Medium-term and peri-lockdown course of psychosocial burden during the ongoing COVID-19 pandemic: a longitudinal study on patients with pre-existing mental disorders

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.

Association of Different Restriction Levels With COVID-19-Related Distress and Mental Health in Somatic Inpatients: A Secondary Analysis of Swiss General Hospital Data

“…Similarly, studies in Greece and in the Netherlands observed high levels of distress but no symptoms of depression or anxiety, or changes in mental quality of life in patients with chronic disease and dialysis patients, respectively ( 14 , 41 ). Also in line with present findings is a German study investigating a cohort of patients with pre-existing mental disorders reporting an increase of psychosocial burden in patients in April/May 2020 before normalizing to pre-pandemic levels in November/December 2020 ( 42 ). At the same time, symptoms of mental disorders only changed minimally ( 42 ).…”

“…Also in line with present findings is a German study investigating a cohort of patients with pre-existing mental disorders reporting an increase of psychosocial burden in patients in April/May 2020 before normalizing to pre-pandemic levels in November/December 2020 ( 42 ). At the same time, symptoms of mental disorders only changed minimally ( 42 ).…”

Changes in Prevalence and Severity of Domestic Violence During the COVID-19 Pandemic: A Systematic Review

“…Nonetheless, studies identified for this review highlight a need for data pertaining to prevalence and severity of different types of DV from multiple timepoints prior to the COVID-19 outbreak and over the course of the pandemic with multiple measurements during the pandemic. Repeated assessments over the course of the pandemic are further warranted given different pandemic phases and waves, which in turn may be characterized by differential stressors ( 71 , 72 ). For instance, the COVID-19 outbreak and immediate governmental measures represented an entirely new and unknown situation for most of the global population, characterized by uncertainty and an immediate increase in stress related to employment and finances for many.…”

“…Although this initial uncertainty may by now have decreased, long-term adjustment to the pandemic and the ever-changing implications for day-to-day life may vary considerably among individuals given their specific experiences and living conditions. Thus, repeated assessments of DV over the course of the pandemic may offer the opportunity to distinguish between the pandemic's initial stress, potentially resulting in emotional turmoil, in turn increasing the risk for interpersonal aggression, vs. long-term stress, potentially resulting in emotional depletion/depression in turn also increasing the risk for interpersonal aggression ( 71 , 72 ).…”

Mental health during the COVID-19 pandemic, impact of childhood trauma in psychiatric disorders, and predictable biomarkers for bipolar disorder

“…Patients with major mental disorders are recognized as a risk for adverse outcomes. Using the Goettingen psychosocial Burden and Symptoms Inventory (Goe-BSI), Bartels and colleagues evaluated psychosocial burden, psychiatric symptoms, and resilience at the end of the first (April/May 2020) and the second lockdown in Germany (November/December 2020) [ 1 ]. Psychosocial burden varied significantly overtime with an increase from the pre-pandemic to the initial phase, followed by a steady decrease across both lockdowns, normalizing in November/December 2020.…”