Evolution of psychosocial burden and psychiatric symptoms in patients with psychiatric disorders during the Covid-19 pandemic

Abstract

The Covid-19 pandemic highly impacts mental health worldwide. Patients with psychiatric disorders are a vulnerable risk population for worsening of their condition and relapse of symptoms. This study investigates the pandemic-related course of psychosocial burden in patients with pre-existing mental disorders. With the newly developed Goettingen psychosocial Burden and Symptom Inventory (Goe-BSI) psychosocial burden has been traced retrospectively (1) before the pandemic (beginning of 2020), (2) at its beginning under maximum lockdown conditions (March 2020), and (3) for the current state after maximum lockdown conditions (April/May 2020). The Goe-BSI also integrates the Adjustment Disorder New Module (ADNM-20), assesses general psychiatric symptoms, and resilience. A total of 213 patients covering all major psychiatric disorders (ICD-10 F0-F9) were interviewed once in the time range from April, 24th until May 11th, 2020. Across all diagnoses patients exhibited a distinct pattern with an initial rise followed by a decline of psychosocial burden (p < 0.001, partial η² = 0.09; Bonferroni-corrected pairwise comparisons between all three time-points: p < 0.05 to 0.001). Female gender and high ADNM-20 scores were identified as risk factors for higher levels and an unfavorable course of psychosocial burden over time. Most psychiatric symptoms remained unchanged. Trajectories of psychosocial burden vary in parallel to local lockdown restrictions and seem to reflect an adaptive stress response. For female patients with pre-existing mental disorders and patients with high-stress responses, timely and specific treatment should be scheduled. With the continuation of the pandemic, monitoring of long-term effects is of major importance, especially when long incubation times for the development of mental health issues are considered.

Keywords: Adjustment disorder; Coronavirus; Mental health; Psychosocial stress; SARS-CoV-2.

Fig. 1

Course of psychosocial burden in patients with psychiatric disorders during different phases of the Covid-19 pandemic. a Course of the total sample (N = 210); differentiated by b gender (binary); c ICD-10 F-axes; d the ADNM-20 cut-off value indicating a high risk for adjustment disorder.* p < 0.05, ** p < 0.01, *** p < 0.001. Mean values with 95%-CIs (a, b, d) and Bonferroni corrected pairwise comparisons (a, b, d). Psychosocial burden is presented as mean of ratings on the 10-point Likert scales for psychosocial stress, psychiatric symptomatology, and quality of life. Ratings were performed retrospectively (before the pandemic: beginning of 2020; at the beginning of the pandemic: mid-March 2020), and for the current state (April/May 2020)

Fig. 2

Pandemic-related symptom levels of adjustment disorder measured by the ADNM-20 in patients with psychiatric disorders. Differentiated by a gender (binary), N = 183; b by ICD-10 F-axes (F2 to F8), N = 197. *p < 0.05, **p < 0.01, ***p < 0.001. Mean values with 95%-CIs and Bonferroni corrected pairwise comparisons for the ADNM-20 sum score (range: 20 to 80 points)