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.

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

Fig. 1

Medium-term and peri-pandemic course of psychosocial burden in patients with pre-existing mental disorders. A Course of the total sample (N = 156); differentiated by B gender (binary), N = 133; C ICD-10 F-axes (F2 to F8), N = 132; D ADNM-20 cut-off value indicating a high risk for adjustment disorder, N = 149; E psychiatric comorbidities: one vs. multiple F-diagnoses, N = 156.* p < 0.05, ** p < 0.01, *** p < 0.001. Mean values with 95%-CIs (A, B, D, E) and Bonferroni-corrected pairwise comparisons (A, B, D, E). Psychosocial burden is presented as mean of ratings on the 10-point Likert scales for psychosocial stress, psychiatric symptomatology, and quality of life. Ratings comprised pre-pandemic estimates (early 2020, retrospective rating), ratings very early during the pandemic/first lockdown (mid-March 2020, retrospective rating), at the end of the first lockdown (April/May 2020), and for the current state during the second lockdown (November/December 2020)

Fig. 2

Medium-term and peri-pandemic course of symptom levels of adjustment disorder measured by the ADNM-20 in patients with pre-existing mental disorders, for T₁ (1st lockdown, April/May 2020) and T₂ (2nd lockdown, November/December 2020), A for the total sample (N = 152); differentiated by B gender (binary), N = 130; C ICD-10 F-axes (F2 to F8), N = 145; D psychiatric comorbidities: one vs. multiple F-diagnoses, N = 152. * 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)