As the global population grappled with the immediate health risks posed by COVID-19 infection, it also faced the prospect of long-term consequences resulting from the virus.
The pandemic forced health systems to operate on the brink of collapse, compelling governments to implement stringent measures such as travel restrictions, school and workplace closures, social distancing, quarantine, isolation, and restrictions on public access.
These measures aimed to curb the virus’s spread and protect public health. However, they also had unforeseen consequences, particularly on mental health and the occurrence of new-onset psychiatric disorders.
Mental Health Impacts of the COVID-19 Pandemic
Numerous studies conducted during the pandemic have shed light on the profound impact on mental health. Online questionnaires and surveys have shown a marked deterioration in the mental well-being of the general population. Symptoms of depression, anxiety, insomnia, and acute stress became more prevalent.
Concurrently, studies noted a significant decline in psychiatric Emergency Department (pED) presentations, especially during the early stages of the pandemic. However, these presentations were characterized by more severe cases.
Several factors contributed to the decrease in pED visits, including the fear of contracting COVID-19 at the hospital, concerns about overwhelming the healthcare system, and government advisories to stay at home. This decline in psychiatric care could have further exacerbated existing somatic conditions, such as diabetes.
The Burden of Psychiatric Disorders
Mental disorders were already a leading cause of disability worldwide before the COVID-19 pandemic, accounting for 16% of disability-adjusted life-years over the past two decades. Given the pandemic’s potential to increase the prevalence of psychiatric disorders, it is imperative to investigate the emergence of new-onset psychiatric disorders. Such an increase carries long-lasting implications for individuals, the healthcare system, and the economy.
Focus on Post-COVID-19 Psychiatric Disorders
There is mounting evidence that individuals who have had COVID-19 infections are at risk of developing psychiatric disorders, such as depression, psychosis, and anxiety disorders, either as preexisting conditions or as new-onset diagnoses. These conditions may result from immune responses, such as cytokine storms, triggered by the infection or from direct viral infiltration of the central nervous system.
Investigating Indirect Effects on New-Onset Psychiatric Disorders
In this study, we shift our focus from the direct sequelae of COVID-19 infection to the indirect effects of the pandemic on the emergence of new-onset psychiatric disorders. The indirect effects may result from a range of factors, including the fear of COVID-19 infection, social isolation during lockdowns, disruption of daily routines, financial insecurity, and changes in the healthcare system’s structure, such as reduced access to outpatient psychiatric and psychotherapeutic care.
Limited Research on Indirect Effects
Studies on new-onset psychiatric disorders stemming from the pandemic’s indirect effects are still relatively scarce. Preliminary findings from Italy suggest a significant increase in participants meeting the criteria for at least one new-onset psychiatric disorder during the pandemic waves.
Similarly, a study in Germany found more treatment-naive patients presenting with neurotic, stress-related, and somatoform disorders, potentially indicating an increase in new-onset diagnoses. Meanwhile, an Israeli study reported a substantial rise in new-onset psychosis or mania in pED presentations during the first wave of the pandemic. A study from New York revealed an increase in new-onset psychiatric disorders among children and adolescents but not among adults.
Objective of the Current Study
To explore the indirect effect of the COVID-19 pandemic on new-onset psychiatric disorders, this study examines the number of new-onset psychiatric diagnoses in pED presentations during the second wave of the pandemic compared to the pre-pandemic period. The study particularly focuses on diagnostic subgroups and defines risk groups, including age, gender, homelessness, custody, and familial relationships, which may be particularly vulnerable.
The study analyzes patient records from a major psychiatric Emergency Department in Berlin, Germany, during the second wave of COVID-19. It seeks to validate the occurrence of new-onset psychiatric diagnoses, thereby shedding light on the uncharted territory of the pandemic’s indirect effects on mental health.
Incidence of New-Onset Psychiatric Diagnoses
In contrast to the initial phase of the COVID-19 pandemic when most studies reported a decrease in psychiatric presentations, this study shows an approximately consistent number of cases during the pandemic’s second wave. The observed consistency may be attributed to local variations in the pandemic’s impact and the extended observation period used in this study.
Substance Use Disorders
One of the most striking findings of this study is the significant increase in new-onset substance use disorders during the COVID-19 period, with a 192.5% rise. This is a departure from the initial phase of the pandemic, where the number of patients with substance use disorders decreased. A sub-analysis indicates that a substantial portion of new-onset substance use disorders during the COVID-19 period was related to acute alcohol intoxication, aligning with global trends of increased alcohol consumption during the pandemic. Factors contributing to this surge include the suspension of low-threshold addiction services and the shift from social drinking to solitary consumption due to pandemic restrictions. Additionally, drug supply shortages due to travel restrictions may have led individuals to seek substances from unfamiliar sources, thereby increasing the risk of exposure to contaminated substances.
The study reveals a 115.8% increase in depressive disorders during the COVID-19 period, and individuals with depression had approximately three times higher odds of experiencing a new-onset of the disorder. This increase aligns with global reports of a rise in depressive symptoms during the pandemic. Contributing factors include social isolation, job loss, and financial insecurity, all of which were exacerbated by the pandemic. The data also suggests that individuals with new depressive symptoms may have turned to the pED for care rather than seeking help from psychiatric practices or outpatient mental health services, which likely holds true for other diagnostic subgroups as well. It’s worth noting that depression has the highest lifetime prevalence among psychiatric diagnoses, making it particularly susceptible to the pandemic’s effects.
Schizophrenia Spectrum and Psychotic Disorders
The study shows a significant increase in new-onset schizophrenia spectrum and psychotic disorders during the COVID-19 period. This diagnostic subgroup was also a predictor for new-onset diagnoses during this period. This finding is consistent with previous studies that noted a rise in patients with psychotic disorders during the pandemic. Factors contributing to this increase include direct neuropsychiatric effects of SARS-CoV-2 infection and indirect effects related to the pandemic’s societal and psychological impact. The prevalence of delusional symptoms also increased during the pandemic, further supporting the association between psychosis and the pandemic.
The study finds that, while fewer patients with anxiety disorders presented to the pED in general, those with anxiety disorders showed a 63.6% increase in new-onset cases during the COVID-19 period. These findings are in line with other studies that reported an increase in anxiety symptoms in the general population. The reasons for this increase include general fear associated with the pandemic, including fear of COVID-19 infection, and heightened social fears due to social distancing measures. This study provides further evidence that the pandemic has had a profound impact on individuals’ mental health, particularly in relation to anxiety disorders.
A noteworthy observation in the study is the increase in the relative attendance of patients in police custody during the COVID-19 period. Significantly, a high proportion of patients with new-onset psychiatric disorders attended police custody. This data aligns with other studies reporting higher proportions of police referrals. “Attendance in police custody” also emerged as a predictor for new-onset diagnoses during the COVID-19 period, suggesting that many of these cases had high acuity. This could be related to individuals waiting until their condition became severe, partly due to fear of contracting COVID-19 in healthcare settings. Delayed help-seeking behaviors may have contributed to these outcomes.
New-Onset Diagnoses and 7-Day Incidence Rate
Surprisingly, there was no significant correlation between the number of new-onset psychiatric diagnoses and the 7-day incidence of COVID-19 cases in Berlin. This finding contradicts a study from Israel, which suggested a link between lockdown measures and an increase in new-onset psychosis and mania. It highlights the complexities of the pandemic’s effects, which can vary significantly between countries and populations. The extent of lockdown measures may also be an explanatory factor, with different regions implementing distinct measures.
A History of COVID-19 Infection
The study casts doubt on the idea that post-COVID-19 infection is a driving factor behind the increase in new-onset psychiatric diagnoses. Unlike what one might expect if this were the case, there was no sustained increase in new-onset cases over time as the virus continued to spread. Furthermore, the study reports an increase in new-onset psychiatric disorders in various diagnostic categories, not just those typically associated with COVID-19 infection. This suggests that the pandemic’s indirect effects, such as the socioeconomic and psychological impact, are more influential in driving the observed increase in new-onset psychiatric diagnoses.
The COVID-19 pandemic has disrupted the world in myriad ways, with significant implications for mental health. While much attention has been paid to the direct psychiatric consequences of the virus, the indirect effects of the pandemic, such as isolation, fear, and disruptions in healthcare access, may also be contributing to the emergence of new-onset psychiatric disorders.
The present study’s findings aim to illuminate this hidden crisis and provide valuable insights for policymakers, healthcare providers, and individuals dealing with the long-term repercussions of the pandemic.
Understanding and addressing new-onset psychiatric disorders is crucial for building resilient healthcare systems and supporting individuals who have been affected by this unprecedented global crisis.
reference link >https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1240703/full