Global health disparities in vulnerable populations of psychiatric patients during the COVID-19 pandemic

Abstract

The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population. In this narrative review, we examine the impact of the pandemic on significant global health disparities affecting vulnerable populations of psychiatric patients: People of diverse ethnic background and color, children with disabilities, sexual and gender minorities, pregnant women, mature adults, and those patients living in urban and rural communities. The identified disparities cause worsened mental health outcomes placing psychiatric patients at higher risk for depression, anxiety and posttraumatic stress disorder symptoms. Those psychiatric patients who are ethnic minorities display barriers to care, including collective trauma and structural racism. Sexual and gender minorities with mental illness face discrimination and limited access to treatment. Pregnant women with psychiatric diagnoses show higher exposure to domestic violence. Children with disabilities face a higher risk of worsening behavior. Mature adults with psychiatric problems show depression due to social isolation. Psychiatric patients who live in urban communities face pollutants and overcrowding compared to those living in rural communities, which face limited access to telehealth services. We suggest that social programs that decrease discrimination, enhance communal resilience, and help overcome systemic barriers of care should be developed to decrease global health disparities in vulnerable population.

Psychiatric sequelae in COVID-19 survivors: A narrative review

“…The pandemic itself is a significant psychological stressor in addition to its enormous impact on social and economic sectors worldwide. Isolation and small social networks during quarantine period limit access to external supports[ 17 ].…”

Cross-National Variations in COVID-19 Mortality: The Role of Diet, Obesity and Depression

“…Considering the higher risk of adverse outcomes in patients with these disorders, they should be encouraged to receive immunization and assisted in accessing it; however, a note of caution is justified given the concerns for reduced host immune responses in these disorders [97,98]. More detailed discussions of some of these strategies are available in published reviews [99,100].…”

Commentary on the special issue on disproportionate exposure to trauma: Trauma, stress, and adversities and health disparities among disenfranchised groups globally during the COVID pandemic

“…It is fair to say that COVID‐19 has magnified the prepandemic fault lines of race, ethnicity, gender, gender identity, and sexual orientation rather than becoming the global “equalizer” disease it was projected to be. Marginalized populations have experienced significant disadvantage with respect to COVID‐19 exposure, susceptibility, and treatment access, as well as in the psychosocial effects of the pandemic (Diaz et al., 2021; Ruprecht et al., 2021). Biomedical factors and social determinants of health are proposed to underpin these health disparities, which hold up even after factoring in sociodemographic and comorbidity confounds.…”

“…Discrimination stressors in sexual and gender minorities (i.e., lesbian, gay, bisexual, transgender, two‐spirit, queer, questioning, intersex, and asexual [LGBT2SQIA+] individuals) are similarly of concern. In these minorities, COVID‐19 has magnified prepandemic inequities, such as finances, access to employment, health care, stigma, and transphobic violence, adding to the preexisting mental health burden in this population (e.g., PTSD, anxiety, depression, suicidality) and to overall lower levels of well‐being (Buspavanich et al., 2021; Diaz et al., 2021; Gibb et al., 2020; Krause, 2021; Salerno et al., 2020). Corroborating this, the authors of a study in an LGBT+ community in Hong Kong found that sexual minority–specific COVID‐19‐related stressors explained significantly more of the variance in depressive and anxiety symptoms above and beyond other COVID‐19‐related stressors (Suen et al., 2021).…”