What are the mental health changes associated with the COVID-19 pandemic in people with medical conditions? An international survey.

Objectives: The COVID-19 pandemic has negatively impacted mental health worldwide but there is paucity of knowledge regarding the level of change in mental health in people with a medical condition (physical/psychiatric). The objectives of this study were (1) to compare the change in mental health in people with and without medical conditions, (2) to assess the change in various types of medical conditions, (3) to evaluate the association between change in mental health and number of comorbidities, and (4) to investigate the influence of receiving treatment and activity limitation imposed by the medical condition(s).

Design: Cross-sectional.

Setting: Online international survey.

Participant: English-speaking adults (age ≥18) were included in the study, with no exclusions based on sex/gender or location. 1276 participants (mean age 30.4, 77.7% female) were included.

Primary And Secondary Outcome Measures: Pre and during COVID-19 pandemic symptoms of anxiety (Generalized Anxiety Disorder-2) and depression (Patient Health Questionnaire-9) were assessed. The Self-Administered Comorbidity Questionnaire was used to collect data regarding medical conditions.Repeated-measures analysis of covariance (objectives 1, 2 and 4) and Pearson's correlation coefficient (objective 3).

Results: 50.1% of participants had a medical condition. During the COVID-19 pandemic, compared with people with no medical condition, people with both psychiatric and physical conditions experienced significantly higher symptoms of anxiety (12%, p=0.009) and depression (9.4%, p<0.001). Although not statistically significant, the increase in anxiety and depression occurred across seven major categories of conditions. An association was found between having a higher number of medical conditions with higher anxiety and depression symptoms (r=0.16 anxiety, r=0.14 depression, p<0.001). Receiving treatment and being functionally limited by the disease did not have a significant impact on the amount of change (p>0.05).

Conclusions: During the COVID-19 pandemic, people who had a combination of psychiatric and physical conditions experienced greater symptoms of anxiety and depression. Patients with chronic diseases may need extra support to address their mental health as a result of the pandemic.