Impulsivity as a Risk Factor for Addictive Disorder Severity during the COVID-19 Lockdown: Results from a Mixed Quantitative and Qualitative Study.

Interindividual differences in personality traits, especially impulsivity traits, are robust risk factors for addictive disorders. However, their impact on addictive disorders during the COVID-19 lockdown remains unknown. This study assessed patients being followed for addictive disorders before the lockdown. We aimed to determine whether impulsivity traits (i.e., negative- and positive urgency) were associated with addictive disorders severity during the lockdowns. We also explored the patients' subjective experiences, focusing on high versus low impulsivity. The quantitative study assessed 44 outpatients consulting for addictive disorders, for impulsivity, emotion regulation, anxiety/depression, and their addictive disorder characteristics, using self-administered questionnaires. In the qualitative study, six patients from the quantitative study were assessed using guided interviews. We observed that higher negative and positive urgencies were associated with addictive disorder severity. The subjective experiences of patients during the lockdowns differed according to their emotion-related impulsivity: high versus low. Low impulsive patients used online technologies more effectively to maintain follow-up, with more positive reappraisal. In contrast, highly impulsive patients reverted more frequently to self-medication with substances and/or behaviors, more social isolation, and found coping with negative emotions more challenging. Overall, the patient's ability to cope with stressful events, like the COVID-19 lockdown, depended on their emotion-related impulsivity.

Impact of a phone call with a medical student/general practitioner team on morbidity of chronic patients during the first French COVID-19 lockdown (COVIQuest): a cluster randomised trial.

OBJECTIVES: The first COVID-19 lockdown led to a significantly reduced access to healthcare, which may have increased decompensations in frail patients with chronic diseases, especially older patients living with a chronic cardiovascular disease (CVD) or a mental health disorder (MHD). The objective of COVIQuest was to evaluate whether a general practitioner (GP)-initiated phone call to patients with CVD and MHD during the COVID-19 lockdown could reduce the number of hospitalisation(s) over a 1-month period. DESIGN: This is a cluster randomised controlled trial. Clusters were GPs from eight French regions. PARTICIPANTS: Patients ≥70 years old with chronic CVD (COVIQuest_CV subtrial) or ≥18 years old with MHD (COVIQuest_MH subtrial). INTERVENTIONS: A standardised GP-initiated phone call aiming to evaluate patients' need for urgent healthcare, with a control group benefiting from usual care (ie, the contact with the GP was by the patient's initiative). MAIN OUTCOME MEASURES: Hospital admission within 1 month after the phone call. RESULTS: In the COVIQuest_CV subtrial, 131 GPs and 1834 patients were included in the intervention group and 136 GPs and 1510 patients were allocated to the control group. Overall, 65 (3.54%) patients were hospitalised in the intervention group vs 69 (4.57%) in the control group (OR 0.82, 95% CI 0.56 to 1.20; risk difference -0.77, 95% CI -2.28 to 0.74). In the COVIQuest_MH subtrial, 136 GPs and 832 patients were included in the intervention group and 131 GPs and 548 patients were allocated to the control group. Overall, 27 (3.25%) patients were hospitalised in the intervention group vs 12 (2.19%) in the control group (OR 1.52, 95% CI 0.82 to 2.81; risk difference 1.38, 95% CI 0.06 to 2.70). CONCLUSION: A GP-initiated phone call may have been associated with more hospitalisations within 1 month for patients with MHD, but results lack robustness and significance depending on the statistical approach used. TRIAL REGISTRATION NUMBER: NCT04359875.