Impact of COVID-19 pandemic on major depressive disorder in acute psychiatric inpatients

Abstract

IntroductionThe spread of the coronavirus disease 2019 (COVID-19) pandemic and the subsequent restrictions significantly affected mental health, especially major depressive disorder (MDD) whose incidence increased by 27.6% in 2020, after the COVID-19 outbreak. Few studies focused on the impact of the pandemic on the clinical characteristics of outpatients with MDD and even fewer on inpatients admitted for a major depressive episode (MDE). We aimed to compare the characteristics of MDD of two groups of patients admitted for an MDE before and after the pandemic outbreak and to investigate which variables are significantly related to post-lockdown hospitalizations.MethodsThis retrospective study included 314 patients with MDD hospitalized from January 2018 to December 2021 for an MDE (DSM-5) before (n = 154) and after (n = 160) the Italian lockdown (9th of March 2020). We compared patients' sociodemographic and clinical characteristics. The characteristics significantly different between the two groups were included in a logistic regression to identify the factors more strictly associated with post-lockdown hospitalizations.ResultsDuring post-lockdown hospitalization, we found a higher rate of severe MDE (33 patients, 21.4%, in the pre-lockdown and 55 patients, 34.4%, in the post), MDE with psychotic features (3 patients, 2.0%, in the pre-lockdown and 11 patients, 6.9%, in the post-lockdown), and suicidal ideation (42, 27.3%, in the pre-lockdown and 67, 41.9%, in the post-lockdown), with a lower proportion of patients followed by psychiatric services before admission (106 patients, 68.8%, in the pre-lockdown and 90 patients, 56.3%, in the post-lockdown) and a higher percentage of them in treatment with psychotherapy (18 patients, 11.7% in the pre-lockdown and 32, 20.0%, in the post-lockdown) and more frequent increase of the antidepressant dosage (16 patients, 10.4% in the pre-lockdown and 32 patients, 20.0% in the post-lockdown) and adoption of augmentation strategies (13 patients, 8.4%, in the pre-lockdown and 26 patients, 16.3%, in the post-lockdown) to treat the MDE. In the regression model, post-lockdown hospitalizations were significantly associated with suicidal ideation (OR = 1.86; p = 0.016) and psychotic features (OR = 4.41; p = 0.029) at admission, the increase in the antidepressant daily dose (OR = 2.45; p = 0.009), and the employment of an augmentation therapy (OR = 2.25; p = 0.029).DiscussionThese results showed an association between the COVID-19 pandemic and the occurrence of MDE with more severe clinical features. This might be true also for future calamities, suggesting that in these emergency contexts, patients with MDD would require more attention, resources, and intense treatments with a specific focus on suicide prevention.

Impact of COVID-19 on the treatment of depressive patients in Germany–a gap in care for the mentally ill?

“…Nevertheless, in Italy, a country heavily affected by the pandemic, suicide attempts among psychiatric inpatients increased during 2020 pointing toward a worsening of psychiatric conditions ( 49 ). In line, Brasso et al ( 50 ) demonstrated that MDD patients admitted to hospital after the lockdown suffered from a higher rate of suicidal ideation and more psychotic features. Furthermore, a higher antidepressant dosage and more augmentation therapy strategies were applied in those patients.…”

“…Furthermore, a higher antidepressant dosage and more augmentation therapy strategies were applied in those patients. These findings highlight the impact the pandemic had on depressive symptom severity ( 50 ). Also, in Japan a decline in suicide rates during the first wave was reported for children as well as for adults ( 51 , 52 ), followed by a substantial increase in suicides by adults from July to October 2020 ( 52 ).…”

Neurocognitive Changes in Patients with Post-COVID Depression

“…The COVID-19 pandemic significantly contributed to an increase in the rate of depressive episodes within MDD [ 47 ]. In our study, the criteria for defining the PCD group corresponded to the clinical criteria for diagnosing a depressive episode within MDD according to ICD-10.…”

Effects of malnutrition on child neurodevelopment and mental health

“…Una mayor participación paterna [OR 1,5 (1,09, 2,07)] se asoció con mayor retraso frente a las normas internacionales. La maternidad adolescente [OR 4,09 (1,40,11,87)] disminuyó el desarrollo de los niños frente a sus pares. El compromiso de los adultos no parentales redujo las probabilidades de retraso para ambos resultados [OR (95 % IC = 0,76 (0,63, 0,91) y 0,27 (0,15, 0,48)] respectivamente.…”

“…Varias herramientas tecnológicas son utilizadas en la práctica clínica e independientemente de sus limitaciones, lo cual podría demostrar su eficacia para el control de la composición corporal. 24 Brasso C, Cisotto M, Del Favero E, Giordano B, Villari V, Rocca P. (2023) (40) China Original Comparar las características del trastorno depresivo mayor de dos grupos de pacientes ingresados antes y después del brote pandémico de COVID-19 e investigar las variables relacionadas con hospitalizaciones En 757 niños y adolescentes de 8 a 18 años de edad, hospitalizados con trastorno depresivo mayor, la evaluación antropométrica evidenció: bajo peso 8,2 %, sobrepeso 15,5 % y obesidad 10,4 %. Con respecto a ideas suicidas e intentos suicidas, la prevalencia de ideas suicidas en pacientes con bajo peso fue de 22,6 %, sobrepeso 20,5 % y obesidad 19,0 %, mientras que en intentos de suicidio en pacientes con bajo peso fue de 8,1 %, sobrepeso 12,0 % y obesidad 13,9 %, evidenciando que el IMC se correlacionó positivamente con la edad de la primera hospitalización, duración total de la enfermedad y número de hospitalizaciones por dicho trastorno.…”