Background
The negative mental health impact of the COVID-19 pandemic has been well documented.1 Published reports find that individuals with pre-existing medical or mental illnesses have higher rates of COVID-19 morbidity and mortality.2-3 In addition, history of medical or mental illness are risk factors for anxiety and distress during the pandemic.4 Evaluating the differential relationship between pre-existing health conditions and mental health outcomes during the pandemic may identify those at most risk and inform interventions.5
Objectives
To evaluate the relationship between pre-existing health conditions (medical, mental health, or both) and mental health outcomes (clinical and COVID-specific) during the COVID-19 pandemic. To compare changes in disability and distress between groups at two timepoints separated by six months.
Methods
This is a sub-analysis of an online, longitudinal study (NCT04339790) of the mental health impact of the COVID-19 pandemic launched in April 2020. A convenience sample of adults completed surveys upon enrollment and six months later: disability (WHODAS 2.0), distress (Kessler-5), and COVID-19 specific outcomes (Psychosocial Impact of COVID-19 Survey). Self-report clinical history data from participants enrolled during the pandemic lockdown period (April-May 2020) was used to form four groups: No Health Condition (Group 1, N=398), Medical Health Condition (Group 2, N=241), Mental Health Condition (Group 3, N=350), and Mental and Medical Health Condition (Group 4, N=328).
Results
The sample (N=1,317) included predominantly white (90.4%) female (81.4%) participants, mean age of 48.0 years. Age, sex, and income were controlled for in all analyses due to demographic differences between groups. Group 1 was used as the reference group. All comparisons of clinical outcomes resulted in significantly higher ratings of disability and distress. Odds ratios for group comparisons of clinical outcomes upon enrollment were: Group 2 – disability (1.7), distress (1.4); Group 3 – disability (4.7), distress (4.1); Group 4 – disability (7.2), distress (5.5). While all groups reported significantly increased worry about the impact of COVID-19 on their physical health compared to Group 1, only Group 3 and Group 4 reported increased worry about the impact of COVID-19 on their mental health. Six months later, all groups reported consistent levels of disability and distress, although Group 3 and Group 4 were particularly elevated. Slopes of change in distress did not differ between subgroups, although Group 4 increased significantly more in disability (B(SE)=0.77(0.39), p<0.05).
Discussion
We found associations between pre-existing medical, mental, and both conditions and negative clinical outcomes; a dose response relationship was observed. Patterns in COVID-19 specific responses between groups suggest differential responses to COVID-19 stressors based on premorbid illness status. Additionally, comparison of slopes of clinical outcomes among subgroups find persistent levels of disability and distress after 6 months, although these clinical symptoms remain particularly elevated in individuals with mental health conditions.
Conclusion
Individuals with pre-existing health conditions, particularly mental health conditions, are at increased risk for adverse mental health outcomes during the COVID-19 pandemic. Future analysis will control for pandemic-related variables, such as social support and loneliness, to examine which factors contribute to increased mental health symptoms in individuals with pre-existing health conditions.
References
-
1.
Czeisler M, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic - United States, June 24-30, 2020. MMWR Morbidity and mortality weekly report. 2020;69:1049-1057.
-
2.
Sanyaolu A, et al. Comorbidity and its Impact on Patients with COVID-19. SN Compr Clin Med. 2020;2:1069–1076.
-
3.
Vai B, et al. Mental disorders and risk of COVID-19-related mortality, hospitalization, and intensive care unit admission: a systematic review and meta-analysis. The Lancet Psychiatry. 2021;8(9):797-812.
-
4.
Xiong J, et al. Impact of COVID-19 pandemic on mental health in the general population: A systematic review. J Affect Disord, 2020;277:55–64.
-
5.
Egede J, et al. Relationship between physical and mental health comorbidities and COVID-19 positivity, hospitalization, and mortality. J Affect Disord. 2021;283:94-100