Psychological symptoms during and after Austrian first lockdown in individuals with bipolar disorder? A follow-up control-group investigation

Abstract

Background The coronavirus disease (COVID-19) pandemic, a global health crisis, has resulted in widespread socioeconomic restrictions including lockdown, social distancing, and self-isolation. To date, little is known about the psychological impact of the COVID-19 pandemic and lockdown on patients with bipolar disorder as a particularly vulnerable group. Methods An online survey was conducted in Austria at two points of measurement (T1 April 2020 during the first lockdown vs. T2 May 2020 at post-lockdown). The sample comprises 20 patients with bipolar disorder (mean age = 49.4 ± 15.6 years) and 20 healthy controls (mean age = 32.7 ± 9.6 years). A 2 × 2 factorial design to compare two time points (T1 vs. T2) and two groups (patients vs. healthy controls) was used. Main outcome measures included the Brief Symptom Inventory-18 (BSI-18) and a (non-validated and non-standardized) assessment to determine COVID-19 fears and emotional distress due to social distancing. Multiple linear regression analyses were used to assess the longitudinal association of COVID-19 fears/emotional distress due to social distancing during lockdown (T1) and psychological symptoms after lockdown (T2). Results At T1, results demonstrated higher scores in BSI-18 subscales depression, anxiety and global severity index as well as emotional distress due to social distancing in bipolar patients compared to controls. There was a significant time x group interaction in the BSI-18 subscale somatization showing a decreasing trend in patients with BD compared to controls. No time effects in BSI-18 subscales or COVID-19 fears/emotional distress due to social distancing were observed. Regression analyses showed that COVID-19 fears during lockdown predicted somatization, only in patients. Conclusions There was a connection between the lockdown measures and somatization symptoms observed in patients. When the first steps of easing the social restrictions in May 2020 took place, somatization decreased only in the bipolar compared to the control group. Higher COVID-19 fears during lockdown predicted later symptoms at post-lockdown. Long-term impacts of the COVID-19 pandemic need further investigations to improve current therapeutic approaches and prevent fears and distress during lockdown in individuals with bipolar disorder in times of crisis.

Greater Emotional Distress Due to Social Distancing and Greater Symptom Severity during the COVID-19 Pandemic in Individuals with Bipolar Disorder: A Multicenter Study in Austria, Germany, and Denmark

“…However, our finding that individuals with BD were, in general, more emotionally distressed due to social distancing than HC is consistent with the current literature. Previous research was able to show that social distancing has a negative impact on psychological well-being in the general population [45,46], and specifically in individuals with BD, not least because of subsequent changes in routines, employment, and social support [28,29]. Specifically, social support is very important when it comes to avoiding recurrence of BD and striving for remission [47,48]; thus, it is obvious that withdrawal of social contacts leads to more emotional distress in BD [49].…”

“…Indeed, an Australian study found that BD was associated with higher psychological distress during the COVID-19 pandemic, even in comparison to other psychiatric diseases [27]. Specifically, social distancing seems to have a negative impact on mood in individuals with BD, not least because of the disruptions in daily routines and structure, loss of income, job insecurity, and social support [28,29]. Further, COVID-19-induced lockdowns and subsequent social distancing expose individuals with BD to a higher risk of depressive relapses through the dysregulation of biological rhythms [17] and higher somatization symptoms [28].…”

“…Specifically, social distancing seems to have a negative impact on mood in individuals with BD, not least because of the disruptions in daily routines and structure, loss of income, job insecurity, and social support [28,29]. Further, COVID-19-induced lockdowns and subsequent social distancing expose individuals with BD to a higher risk of depressive relapses through the dysregulation of biological rhythms [17] and higher somatization symptoms [28]. Moreover, fears regarding COVID-19 may vary depending on lockdown regulations and could be associated with worse sleep quality in BD [30].…”

Decrease in Social Zeitgebers Is Associated With Worsened Delayed Sleep-Wake Phase Disorder: Findings During the Pandemic in Japan

“…Comorbidity of DSWPD to mood disorders is common; moreover, it has been suggested that patients with mood disorders are vulnerable to the disruption of sleep-wake schedules ( 45 , 46 ). During the COVID-19 pandemic, symptoms of depression and anxiety in patients with major depressive disorder and bipolar disorder worsened ( 47 , 48 ). Particularly for bipolar disorder, CRSWD is considered to be closely related to its pathogenesis ( 49 ); lockdown may have led to the recurrence of depressive symptoms in patients with bipolar disorder through the dysregulation of sleep-wake rhythms ( 50 ).…”

Psychological and behavioral response on the COVID-19 pandemic in individuals with bipolar disorder: A multicenter study

“…Concerns about maintaining and improving treatment adherence in individuals with BD during the COVID-19 pandemic have already been raised by several researchers. ( Hernández-Gómez et al, 2021 , Yocum et al, 2021 ) Furthermore, it was found that the pandemic was associated with more psychological distress, ( Dalkner et al, 2021 , Di Nicola et al, 2020 ) more post-traumatic stress symptoms, ( Asmundson et al, 2020 ) and higher levels of fear and sleep problems ( Fellendorf et al, 2021 ) in BD compared to healthy controls (HC). In contrast to that, other studies have reported no differences in mood symptomatology between individuals with BD and HC, ( Karantonis et al, 2021 , Pinkham et al, 2020 ) necessitating continued research in this area of interest.…”