Lockdown, COVID-19 incidence worsened outcomes in patients with mood, anxiety disorders

Patients with mood or anxiety disorders had significant rates of PTSD, depressive and anxiety symptoms that often persisted beyond 3 months following lockdown for the COVID-19 pandemic, according to study results.

Further, individuals in areas with high incidence of COVID-19 had increased risk for PTSD.

“The present naturalistic study, conducted at the end of Italy’s first national COVID-19 lockdown phase, examined, for the first time, the effect of COVID-19 outbreak intensity on the presence and magnitude of posttraumatic stress, anxiety and depression symptoms in a sample of subjects with mood or anxiety disorders who were treated in two outpatient clinics in areas with differing infection incidence,” Claudia Carmassi, MD, PhD, of the department of clinical and experimental medicine at the University of Pisa in Italy, and colleagues wrote. “Specifically, our aim was to investigate whether subjects living in a high incidence area presented higher levels of anxiety, depressive and traumatic symptoms, besides lower levels of functioning, than those living in a low incidence area.”

The subjects were assessed again at 3 months to determine change in symptoms and development of posttraumatic stress symptoms/disorder and related risk factors, they said.

Carmassi and colleagues included 102 individuals with a DSM-5 anxiety or mood disorder between June 2020 and July 2020 and examined them at baseline (T0) and after 3 months (T1) via the Impact of Event Scale-Revised, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-item, and Work and Social Adjustment Scale. They also used the Trauma and Loss Spectrum Self-Report for PTSD at T1.

Results showed higher levels of traumatic symptoms among patients from the high COVID-19 incidence area compared with those from the low COVID-19 incidence area (P < .001) at T0. They noted a decrease at T1 with respect to T0 (P = .001). Twenty-three patients (53.5%) from the high COVID-19 incidence area and nine (18%) from the low COVID-19 incidence area (P < .001) had full or partial DSM-5 PTSD linked to the COVID-19 pandemic.

“We found a robust effect of level of exposure to the pandemic as a major risk factor for PTSD development,” Carmassi and colleagues wrote. “This finding highlights the unmet needs for health care in the vulnerable psychiatric population, suggesting that clinicians should systematically assess PTSD symptoms in the aftermath of lockdowns and across the pandemic waves, particularly in the most affected areas. We believe that the increasing use of telehealth services in such periods will possibly reduce the hazard of person-to-person exposure and allow continuous follow-up of patients.”

However, they noted long-term studies are needed to assess the course of traumatic burden over time, and the effects of targeted health care strategies also extended to other psychiatric diagnoses.