Mental health of patients with mental illness during the COVID-19 pandemic lockdown: A questionnaire-based survey weighted for attrition

ABSTRACT Importance Individuals with pre-existing mental illness may be particularly vulnerable to the negative impact that the coronavirus disease 2019 (COVID-19) pandemic seems to have on mental health. Most prior studies on this topic are limited by non-random sampling, lacking information on non-respondents, and self-reporting of mental illness. In the present study, we aimed to overcome these limitations via random sampling, acquisition of clinical and sociodemographic data on both respondents and non-respondents, and weighting of results informed by attrition. Objective To assess whether patients with mental illness experienced deterioration in mental health during the nationwide COVID-19 lockdown of Denmark in the Spring of 2020. Design A cross-sectional, questionnaire-based survey coupled with sociodemographic and clinical data from the medical records of all invitees. The latter enabled analysis of attrition and weighting of results. Setting The psychiatric services of the Central Denmark Region. Participants A total of 992 randomly drawn patients diagnosed with mental illness in the psychiatric services of the Central Denmark Region prior to the lockdown responded to the online survey (response rate of 21.6%). Exposure The four-week nationwide lockdown during the COVID-19 pandemic (from March 11 to April 15, 2020). Main Outcomes and Measures The online questionnaire included the 18-item Brief Symptom Inventory (BSI-18), the five-item World Health Organization Well-Being Index (WHO-5), and 14 questions evaluating worsening or improvement in symptoms during the lockdown using the pre-pandemic period as reference. Perceived reasons for deterioration of mental health were also reported. Results The weighted mean WHO-5 and BSI-18 scores were 38 and 28, respectively. A total of 52% of the respondents reported that their mental health had deteriorated during the lockdown, while 33% reported no change, and 16% reported improvement. The most commonly reported reasons for deterioration were loneliness, disruption of routines, concerns about coronavirus, less frequent contact with family/friends, boredom, and reduced access to psychiatric care. Conclusion and Relevance More than half of the patients with mental illness reported worsening of their mental health during the pandemic lockdown. There should be increased emphasis on ensuring both social and clinical support for individuals with mental illness during pandemics. KEY POINTS Questions Did patients with mental illness experience worsening of their mental health during the nationwide COVID-19 lockdown of Denmark in the Spring of 2020? Findings Of the 925 respondents, 52% reported that their mental health had deteriorated during the lockdown, while 33% reported no change and 16% reported improvement. The most commonly reported reasons for deterioration were loneliness and disruption of routines. Meaning These findings suggest that there should be increased emphasis on ensuring both social and clinical support for individuals with mental illness during the ongoing and potential future pandemics.