The mental health impact of the COVID-19 pandemic on people with and without depressive, anxiety, or obsessive-compulsive disorders: a longitudinal study of three Dutch case-control cohorts

Abstract

Background: The impact of the COVID-19 pandemic on mental health in people with pre-existing mental health disorders is unclear. In three psychiatry case-control cohorts, we compared the perceived mental health impact and coping and changes in depressive symptoms, anxiety, worry, and loneliness before and during the COVID-19 pandemic between people with and without lifetime depressive, anxiety, or obsessive-compulsive disorders.

Methods: Between April 1 and May 13, 2020, online questionnaires were distributed among the Netherlands Study of Depression and Anxiety, Netherlands Study of Depression in Older Persons, and Netherlands Obsessive Compulsive Disorder Association cohorts, including people with (n=1181) and without (n=336) depressive, anxiety, or obsessive-compulsive disorders. The questionnaire contained questions on perceived mental health impact, fear of COVID-19, coping, and four validated scales assessing depressive symptoms, anxiety, worry, and loneliness used in previous waves during 2006-16. Number and chronicity of disorders were based on diagnoses in previous waves. Linear regression and mixed models were done.

Findings: The number and chronicity of disorders showed a positive graded dose-response relation, with greater perceived impact on mental health, fear, and poorer coping. Although people with depressive, anxiety, or obsessive-compulsive disorders scored higher on all four symptom scales than did individuals without these mental health disorders, both before and during the COVID-19 pandemic, they did not report a greater increase in symptoms during the pandemic. In fact, people without depressive, anxiety, or obsessive-compulsive disorders showed a greater increase in symptoms during the COVID-19 pandemic, whereas individuals with the greatest burden on their mental health tended to show a slight symptom decrease.

Interpretation: People with depressive, anxiety, or obsessive-compulsive disorders are experiencing a detrimental impact on their mental health from the COVID-19 pandemic, which requires close monitoring in clinical practice. Yet, the COVID-19 pandemic does not seem to have further increased symptom severity compared with their prepandemic levels.

Funding: Dutch Research Council.

Figure 1

COVID-19-specific dimensions in relation to severity and chronicity of depressive, anxiety, or obsessive-compulsive disorders Severity is the number of lifetime disorders. Chronicity is the percentage of previous waves with current disorders. The crude mean refers to the mean score in each dimension by mental health disorder status. To create the forest plot, each COVID-19-specific dimension score was standardised. The adjusted standardised score was derived from linear regression, adjusted for age, gender, education, living situation, and date of response.

Figure 2

Trajectories of symptom severity before and during the COVID-19 pandemic in relation to severity and chronicity of depressive, anxiety, or obsessive-compulsive disorders Severity is the number of lifetime disorders (A). Chronicity is the percentage of previous waves with current disorders (B). Baseline levels refer to average scores of QIDS, BAI, PSWQ, and DeJong Q in the preceding waves before the COVID-19 pandemic. Mixed models were adjusted for age, gender, education, living situation, and date of response. Data are mean; error bars show the SE. QIDS=16-item Quick Inventory of Depressive Symptoms. BAI=21-item Beck Anxiety Inventory. PSWQ=11-item Penn State Worry Questionnaire. DJGLS=6-item De Jong Gierveld Loneliness Scale.