Impact of COVID-19 pandemic related stressors on patients with anxiety disorders: A cross-sectional study

Abstract

The COVID-19 pandemic and related containment measures are affecting mental health, especially among patients with pre-existing mental disorders. The aim of this study was to investigate the effect of the first wave and its aftermath of the pandemic in Germany (March-July) on psychopathology of patients diagnosed with panic disorder, social anxiety disorder and specific phobia who were on the waiting list or in current treatment at a German university-based outpatient clinic. From 108 patients contacted, forty-nine patients (45.37%) completed a retrospective survey on COVID-19 related stressors, depression, and changes in anxiety symptoms. Patients in the final sample (n = 47) reported a mild depression and significant increase in unspecific anxiety (d = .41), panic symptoms (d = .85) and specific phobia (d = .38), while social anxiety remained unaltered. Pandemic related stressors like job insecurities, familial stress and working in the health sector were significantly associated with more severe depression and increases in anxiety symptoms. High pre-pandemic symptom severity (anxiety/depression) was a risk factor, whereas meaningful work and being divorced/separated were protective factors (explained variance: 46.5% of changes in anxiety and 75.8% in depressive symptoms). In line with diathesis-stress models, patients show a positive association between stressors and symptom load. Health care systems are requested to address the needs of this vulnerable risk group by implementing timely and low-threshold interventions to prevent patients from further deterioration.

Fig 1. Changes in anxiety symptoms during and after the first wave of the pandemic.

Mean scores of changes in symptoms of panic disorder, social anxiety disorder and specific phobia. Significance levels indicate difference from a mean score of three, which would be no change. The solid line within the violin plots illustrates the median, and the dashed lines show the interquartile range. ***p < .001. **p < .01. *p < .05.

Fig 2. Severity of depression symptoms during and after the first wave of the pandemic.

The solid line within the violin plots illustrates the median, and the dashed lines show the interquartile range.

Fig 3. Questions concerning strength of stressors related to the pandemic.

Mean and standard deviation of all participants.

Fig 4. Questions about the relevance of stressors related to the pandemic.

Percentages of participants answering yes or partly.