Table 6.

The impact of COVID-19 on stress resilience and mental health in patients with a psychiatric disorder.

Study	Population	Time period/ wave	Study type and sample size	Objective(s)/Main outcomes	Inclusion criteria	Main findings/Summary
Adults with a psychiatric disorder
Lee, S. W. et al., S.W. 2020	South Korean adult patients with non-affective or affective disorders with psychotic features	Jan 1 - May 15 2020,	Cross-sectional, N = 164,540 individuals without a mental illness (mean age 46.2 years (±18.3) and N = 51,878 with a mental illness (mean age 61.6 years (±19.2)	The associations between mental illness and the likelihood of a positive COVID-19 test result and the clinical outcomes of COVID-19	Being older than 20 years, presence of a SARS-CoV-2 test during the study period	1391 (3.0%) people without a mental illness and 1383 (2.9%) of those with a mental illness tested positive for COVID-19. People with a previous diagnosis of a mental illness had the same risk for testing positive for COVID-19 as people with no history of mental illness in a nationwide cohort from South Korea.
Li, L. et al., L. 2020	US adults, hospitalized COVID-19 positive patients	Two waves; T1: February 15 - April 25 2020,, and T2: May 27 2020,	Cohort, N = 1685	The association between having any prior psychiatric diagnosis and COVID-19 related mortality of hospitalized patients with COVID-19	Being hospitalized for COVID-19	Patients with a prior psychiatric diagnosis while hospitalized for COVID-19 had a higher mortality rate compared those without a psychiatric disorder (hazard ratio, 1.5; 95% CI, 1.1–1.9; P = 0.003).
Wang, Q. et al., 2020	US adult patients	Up to July 2020	Case-control, N = 61,783,950	The impact of a recent (within past year) diagnosis of a mental disorder – including attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, depression and schizophrenia – on the risk for COVID-19 infection and related mortality and hospitalization rates	Having an electronic health record	Patients with a recent (within past year) diagnosis of a mental disorder had a significantly higher risk for COVID-19 infection as compared to patients without mental disorders, and also present a worse out- come as evidenced by higher rates of hospitalization and death.
Taquet, M. et al., M. 2021	US adult patients (anonymised data from electronic health records in 54 health-care organisations in the US)	January 20 - August 1 2020,	Cohort, N = 69.8 million (n = 62,354 with COVID-19, mean age 49.3 years (±19.7), 55.4% female)	Bidirectional associations between COVID-19 and psychiatric disorders	Having an electronic health record	Survivors of COVID-19 appear to be at increased risk of psychiatric sequelae, and a psychiatric diagnosis might be an independent risk factor for COVID-19.
Carpiniello et al., 2020	Italian Community Mental Health Centres (CMHC) and General Hospital Psychiatric Wards (GHPW)	April 1–11 2020	Cross-sectional, N = 71 (52.9%) of the 134 (MHDs) and N = 107 (32.6%) of the 318 GHPWs	The impact of the current emergency on the activities of the Italian Mental Health Departments	Being included in the list of Mental Health Departments, updated annually by the Italian Society of Psychiatry	The pandemic has led to a drastic reduction in levels of care, which may produce a severe impact on the mental health of the population.
Robles-Bello et al., 2020	Spanish adults in a sample affected by the COVID-19 pandemic	April 15–26 2020	Cross-sectional, N = 1345 (15.57% aged 18–28 years, 17.03% aged 29–39 years, 18.01% aged 40–49 years, 16.95% aged 50–59 years, 17.36% aged 60–69 years, 15.08% aged ≥70 years, 63.35% female)	The level of resilience of the general Spanish population exposed to a traumatic situation by the COVID-19 pandemic	Being 18 years or older, having a Spanish nationality, being a resident in Spain, having read the information sheet and accepted the informed consent, having completed the questionnaire.	The Spanish population exposed to confinement presented high levels of resilience, but no relevant post-traumatic growth took place. Having a higher academic level, being autonomous), along with self-efficacy) and to a lesser extent optimism predicted a resilient outcome.
Burrai et al., 2020	Italian adult patients in Residential Rehabilitation Communities and healthy controls	April - May 2020 (precise period unknown)	Cross-sectional, N = 77 psychiatric patients (mean age 46.61 years (±12.81), 33.8% female) and N = 100 healthy controls (mean age 46.40 (±11.52), 50% female)	The psychological and emotional impact of isolation on patients in these psychiatric communities, compared to healthy controls	Being 18 years or older and having a diagnosis of at least one psychotic disorder	Statistically significant differences were observed between psychiatric patients and controls on Anxiety, Stress, Worry, and Risk Perception variables.
Horn et al., 2020	French adult patients infected by COVID-19	March 17 - May 11, 2020	Cross-sectional, N = 180 (mean age 53.0 (±16.0))	The prevalence of PTSD in patients with laboratory-confirmed COVID-19	Having a laboratory-confirmed diagnosis of COVID-19, being 18 years or older and being willing to participate	Results showed that 6.5% of the patients presented with probable PTSD. Psychotropic medication, hospitalization, and distress during the acute phase of COVID-19 were significantly associated with the severity of the PTSD symptoms.
Rutherford et al., 2021	US adult patients affected by PTSD	April 1 - May 8 2020,	Cross-sectional, N = 76 (N = 46 with PTSD (mean age 62.5 years (±9.0)) and N = 30 trauma-exposed comparison subjects; TE (mean age 67.4 (±9.4))	PTSD symptoms, social isolation and loneliness among older adults with PTSD compared to TEs	Being 50 years or older, being currently diagnosed with PTSD, having a PTSD duration of at least 6 months, having a Post-traumatic Stress Disorder Checklist (PCL-5) score ≥33, having a score of ≥25 on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)	PTSD symptoms significantly declined among PTSD participants relative to TEs. Sources of resilience may exist based on experience with prior traumas as well as increasing age promoting more adaptive coping styles.
Pinkham, A. et al., 2020	US adult patients affected by severe mental illness	April 3, - June 4 2020,	Longitudinal, N = 148 (N = 92 with schizophrenia spectrum illnesses and N = 56 with affective disorders)	To compare the severity of pre-pandemic symptoms and affective experiences to current symptoms	Having a diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder (I or II) with or without psychotic features or major depression with psychotic features	There were no significant changes in mood experiences or psychotic symptoms over time, and sleep duration was also unaffected.
Ma et al., 2020	Chinese adult schizophrenic patients medically isolated from 10 January 2020 to 30 April 2020, due to having close contact with COVID-19 patients at Wuhan Mental Health Center (aged between 20 and 70 years old)	January 10 - April 30 2020,	Cross-sectional, N = 30 patients with schizophrenia were recruited from Wuhan Mental Health Center (isolation group) N = 30 patients matched with the isolation group recruited from another branch of Wuhan Mental Health Center as controls	To explore the impact of social isolation due to COVID on common inflammatory indicators and psychological characteristics	Having been in close contact with COVID-19 patients, not having a COVID-19 infection after isolation and screening, having been medically isolation for ≥ 14 days, being diagnosed with schizophrenia in accordance with the Diagnostic and Statistical Manual of Mental Diagnostic criteria (DSM-VI), being hospitalizatized for ≥2 years before isolation, being between 20 and 70 years old	Social isolation led to worse anxiety and sleep quality. No effect on inflammatory parameters.
Pan et al., 2021	Dutch adults with and without depressive, anxiety, or obsessive-compulsive disorders (three cohorts:1) the Netherlands Study of Depression and Anxiety (NESDA), 2) the Netherlands Study of Depression in Older Persons (NESDO), and 3) the Netherlands Obsessive Compulsive Disorder Association Study (NOCDA)	April 1 - May 13 2020,	Longitudinal, NESDA: N = 2329 individuals with a depression or anxiety disorder, N = n = 652 controls NESDO: N = 378 individuals with a depressive disorder, N = 132 controls NOCDA: N = 419 individuals with a lifetime diagnosis of obsessive-compulsive disorder	The impact of the COVID-19 pandemic on mental health in people with pre-existing mental health disorders	NESDA: being aged 18=65 years; NESDO: being 60 years or older; NOCDA: being 18 years or older	Although people with depressive, anxiety, or obsessive-compulsive disorders scored higher on all four symptom scales than did individuals without these mental health disorders, both before and during the COVID-19 pandemic, they did not report a greater increase in symptoms during the pandemic
Tanaka & Okamoto, 2021	Japanese general population	February - June 2020 (first wave of pandemic) and July - October 2020 (second wave of pandemic)	Cross-sectional, N = 126 million (data derived from suicide statistics published by the Ministry of Health, Labour, and Welfare)	Suicide mortality during the pandemic in the Japanese population	Unknown	The suicide rate declined substantially during the first wave of the COVID-19 pandemic (February to June 2020), but increased rapidly during the second outbreak (July to October 2020). The COVID-19 pandemic affected almost every community and citizen concurrently.
Nomura et al., 2021	Japanese general population	December 2010-September 2020 (precise period unknown, montly mortality data was obtained from the National Police Agency)	Cross-sectional, N: Unknown	Suicide mortality during the pandemic in the Japanese population	Unknown	For women, excess deaths of 110.00–160.75 (percent excess 22.08–32.26) were observed in July 2020, 96.00–163.56 (19.34–32.95) in August 2020, and 95.00–161.00 (19.83–33.61) in September 2020. No excess deaths from suicide were observed before 2020. For men, no excess deaths were found during the same period.
Sáiz et al., 2020	General Spanish population aged 18 and older	March 19 −26 2020	Cross-sectional, N = 21,207 (mean age 39.7 years (±14.0), 69.6% female)	The prevalence of passive suicidal ideation in a sample of the general Spanish population early in the COVID-19 pandemic and lockdown factors associated with suicidal thoughts	Being 18 years or older	Being of female sex, married or living as married, and working were protective factors against passive suicidal ideation while risk factors were very low income, having elderly dependents, and having a personal history of past/current mental disorder.
Iob, E. et al., 2020 (144)	UK general population (COVID-19 Social Study)	March 21- April 20 2020,	Cross-sectional, N = 44,775 (17.5% aged 18–29 years, 23.2% aged 30–44, 26.9% aged 45–49, 32.4% aged >60 years, 51.0% female)	Patterns of abuse, self-harm and thoughts of suicide/self-harm in the UK during the first month of the COVID-19 pandemic	Presence of data on abuse, self-harm and thoughts of suicide or self-harm on at least one occasion	The reported frequency of abuse, self-harm and thoughts of suicide/self-harm was higher among women, Black, Asian and minority ethnic (BAME) groups and people experiencing socioeconomic disadvantage, unemployment, disability, chronic physical illnesses, mental disorders and COVID-19 diagnosis.
Children and adolescents with a psychiatric disorder
Graell et al., 2020	Patients undergoing treatment in the outpatient clinic, day hospital, and the inpatient program of the Child and Adolescent Eating Disorders Unit (CAEDU) of the Hospital Infantil Universitario Niño Jesús in Madrid.	March 16 - May 10, 2020	Cross-sectional, N = 365 (1818 outpatient consultations; 73.10% remotely and 26.9% face‐to‐face)	The efficacy of a combined teletherapy program aimed at allowing continuity of care for children and adolescents with an eating disorder	Undergoing treatment in the Eating Disorders unit at the time of state-decreed confinement and during the 8-week lockdown period	Almost half of the children and adolescents studied experienced reactivation of eating disorder symptoms despite treatment, and severe patients (25%) presented self‐harm and suicide risk,
Nissen et al., 2020	Danish children and adolescents, newly diagnosed with OCD (clinical group) and Danish children and adolescents who were diagnosed years ago and completed their primary treatment (survey group)	April–May 2020 (precise period unknown)	Cross-sectional, N = 65 (first sample, clinical group, mean age 14.9 (±2.66)); N = 37 (second sample, survey group, mean age 14.14 years (±2.79))	The immediate effect of COVID-19 pandemic on children and adolescents with obsessive compulsive disorder (OCD)	Having been diagnosed with OCD	In both samples, but with an effect more pronounced in the survey group, participants experienced a worsening of their OCD, anxiety, and depressive symptoms
Tanir et al., 2020	Turkish children and adolescents who had been diagnosed with OCD	September 2019 to April 2020 (precise period unknown)	Cross-sectional, N = 61 (mean age 13.62 years (±2.72), 44.3% female)	The effects of COVID-19 pandemic and related confinement on symptom profile, symptom severity and exacerbation of obsessive-compulsive disorder (OCD)	Being diagnosed with OCD and having a Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) score from before the pandemic period	Young subjects with OCD developed additional symptoms and worsen already existing symptoms of OCD during COVID-19 pandemic. There was a significant relationship between the change in CY-BOCS scores with talking/searching in the social environment about COVID-19, daily preoccupation about COVID-19, duration of OCD diagnosis and diagnosis of COVID-19 in someone familiar.
Zhang, J. et al., 2020	Chinese children with ADHD diagnosis	Not specified	Cross-sectional, N = 241 (mean age 9.43 years (±2.39), 19.5% female)	Mental health related conditions of children with ADHD during the COVID-19 outbreak	Being diagnosed with ADHD	During the COVID-19 outbreak, children's ADHD symptoms worsened significantly compared to normal state. Data were reported by parents, and medication status was not known.
Colizzi et al., 2020	Italian children with ASD	April 6–20 2020	Cross-sectional, N = 527 (mean age 13.0 years (± 8.1))	The impact of the COVID-19 pandemic on Autism Spectrum Disorder (ASD) individuals	Being diagnosed with ASD by healthcare professionals affiliated with the Veneto Autism Spectrum Disorder Regional center at the Integrated University Hospital of Verona	The COVID-19 outbreak increased difficulties among autism spectrum disorder individuals.
Turkoglu et al., 2020	Turkish drug-naive children diagnosed with ASD	May 7–14 2020 (during the fifth week following commencement of home confinement)	Cross-sectional, N = 46 (mean age 7.89 years ()range 4–17 years), 17.39% female)	The relationship between chronotype preference/sleep problems and symptom severity of children with Autism Spectrum Disorder (ASD) during the confinement and social isolation of the COVID-19 outbreak	Being diagnosed with ASD and having been regularly monitored and received conventional assessment forms during the 2 months before the commencement of home confinement	ASD exhibited significantly greater sleep problems and chronotype score (eveningness) during the home confinement period compared to non-home confinement. Children with ASD forced into home confinement due to the COVID-19 pandemic showed also increased ASD symptoms.
Mutluer et al., 2020	Turkish individuals with ASD (aged 3–29 years old)	Not specified	Cross-sectional, N = 87 (mean age 13.96 years (±6.1), 17% female)	Response of individuals with ASD to COVID-19 in terms of comprehension and adherence to implemented measure and changes in their behavioural problems	Having been diagnosed with ASD according to DSM-5 criteria by child psychiatrists with over 10 years of experience in ASD	ASD-related behaviours, sleep quality, and hypersensitivity changed significantly from before the pandemic to during the pandemic. COVID-19 inflicted important challenges to individuals with ASD and their caregivers.