ABSTRACT
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.
ABSTRACT
Introduction: From the very beginning, COVID-19 pandemic had a great impact not only on physical, but also on mental health, both in general population and psychiatric patients. Self-isolation, fear of virus exposure and of death, unemployment and poor social network have increased psychological distress and Post-Traumatic Stress Disorder (PTSD) symptoms [1]. Nevertheless, little is known about the difference between subjects affected by mental disorders and healthy individuals in perceiving the pandemic as a traumatic event [2]. Aim: Comparing psychiatric patients and healthy controls (HC) in terms of change over time of post-traumatic symptoms. Methods: Data about demographic and clinical variables were retrospectively collected. Impact of Event Scale Revised (IES-R) scores were registered referring at two time points: T1, during the so-called ‘Phase I’ in March-April 2020 (lockdown period) and T2, during the so-called ‘Phase II’ in May-June 2020 (restarting). Descriptive analyses and linear regression models were performed. Summary of results: A total of 166 outpatients were recruited: 66 patients (39.8%) were affected by Schizophrenia (SKZ), 29 patients (17.5%) by Bipolar Disorder (BD), 36 patients (21.7%) by Major Depressive Disorder (MDD), 17 patients (10.2%) by Anxiety or Obsessive-Compulsive Disorder (OCD), and 18 (10.8%) by Personality Disorders (PDs). HC sample included 57 individuals from general population. The tests of fixed effects showed that time (F=65.44;p<0.001) and diagnosis (F=2.84;p=0.02) each had a significant effect on the change of IES-R scores. In particular, IES-R scores at T1 were overall higher than T2 scores (p<0.001), except for OCD patients. Moreover, patients presented lower IES-R scores than HC (p=0.02), independently from diagnosis. When HC have been compared with the different diagnostic groups, SKZ patients resulted to have significantly lower IES-R scores than HC (p=0.004). Differently, only PD patients showed higher IES-R scores than HC, but the result did not reach the statistical significance (p=0.44). Conclusions: In general, both patients and HC presented a significant decrease of IES-R scores between T1 and T2, when the pandemic showed a decline and preventive restrictions have been removed;only OCD patients have shown a different trend, which can be explained by a global worsening of obsession and compulsion, associated with the urge of control against risks of contamination [3]. Comparing patients and HC, higher scores on IES-R scale have been observed in HC: this trend is particularly meaningful in SKZ subgroup, and it may be explained considering the limited awareness about the risk of infection, associated with less fear or striking emotion related to pandemic [4]. PD patients, in contrast, were found to be more affected by social restrictions than HC, probably because of a greater vulnerability to PTSD symptomatology and poorer coping skills [5], pointing out the need to implement telematic interventions, such as psychotherapy and group therapy. This is, to our knowledge, one of the few studies evaluating and comparing the psychological distress perceived by psychiatric patients (including all major diagnoses) and HC during the first wave of COVID-19 pandemic. Conflict of interest Disclosure statement: The study has been registered on ClinicalTrials.gov with the following ID number: NCT04694482
ABSTRACT
Introduction: SARS-CoV-2 infection causes a pulmonary disease (COVID-19) which spread worldwide in 2020, leading the World Health Organization (WHO) to declare a pandemic [1] and the Italian government firstly to declare a state of emergency, then to impose restrictive measures lasting about two months. COVID-19 pandemic generated fear, anxiety, depression and post-traumatic symptoms in the general population [2,3] as well as among subjects affected by mental disorders [4]. Little is known about which different psychopathological changes the pandemic caused among individuals affected by different psychiatric disorders. Aims: To investigate potential psychopathological changes over time during the first wave of COVID-19 pandemic comparing different psychiatric disorders. Methods: Data about demographic/clinical variables and psychopathological status were retrospectively collected. Specific psychometric scales were administered at three time points: T0 as outbreak of pandemic, T1 as lockdown period, T2 as reopening. Primary outcomes: Brief Psychiatry Rating Scale (BPRS), Clinical Global Impression (CGI), Hamilton Anxiety Rating Scale (HAM-A). Secondary outcomes: Disability Scale (DISS), Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HAM-D), Montgomery and Åsberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Descriptive analyses and linear regression models were performed. Summary of results: A total of 166 outpatients were included. Overall, psychometric scores showed a significant worsening at T1 with a mild improvement at T2 (p<0.05). Only psychotic and OC symptoms did not significantly improve at T2. Primary outcomes: time had a significant effect on the change of BPRS (F=26.56;p<0.001), CGI-severity (F=8.29;p<0.001), CGI-improvement (F=41.88;p<0.001) and HAM-A (F=33.63;p<0.001) scores. BPRS and CGI-S scores were higher among subjects affected by personality disorders (PDs) than in the depressed (MDD) and anxiety/obsessive-compulsive (OC) groups (p<0.05). PD patients also showed higher HAM-A scores than schizophrenia (SKZ) ones (p=0.02). Secondary outcomes: Time had a significant effect on the change of DISS-stress (F=40.80;p<0.001), DISS-support (F=9.26;p<0.001), HAM-D (F=9.50;p<0.001) and MADRS (F=9.40;p<0.001) scores. The time effect was not significant for DISS-disability (F=1.23;p=0.29), PANSS (F=1.37;p=0.26), YMRS (F=2.84;p=0.06) and Y-BOCS (F=0.55;p=0.59) scores. DISS-disability scores were higher in the PD group with respect to bipolar disorder (BD) (p=0.009), MDD (p<0.001) and anxiety/OCD (p=0.03) groups;SKZ and BD patients had lower DISS-stress scores than PD ones (both p values = 0.02). Conclusions: Patients affected by PDs showed to be particularly affected by the negative effects of outbreaks on mental health and perhaps they require specific clinical attention in case of traumatic events such as pandemics. Moreover, although SKZ patients reported lower anxiety levels than PD ones, the worsening of psychotic and OC symptoms should be strictly monitored by clinicians, as these aspects did not improve with the end of lockdown measures. Further studies on larger samples would allow an in-depth comparison of the psychopathological impact of pandemics between the different psychiatric diagnoses. The study has been registered on ClinicalTrials.gov with the following ID number: NCT04694482 No conflict of interest