Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Dec 19, 2021; 11(12): 1387-1406
Published online Dec 19, 2021. doi: 10.5498/wjp.v11.i12.1387
Psychological impact of the COVID-19 pandemic on individuals with serious mental disorders: A systematic review of the literature
Eva Fleischmann, Nina Dalkner, Frederike T Fellendorf, Eva Z Reininghaus
Eva Fleischmann, Nina Dalkner, Frederike T Fellendorf, Eva Z Reininghaus, Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz 8036, Austria
Author contributions: Fleischmann E and Dalkner N contributed equally; Fleischmann E collected the data and wrote the first draft of the paper; Dalkner N supervised the study procedure, edited the paper and gave important intellectual input; Fellendorf F and Reininghaus EZ edited the paper and gave important intellectual input.
Conflict-of-interest statement: The authors do not have any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nina Dalkner, MSc, PhD, Senior Scientist, Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, Graz 8036, Austria. nina.dalkner@medunigraz.at
Received: February 25, 2021
Peer-review started: February 25, 2021
First decision: May 13, 2021
Revised: May 27, 2021
Accepted: November 12, 2021
Article in press: November 12, 2021
Published online: December 19, 2021
Processing time: 292 Days and 13.6 Hours
ARTICLE HIGHLIGHTS
Research background

The coronavirus disease 2019 (COVID-19) is greatly influencing the mental state of individuals from all walks of life. Individuals with serious mental illness (SMI: bipolar disorder, major depressive disorder, and schizophrenia) are especially vulnerable to the reverberations of such a crisis, leading among other symptoms to an increase of depression and anxiety. The pandemic is an excellent opportunity to broaden the understanding of these disorders and improve methods of treatment.

Research motivation

Individuals with SMI having been researched in the course of several studies calls for a coherent analysis of all findings to gain an insight in the mind of these individuals, making their support more efficient. At the time of the search, no other review focusing on solely the clinical characteristics of individuals with SMI had been published in the searched databases.

Research objectives

This review aimed to assess the situation of individuals with SMI and their mental state during the COVID-19 crisis. The following questions were answered: (1) How are individuals with SMI affected by the pandemic in comparison to healthy controls (HC) and what are the main psychiatric symptoms they are displaying? (2) What are risk and protective factors that influence the severity of psychiatric symptoms and who is particularly vulnerable to these factors? And (3) How does symptomatology and frequency of illness episodes change during the course of the pandemic?

Research methods

We systematically searched MEDLINE and PubMed (day of the final search: January 9, 2021), including terms related to the impact of the COVID-19 pandemic on the mental health of individuals with bipolar disorder, major depressive disorder, and schizophrenia. Only studies providing original data were included.

Research results

The search yielded 36 studies. The impact of the COVID-19 pandemic generally affected the mental health of individuals with SMI in a negative way, with individuals with affective disorders being more impacted than those with schizophrenia. The most common symptoms were those of depression, anxiety, and stress. Mental health was mainly influenced by age, resilience, and socioeconomic circumstances, particularly the shortage of mental health services, lack of social support, and inadequate information about COVID-19.

Research conclusions

Mental health services, particularly telemental health services, should be reinforced to better support individuals with SMI and strengthen their resilience. Moreover, individuals with SMI should be supplied with information about the pandemic and the employment of protection measures.

Research perspectives

Future research requires follow-up studies to determine causality and long-term effects, greater sample sizes, and standardization.