Clinical evolution of patients with pre-existing panic disorder during the COVID- 19 pandemic: Two-year longitudinal follow-up in Morocco

Background: Several studies have been conducted on the impact of the COVID-19 pandemic on the general population, but few have examined the longitudinal evolution of psychopathology in patients with mental health disorders at different stages of the pandemic. This study sought to answer these questions by assessing the trajectory of mental health in patients with pre-existing panic disorder in a COVID-19 pandemic setting while evaluating socio-demographic and clinical factors associated with outcomes. Methods This was a longitudinal study of panic disorder patients followed during three waves of the COVID-19 pandemic. Change assessed in mental health status used five validated scales: the Beck Depression Inventory-II (BDI-II), the Beck Anxiety Inventory (BAI), the Impact of Event Scale-revised (IES-R), The Mini International Neuropsychiatric Interview (MINI) for suicidal risk and the Panic Disorder Severity Scale Self Report version (PDSS-SR). Predictors of mental health symptom progression were assessed using multivariate analysis. Results There was a significant wave-to-wave reduction in depressive symptoms, post-traumatic stress, panic disorder severity and suicidal risk. Concerning anxiety symptoms, patients felt better and better during successive waves of the pandemic, with a statistically significant decrease from the first to the second wave of the COVID-19 pandemic. The analytical strategy also enabled the identification of the various socio-demographic and clinical factors likely to be associated with higher panic disorder severity. Conclusion It is timely to raise a series of questions that this research attempts to answer, and to develop personalized strategies for future pandemics in order to minimize the risk of aggravation or relapse in patients with panic disorder in particular, who may be more sensitive to multiple aspects of the pandemic.