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Abstract
Background
Individuals with pre-existing mental illness may be particularly vulnerable to the negative impact that the coronavirus disease 2019 (COVID-19) pandemic seems to have on mental health. Accordingly, the objective of the present study was to assess whether patients with mental illness experienced deterioration in mental health during the COVID-19 lockdown of Denmark in the Spring of 2020.
Methods
We conducted a cross-sectional, questionnaire-based survey coupled with sociodemographic and clinical data from the medical records of all invitees. The latter enabled analysis of attrition and weighting of results. The online questionnaire included the 18-item Brief Symptom Inventory (BSI-18), the five-item World Health Organization Well-Being Index (WHO-5), and 14 questions evaluating worsening or improvement in symptoms during lockdown using the pre-pandemic period as reference.
Results
A total of 992 randomly drawn patients with mental illness from the psychiatric services of the Central Denmark Region responded to the questionnaire (response rate = 21.6%). The weighted mean WHO-5 and BSI-18 scores were 38 and 28, respectively. A total of 52% of the respondents reported that their mental health had deteriorated during the lockdown, while 33% reported no change, and 16% reported improvement. The most commonly reported reasons for deterioration were loneliness, disruption of routines, concerns regarding the coronavirus, less contact with family/friends, boredom, and reduced access to psychiatric care.
Conclusion
More than half of the patients reported worsening of their mental health during the pandemic lockdown. There should be an increased emphasis on ensuring both social and clinical support for individuals with mental illness during pandemics.
Supplementary data from electronic health records
Sociodemographic (age, sex, civil status, and municipality of residence) and clinical data (most recent main diagnosis [according to the ICD-10], duration of potential admissions, and a number of outpatient contacts for the 5 years prior to 25th June 2020) were extracted from the electronic medical records of all invitees. In defining diagnostic subgroups, the following ICD-10 code hierarchy was employed based on the patients’ most recent main diagnosis: F2x (psychotic disorders) > F3x (mood disorders) > F4x (anxiety- and stress-related disorders) > F5x (eating, sleeping, and other behavioral syndromes associated with physiological disturbances) > F6x (personality disorders) > F8x (developmental disorders including autism) > F9x (child and adolescent mental disorders) > F1x (substance abuse disorders).
Acknowledgments
The authors thank Mia Buhl Povlsen and Gitte Kobberøe for practical assistance with the distribution of the questionnaires. Bettina Nørremark is thanked for the extraction of data from the medical records. Anders Helles Carlsen is thanked for the review of the statistical code.
Disclosure statement
SDØ has received the 2020 Lundbeck Foundation Young Investigator Prize. The remaining authors report no conflicts of interest.
Additional information
Funding
Notes on contributors
Pernille Kølbæk
Pernille Kølbæk, MD (2017), PhD (2020), is currently a Postdoctoral Researcher at Aarhus University Hospital – Psychiatry, Denmark.
Oskar Hougaard Jefsen
Oskar Hougaard Jefsen, MD (2021) is currently a PhD student at Aarhus University Hospital – Psychiatry, Denmark.
Maria Speed
Maria Speed, Cand.Scient, PhD (2018) is currently a Statistician at Aarhus University Hospital – Psychiatry, Denmark.
Søren Dinesen Østergaard
Søren Dinesen Østergaard, MD (2009), PhD (2014), is currently a Professor of Psychiatry at Aarhus University Hospital – Psychiatry, Denmark.