COVID-19-associated psychiatric disorders
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]
Synonyms and keywords: COVID-19-associated psychiatric disorders
Overview
Historical Perspective
- In November 2019, the new coronavirus (COVID-19) was detected in Wuhan in the Hubei state of China for the first time.[1]
- By April 2020, stay-at-home advisories, or shelter-in-place policies have been applied in 42 states of the United States affecting no less than 316 million people (close to 96% of the US population).[2]
- Based on multiple studies done in early 2020, the number of internet searches for mental health symptoms has been significantly increased. Furthermore, from the start of the pandemic, more people requested mental health services.[3]
Classification
The following are COVID-19-associated mental disorders that have been reported:[4][5][6][7]
- Depression
- Post-traumatic stress disorder
- Anxiety
- Somatization
- Mood swing
- Attention-deficit hyperactivity disorder (ADHD)
- Panic disorder
- Obsessive-compulsive disorder
- Psychosis
Pathophysiology
The pathophysiology of COVID-19-associated psychiatric disorders can be explained by the body's immunologic response to the virus or due to the psychological stressors such as isolation, loneliness, stigma, concerns about infecting others, and fear of death.
Immunologic Response To the Virus
- Respiratory viral diseases are associated with psychological disorders, which can be presented both acutely and chronically.[5]
- The coronavirus is a neurotropic virus and can cause mental disorder by affecting the central nervous system or via the immune system response.[7][5].[8]
- Some data supported the role of inflammatory biomarkers from an infection on development of depression's symptoms such as anhedonia.[9]
Psychological Stressors
- The unknown nature of the virus within the first months, the uncertainty of its transmission route, and the high rate of hospitalization and mortality led to serious concern and distress among individuals.[10]
- Disruption of the routine day-to-day life due to strict quarantine measures, closing of schools, and cancelling all social events was one of the important determinants.
Causes
Differentiating [disease name] from other Diseases
Epidemiology and Demographics
- Based on a large national study done in the United States, the prevalence of depression has more than doubled during the COVID-19 pandemic.[11]
- The prevalence of depression among adults older than 18 years old in the United States was estimated at 28.6%, only from April to May 2020. During this time, 8.4% of adults reported having suicidal ideation and 18.2% initiated or increased substance usage. Only three months later (September 2020) the rate of depression among American adults older than 18 years old raised to 33%, and the prevalence rate of suicidal ideation increased to 11.9% (Lee & Singh, 2021).[12]
Age
- Patients of all age groups may develop mental disorder due to the COVID-19, nevertheless, younger population were more vulnerable to develop psychiatric disorders during the COVID-19 pandemic.[1][13][11]
- Based on a systematic review, mental disorder due to COVID-19 pandemic was higher in the age group of 21-40 years.[10]
- Another study which was done on 1653 participants globally, suggested that the high rate of mental disorders among the younger population was related to poor sleep and loneliness of this population.[3]
Gender
- female are more commonly affected with COVID-19-related mental disorders than male.[14][1]
- Supported by a study in Canada, young females are among the populations with a high prevalence of mental disorders during the pandemic.[15]
Race
- Ethnic and racial minorities were related to a higher rate of mental health difficulties during the COVID-19 pandemic. Based on a large national study, Hispanics and African Americans had the highest rate of Depression in the United States, compared to other races.[11]
Risk Factors
Common risk factors relating to COVID-19-associated psychiatric disorders:[15][1][12][16][13][17][18][6][19]
- Economic status
- Economic inequalities have been known as a risk factor for mood disorders such as depression and the COVID-19 pandemic exacerbated the economic issues of many people in the United States.[20]
- Marital status
- Being single (unmarried, living with parents, widow, or divorcee) is one of the factors associated with a higher rate of mental illnesses such as depression during the pandemic.
- Level of education
- Female gender
- Certain occupations such as medical workers
- Social media exposure
- Based on a study in China, more than two hours of exposure to the COVID-19 news via social media was associated with a higher rate of depression.
- History of a chronic underlying medical illness[13]
- History of previous mental disorder[13][11]
- Sever pain during the COVID-19
- Poor sleep
- Having a relative with COVID-19
Natural History, Complications and Prognosis
- The clinical presentations are strongly related to the type of the COVID-19-associated mental disorder.
- As a result of the COVID-19 pandemic the following chain of emotional issues developed among individuals:[15]
- Guilt
- Stress
- Loneliness
- Stigma
- Helplessness
- Anger
- Despair
- Fear
- Behaviors such as substance usage has been increased during the COVID-19 pandemic in the United States.[12]
- If left untreated, complications such as suicide can occur.[12]
Diagnostic Criteria
- Diagosis can be made if a psychiatric disorder associated to the COVID-19; either in a COVID-19 patient, or in an individual who lived during the COVID-19 pandemic has been observed.
History and Symptoms
- Symptoms of COVID-19-associated psychiatric disorders may include the following:
Physical Examination
- Patients with COVID-19-associated psychiatric disorders usually appear normal.
Laboratory Findings
- There are no specific laboratory findings associated with COVID-19-associated psychiatric disorders.
Electrocardiogram
There are no ECG findings associated with COVID-19-associated psychiatric disorders.
X-ray
There are no x-ray findings associated with COVID-19-associated psychiatric disorders.
Echocardiography or Ultrasound
There are no echocardiography/ultrasound findings associated with COVID-19-associated psychiatric disorders.
CT scan
There are no CT scan findings associated with COVID-19-associated psychiatric disorders.
MRI
There are no MRI findings associated with COVID-19-associated psychiatric disorders.
Other Imaging Findings
There are no other imaging findings associated with COVID-19-associated psychiatric disorders.
Other Diagnostic Studies
There are no other diagnostic studies associated with COVID-19-associated psychiatric disorders.
References
- ↑ 1.0 1.1 1.2 1.3 Ustun G (2021). "Determining depression and related factors in a society affected by COVID-19 pandemic". Int J Soc Psychiatry. 67 (1): 54–63. doi:10.1177/0020764020938807. PMC 7331110 Check
|pmc=value (help). PMID 32605422 Check|pmid=value (help). - ↑ Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galea S (2020). "Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic". JAMA Netw Open. 3 (9): e2019686. doi:10.1001/jamanetworkopen.2020.19686. PMC 7489837 Check
|pmc=value (help). PMID 32876685 Check|pmid=value (help). - ↑ 3.0 3.1 Varma P, Junge M, Meaklim H, Jackson ML (2021). "Younger people are more vulnerable to stress, anxiety and depression during COVID-19 pandemic: A global cross-sectional survey". Prog Neuropsychopharmacol Biol Psychiatry. 109: 110236. doi:10.1016/j.pnpbp.2020.110236. PMC 7834119 Check
|pmc=value (help). PMID 33373680 Check|pmid=value (help). - ↑ Halaris AE, Belendiuk KT, Freedman DX (1975). "Antidepressant drugs affect dopamine uptake". Biochem Pharmacol. 24 (20): 1896–7. doi:10.1016/0006-2952(75)90412-8. PMID psychiatric disorders COVID-19-associated psychiatric disorders Check
|pmid=value (help). - ↑ 5.0 5.1 5.2 Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I; et al. (2020). "Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors". Brain Behav Immun. 89: 594–600. doi:10.1016/j.bbi.2020.07.037. PMC 7390748 Check
|pmc=value (help). PMID 32738287 Check|pmid=value (help). - ↑ 6.0 6.1 de Sousa Moreira JL, Barbosa SMB, Vieira JG, Chaves NCB, Felix EBG, Feitosa PWG; et al. (2021). "The psychiatric and neuropsychiatric repercussions associated with severe infections of COVID-19 and other coronaviruses". Prog Neuropsychopharmacol Biol Psychiatry. 106: 110159. doi:10.1016/j.pnpbp.2020.110159. PMC 7605739 Check
|pmc=value (help). PMID 33147504 Check|pmid=value (help). - ↑ 7.0 7.1 Steardo L, Steardo L, Verkhratsky A (2020). "Psychiatric face of COVID-19". Transl Psychiatry. 10 (1): 261. doi:10.1038/s41398-020-00949-5. PMC 7391235 Check
|pmc=value (help). PMID 32732883 Check|pmid=value (help). - ↑ Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L; et al. (2020). "Nervous system involvement after infection with COVID-19 and other coronaviruses". Brain Behav Immun. 87: 18–22. doi:10.1016/j.bbi.2020.03.031. PMC 7146689 Check
|pmc=value (help). PMID 32240762 Check|pmid=value (help). - ↑ Miller AH, Raison CL (2016). "The role of inflammation in depression: from evolutionary imperative to modern treatment target". Nat Rev Immunol. 16 (1): 22–34. doi:10.1038/nri.2015.5. PMC 5542678. PMID 26711676.
- ↑ 10.0 10.1 Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M; et al. (2020). "Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis". Global Health. 16 (1): 57. doi:10.1186/s12992-020-00589-w. PMC 7338126 Check
|pmc=value (help). PMID 32631403 Check|pmid=value (help). - ↑ 11.0 11.1 11.2 11.3 Khubchandani J, Sharma S, Webb FJ, Wiblishauser MJ, Bowman SL (2021). "Post-lockdown depression and anxiety in the USA during the COVID-19 pandemic". J Public Health (Oxf). 43 (2): 246–253. doi:10.1093/pubmed/fdaa250. PMC 7928742 Check
|pmc=value (help). PMID 33426559 Check|pmid=value (help). - ↑ 12.0 12.1 12.2 12.3 Lee H, Singh GK (2021). "Monthly trends in self-reported health status and depression by race/ethnicity and socioeconomic status during the COVID-19 Pandemic, United States, April 2020 - May 2021". Ann Epidemiol. 63: 52–62. doi:10.1016/j.annepidem.2021.07.014. PMC 8435379 Check
|pmc=value (help). PMID 34358622 Check|pmid=value (help). - ↑ 13.0 13.1 13.2 13.3 Hossain MM, Tasnim S, Sultana A, Faizah F, Mazumder H, Zou L; et al. (2020). "Epidemiology of mental health problems in COVID-19: a review". F1000Res. 9: 636. doi:10.12688/f1000research.24457.1. PMC 7549174 Check
|pmc=value (help). PMID 33093946 Check|pmid=value (help). - ↑ Moghanibashi-Mansourieh A (2020). "Assessing the anxiety level of Iranian general population during COVID-19 outbreak". Asian J Psychiatr. 51: 102076. doi:10.1016/j.ajp.2020.102076. PMC 7165107 Check
|pmc=value (help). PMID 32334409 Check|pmid=value (help). - ↑ 15.0 15.1 15.2 McQuaid RJ, Cox SML, Ogunlana A, Jaworska N (2021). "The burden of loneliness: Implications of the social determinants of health during COVID-19". Psychiatry Res. 296: 113648. doi:10.1016/j.psychres.2020.113648. PMID 33348199 Check
|pmid=value (help). - ↑ Firew T, Sano ED, Lee JW, Flores S, Lang K, Salman K; et al. (2020). "Protecting the front line: a cross-sectional survey analysis of the occupational factors contributing to healthcare workers' infection and psychological distress during the COVID-19 pandemic in the USA". BMJ Open. 10 (10): e042752. doi:10.1136/bmjopen-2020-042752. PMC 7580061 Check
|pmc=value (help). PMID 33087382 Check|pmid=value (help). - ↑ Kämpfen F, Kohler IV, Ciancio A, Bruine de Bruin W, Maurer J, Kohler HP (2020). "Predictors of mental health during the Covid-19 pandemic in the US: Role of economic concerns, health worries and social distancing". PLoS One. 15 (11): e0241895. doi:10.1371/journal.pone.0241895. PMC 7657497 Check
|pmc=value (help). PMID 33175894 Check|pmid=value (help). - ↑ Ni MY, Yang L, Leung CMC, Li N, Yao XI, Wang Y; et al. (2020). "Mental Health, Risk Factors, and Social Media Use During the COVID-19 Epidemic and Cordon Sanitaire Among the Community and Health Professionals in Wuhan, China: Cross-Sectional Survey". JMIR Ment Health. 7 (5): e19009. doi:10.2196/19009. PMC 7219721 Check
|pmc=value (help). PMID 32365044 Check|pmid=value (help). - ↑ Vindegaard N, Benros ME (2020). "COVID-19 pandemic and mental health consequences: Systematic review of the current evidence". Brain Behav Immun. 89: 531–542. doi:10.1016/j.bbi.2020.05.048. PMC 7260522 Check
|pmc=value (help). PMID 32485289 Check|pmid=value (help). - ↑ Kujawa A, Green H, Compas BE, Dickey L, Pegg S (2020). "Exposure to COVID-19 pandemic stress: Associations with depression and anxiety in emerging adults in the United States". Depress Anxiety. 37 (12): 1280–1288. doi:10.1002/da.23109. PMID 33169481 Check
|pmid=value (help).