Three-Month Follow-up Study of Mental Health Outcomes After a National COVID-19 Lockdown: Comparing Patients With Mood or Anxiety Disorders Living in an Area With a Higher Versus Lower Infection Incidence

Claudia Carmassi, MD, PhD; Liliana Dell’Osso, MD; Carlo Antonio Bertelloni, MD; Virginia Pedrinelli, MD; Valerio Dell’Oste, MD; Annalisa Cordone, MD; Mirella Ruggeri, MD, PhD; Simone Schimmenti, MD; Chiara Bonetto, PhD; Sarah Tosato, MD, PhD

J Clin Psychiatry 2022;83(2):21m14172

ABSTRACT

Objective: The COVID-19 pandemic and the related containment measures can represent a traumatic experience, particularly for populations living in high incidence areas and individuals with mental disorders. The aim of this study was to prospectively examine posttraumatic stress disorder (PTSD), anxiety, and depressive symptoms since the end of the first COVID-19 pandemic wave and Italy’s national lockdown in subjects with mood or anxiety disorders living in 2 regions with increasing pandemic incidence.

Methods: 102 subjects with a DSM-5 anxiety or mood disorder were enrolled from June to July 2020 and assessed at baseline (T0) and after 3 months (T1) with the Impact of Event Scale-Revised, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-Item, and Work and Social Adjustment Scale. At T1, subjects were also assessed by means of the Trauma and Loss Spectrum Self-Report for PTSD.

Results: At T0, subjects from the high COVID-19 incidence area showed higher levels of traumatic symptoms than those from the low COVID-19 incidence area (P < .001), with a decrease at T1 with respect to T0 (P = .001). Full or partial DSM-5 PTSD related to the COVID-19 pandemic emerged in 23 subjects (53.5%) from the high COVID-19 incidence area and in 9 (18.0%) from the low COVID-19 incidence area (P < .001).

Conclusions: Subjects with mood or anxiety disorders presented relevant rates of PTSD, depressive, and anxiety symptoms in the aftermath of the lockdown, and in most cases these persisted after 3 months. The level of exposure to the pandemic emerged as a major risk factor for PTSD development. Further long-term studies are needed to follow up the course of traumatic burden.

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References (63)

Epidemia COVID-19. Aggiornamento nazionale. Istituto Superiore Sanità. Updated May 14, 2020. https://www.epicentro.iss.it/coronavirus/bollettino/Bollettino-sorveglianza-integrata-COVID-19_12-maggio-2021.pdf
Fiorillo A, Sampogna G, Giallonardo V, et al. Effects of the lockdown on the mental health of the general population during the COVID-19 pandemic in Italy: results from the COMET collaborative network. Eur Psychiatry. 2020;63(1):e87. PubMed CrossRef
Qiu J, Shen B, Zhao M, et al. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen Psychiatr. 2020;33(2):e100213. PubMed CrossRef
Giallonardo V, Sampogna G, Del Vecchio V, et al. The impact of quarantine and physical distancing following COVID-19 on mental health: study protocol of a multicentric Italian population trial. Front Psychiatry. 2020;11:533. PubMed CrossRef
Di Giuseppe M, Zilcha-Mano S, Prout TA, et al. Psychological impact of coronavirus disease 2019 among Italians during the first week of lockdown. Front Psychiatry. 2020;11:576597. PubMed CrossRef
Luo M, Guo L, Yu M, et al. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public: a systematic review and meta-analysis. Psychiatry Res. 2020;291:113190. PubMed CrossRef
Ridout KK, Alavi M, Ridout SJ, et al. Changes in diagnostic and demographic characteristics of patients seeking mental health care during the early COVID-19 pandemic in a large, community-based health care system. J Clin Psychiatry. 2021;82(2):20m13685. PubMed CrossRef
Sáiz PA, de la Fuente-Tomas L, García-Alvarez L, et al. Prevalence of passive suicidal ideation in the early stage of the coronavirus disease 2019 (COVID-19) pandemic and lockdown in a large Spanish sample. J Clin Psychiatry. 2020;81(6):20l13421. PubMed CrossRef
Kachadourian LK, Feder A, Murrough JW, et al. Transdiagnostic psychiatric symptoms, burnout, and functioning in frontline health care workers responding to the COVID-19 pandemic: a symptomics analysis. J Clin Psychiatry. 2021;82(3):20m13766. PubMed CrossRef
Carmassi C, Foghi C, Dell’Oste V, et al. PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: what can we expect after the COVID-19 pandemic. Psychiatry Res. 2020;292:113312. PubMed CrossRef
Carmassi C, Cerveri G, Bertelloni CA, et al. Mental health of frontline help-seeking healthcare workers during the COVID-19 outbreak in the first affected hospital in Lombardy, Italy. Psychiatry Res. 2021;298:113763. PubMed CrossRef
Wu C, Hu X, Song J, et al. Mental health status and related influencing factors of COVID-19 survivors in Wuhan, China. Clin Transl Med. 2020;10(2):e52. PubMed CrossRef
Pfefferbaum B, North CS. Mental health and the Covid-19 pandemic. N Engl J Med. 2020;383(6):510–512. PubMed CrossRef
Van Rheenen TE, Meyer D, Neill E, et al. Mental health status of individuals with a mood-disorder during the COVID-19 pandemic in Australia: initial results from the COLLATE project. J Affect Disord. 2020;275:69–77. PubMed CrossRef
Yocum AK, Zhai Y, McInnis MG, et al. Covid-19 pandemic and lockdown impacts: a description in a longitudinal study of bipolar disorder. J Affect Disord. 2021;282:1226–1233. PubMed CrossRef
Carmassi C, Bertelloni CA, Dell’Oste V, et al. Tele-psychiatry assessment of post-traumatic stress symptoms in 100 patients with bipolar disorder during the COVID-19 pandemic social-distancing measures in Italy. Front Psychiatry. 2020;11:580736. PubMed CrossRef
Hao F, Tan W, Jiang L, et al. Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? a case-control study with service and research implications for immunopsychiatry. Brain Behav Immun. 2020;87:100–106. PubMed CrossRef
Holman EA, Thompson RR, Garfin DR, et al. The unfolding COVID-19 pandemic: a probability-based, nationally representative study of mental health in the United States. Sci Adv. 2020;6(42):eabd5390. PubMed CrossRef
Skoda EM, Bäuerle A, Schweda A, et al. Severely increased generalized anxiety, but not COVID-19-related fear in individuals with mental illnesses: a population based cross-sectional study in Germany. Int J Soc Psychiatry. 2021;67(5):550–558 PubMed
Yao H, Chen JH, Xu YF. Patients with mental health disorders in the COVID-19 epidemic. Lancet Psychiatry. 2020;7(4):e21. PubMed CrossRef
Pinkham AE, Ackerman RA, Depp CA, et al. A longitudinal investigation of the effects of the COVID-19 pandemic on the mental health of individuals with pre-existing severe mental illnesses. Psychiatry Res. 2020;294:113493. PubMed CrossRef
Plunkett R, Costello S, McGovern M, et al. Impact of the COVID-19 pandemic on patients with pre-existing anxiety disorders attending secondary care. Ir J Psychol Med. 2021;38(2):123–131. PubMed CrossRef
Gobbi S, Płomecka MB, Ashraf Z, et al. Worsening of preexisting psychiatric conditions During the COVID-19 pandemic. Front Psychiatry. 2020;11:581426. PubMed CrossRef
Muruganandam P, Neelamegam S, Menon V, et al. COVID-19 and severe mental illness: impact on patients and its relation with their awareness about COVID-19. Psychiatry Res. 2020;291:113265. PubMed CrossRef
Di Nicola M, Dattoli L, Moccia L, et al. Serum 25-hydroxyvitamin D levels and psychological distress symptoms in patients with affective disorders during the COVID-19 pandemic. Psychoneuroendocrinology. 2020;122:104869. PubMed CrossRef
Asmundson GJG, Paluszek MM, Landry CA, et al. Do pre-existing anxiety-related and mood disorders differentially impact COVID-19 stress responses and coping? J Anxiety Disord. 2020;74:102271. PubMed CrossRef
Rajkumar RP. Bipolar disorder, COVID-19, and the risk of relapse. Bipolar Disord. 2020;22(6):640. PubMed CrossRef
Carta MG, Ouali U, Perra A, et al. Living with bipolar disorder in the time of Covid-19: biorhythms during the severe lockdown in Cagliari, Italy, and the moderate lockdown in Tunis, Tunisia. Front Psychiatry. 2021;12:634765. PubMed CrossRef
Wang Q, Xu R, Volkow ND. Increased risk of COVID-19 infection and mortality in people with mental disorders: analysis from electronic health records in the United States. World Psychiatry. 2021;20(1):124–130. PubMed CrossRef
Pan KY, Kok AAL, Eikelenboom M, et al. 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. Lancet Psychiatry. 2021;8(2):121–129. PubMed CrossRef
Rossell SL, Neill E, Phillipou A, et al. An overview of current mental health in the general population of Australia during the COVID-19 pandemic: results from the COLLATE project. Psychiatry Res. 2021;296:113660. PubMed CrossRef
Tundo A, Betro’ S, Necci R. What is the impact of COVID-19 pandemic on patients with pre-existing mood or anxiety disorder? an observational prospective study. Medicina (Kaunas). 2021;57(4):304. PubMed CrossRef
Tang W, Hu T, Hu B, et al. Prevalence and correlates of PTSD and depressive symptoms one month after the outbreak of the COVID-19 epidemic in a sample of home-quarantined Chinese university students. J Affect Disord. 2020;274:1–7. PubMed CrossRef
Sun L, Sun Z, Wu L, et al. Prevalence and risk factors for acute posttraumatic stress disorder during the COVID-19 outbreak. J Affect Disord. 2021;283:123–129. PubMed CrossRef
Impatto Dell’Epidemia COVID-19 Sulla Mortalità Totale Della Popolazione Residente Periodo Gennaio–Novembre 2020. Istituto Nazionale di Statistica. December 30, 2020. https://www.epicentro.iss.it/coronavirus/pdf/Rapp_Istat_Iss_gennaio-novembre-2020.pdf
Liu N, Zhang F, Wei C, et al. Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: gender differences matter. Psychiatry Res. 2020;287:112921. PubMed CrossRef
Dell’Osso L, Carmassi C, Massimetti G, et al. Age, gender and epicenter proximity effects on post-traumatic stress symptoms in L’Aquila 2009 earthquake survivors. J Affect Disord. 2013;146(2):174–180. PubMed CrossRef
Breslau N. Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. Can J Psychiatry. 2002;47(10):923–929. PubMed CrossRef
Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–627. PubMed CrossRef
DiGrande L, Perrin MA, Thorpe LE, et al. Posttraumatic stress symptoms, PTSD, and risk factors among lower Manhattan residents 2-3 years after the September 11, 2001 terrorist attacks. J Trauma Stress. 2008;21(3):264–273. PubMed CrossRef
Carmassi C, Akiskal HS, Bessonov D, et al. Gender differences in DSM-5 versus DSM-IV-TR PTSD prevalence and criteria comparison among 512 survivors to the L’Aquila earthquake. J Affect Disord. 2014;160:55–61. PubMed CrossRef
Karantonis JA, Rossell SL, Berk M, et al. The mental health and lifestyle impacts of COVID-19 on bipolar disorder. J Affect Disord. 2021;282:442–447. PubMed CrossRef
First MB, Williams JBW, Karg RS, et al. Structured Clinical Interview for DSM-5 Disorders-Clinician Version SCID-5-CV. American Psychiatric Association Publishing; 2016.
Craparo G, Faraci P, Rotondo G, et al. The Impact of Event Scale-Revised: psychometric properties of the Italian version in a sample of flood victims. Neuropsychiatr Dis Treat. 2013;9:1427–1432. PubMed CrossRef
Rizzo R, Piccinelli M, Mazzi MA, et al. The Personal Health Questionnaire: a new screening instrument for detection of ICD-10 depressive disorders in primary care. Psychol Med. 2000;30(4):831–840. PubMed CrossRef
Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097. PubMed CrossRef
Mundt JC, Marks IM, Shear MK, et al. The Work and Social Adjustment Scale: a simple measure of impairment in functioning. Br J Psychiatry. 2002;180(5):461–464. PubMed CrossRef
Dell’Osso L, Carmassi C, Rucci P, et al. A multidimensional spectrum approach to post-traumatic stress disorder: comparison between the Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS) and the Self-Report instrument (TALS-SR). Compr Psychiatry. 2009;50(5):485–490. PubMed CrossRef
Carmassi C, Gesi C, Corsi M, et al. Exploring PTSD in emergency operators of a major university hospital in Italy: a preliminary report on the role of gender, age, and education. Ann Gen Psychiatry. 2018;17(1):17. PubMed CrossRef
McLaughlin KA, Koenen KC, Friedman MJ, et al. Subthreshold posttraumatic stress disorder in the World Health Organization World Mental Health Surveys. Biol Psychiatry. 2015;77(4):375–384. PubMed CrossRef
Armenian HK, Morikawa M, Melkonian AK, et al. Loss as a determinant of PTSD in a cohort of adult survivors of the 1988 earthquake in Armenia: implications for policy. Acta Psychiatr Scand. 2000;102(1):58–64. PubMed CrossRef
Piotrkowski CS, Brannen SJ. Exposure, threat appraisal, and lost confidence as predictors of PTSD symptoms following September 11, 2001. Am J Orthopsychiatry. 2002;72(4):476–485. PubMed CrossRef
Lee TM, Chi I, Chung LW, et al. Ageing and psychological response during the post-SARS period. Aging Ment Health. 2006;10(3):303–311. PubMed CrossRef
Chan CL, Wang CW, Qu Z, et al. Posttraumatic stress disorder symptoms among adult survivors of the 2008 Sichuan earthquake in China. J Trauma Stress. 2011;24(3):295–302. PubMed CrossRef
Xu J, Zheng Y, Wang M, et al. Predictors of symptoms of posttraumatic stress in Chinese university students during the 2009 H1N1 influenza pandemic. Med Sci Monit. 2011;17(7):PH60–PH64. PubMed CrossRef
Lin CY, Peng YC, Wu YH, et al. The psychological effect of severe acute respiratory syndrome on emergency department staff. Emerg Med J. 2007;24(1):12–17. PubMed CrossRef
Forte G, Favieri F, Tambelli R, et al. COVID-19 pandemic in the Italian population: validation of a post-traumatic stress disorder questionnaire and prevalence of PTSD symptomatology. Int J Environ Res Public Health. 2020;17(11):4151. PubMed CrossRef
Somma A, Krueger RF, Markon KE, et al. A longitudinal study on clinically relevant self-reported depression, anxiety and acute stress features among Italian community-dwelling adults during the COVID-19 related lockdown: evidence of a predictive role for baseline dysfunctional personality dimensions. J Affect Disord. 2021;282:364–371. PubMed CrossRef
Vindegaard N, Benros ME. COVID-19 pandemic and mental health consequences: systematic review of the current evidence. Brain Behav Immun. 2020;89:531–542. PubMed CrossRef
Koenders M, Mesbah R, Spijker A, et al. Effects of the COVID-19 pandemic in a preexisting longitudinal study of patients with recently diagnosed bipolar disorder: indications for increases in manic symptoms. Brain Behav. 2021;11(11):e2326. PubMed CrossRef
Diaz A, Baweja R, Bonatakis JK, et al. Global health disparities in vulnerable populations of psychiatric patients during the COVID-19 pandemic. World J Psychiatry. 2021;11(4):94–108. PubMed CrossRef
Fagiolini A, Cuomo A, Frank E. COVID-19 diary from a psychiatry department in Italy. J Clin Psychiatry. 2020;81(3):20com13357. PubMed CrossRef
Zimmerman M, Terrill D, D’Avanzato C, et al. Telehealth treatment of patients in an intensive acute care psychiatric setting during the COVID-19 pandemic: comparative safety and effectiveness to in-person treatment. J Clin Psychiatry. 2021;82(2):20m13815. PubMed CrossRef