealistic pessimism, may play an important role in obsessive‐compulsive disorder and may also be involved in the development of the disorder.

This study highlights the importance that prevention programs during a pandemic should include targeting unrealistic pessimism.