Long-term effects of the COVID-19 pandemic on five mental and psychological disorders: in terms of the number of disease visits, drug consumption, and scale scores

Anxiety and depressive disorders are common psychiatric problems and occur across all age groups. During the COVID-19 pandemic, there has been a growing awareness of the emotional impact of the pandemic. Researchers in China have investigated the general population’s psychological and mental responses during the COVID-19 pandemic. And they found that more than half of respondents rated the psychological and mental impact of the COVID-19 pandemic as moderate or severe, 16.5% reported moderate to severe depressive symptoms, and about a third reported moderate to severe anxiety symptoms [19]. Another research team in China sampled and analyzed the online posts of about 18,000 Chinese social media users before and after the COVID-19 outbreak. The researchers found that negative emotions such as anxiety, depression, and anger increased, while positive emotions and life satisfaction decreased [20]. Besides, Japan also reported 15 similar data, and its economy took a huge hit [21]. Studies have also reported on the psychological and mental profile of patients with (or suspected) COVID-19 infection and found that they may experience strong emotional and behavioral responses, such as fear, boredom, loneliness, anxiety, insomnia, or anger, which may evolve depression, anxiety, post-traumatic stress, or paranoia, and may even lead to suicide [22, 23]. And these conditions were especially prevalent among patients who were quarantined because their psychological and mental distress tend to be higher [24]. Our study found an upward trend in both annual disease inital diagnosis and disease growth rates for anxiety and depressive disorders, with peaks in 2021. But in terms of the number of visits for anxiety, we found a downward trend in 2020, which may be related to the shock of the outbreak of the COVID-19.

COVID-19-related illnesses can cause insomnia in patients, which can alter the immune system and negatively impact health. Thus, this prompted us to focus on the relationship between the COVID-19 pandemic and sleep disorders. Exposure to stress, such as social limitations and changes in daily life, accompanied by various sleep disturbances, is known as the phenomenon of coronary insomnia. For healthy people in quarantine, lifestyle changes, fear of infection, and reduced ability to cope with stress contribute to insomnia [25]. Psychosocial and mental stress can also affect sleep patterns and lead to a worsening of individual sleep quality [26. A paper reported that the COVID-19 pandemic will affect circadian rhythms, leading to sleep-wake disturbances [27]. Among individuals who self-isolated during the COVID-19 pandemic, a research team found that isolated individuals generally had higher anxiety and stress levels and lower sleep quality [19]. In addition to implementing epidemiological and preventive measures, sleep hygiene should be promoted as a comprehensive response strategy to the COVID-19 pandemic. Combined with existing research, we concluded that the COVID-19 pandemic harms sleep. In this regard, we also conducted surveys and confirmed that sleep disorders growth rates, drug consumption, and scale scores all increased significantly after the outbreak.

The stressors associated with the COVID-19 pandemic is numerous, including fear of getting sick and dying, fear of infecting others, grief related to the loss of a loved one, social isolation from family and friends, and loss of jobs, business, and income [28]. People living in stressful environments for a long time are more likely susceptible to mental illness. Data from various sources suggested that the current impact of the COVID-19 pandemic can manifest itself as an increase in psychiatric symptoms, such as pandemic-related trauma and stressor-related disorder (TSRD) symptoms, as well as an increase in suicidal ideation and drug consumption [29, 30]. This study also studied the COVID-19 pandemic and stress disorder and found that the number of the inital diagnosis, the number of disease visits, and disease growth rates for stress disorders after the outbreak increased.

The COVID-19 pandemic has had a profound impact on the severity of symptoms in eating-excretion Disorders, with lack of exercise, reduced income, increased stress, and lack of in-person health care all appearing to have contributed to this development. The relationship between the COVID-19 pandemic and eating-excretion disorders is one of the current hotspots. Many studies have been conducted, but the results were inconsistent. A study has reported a sharp rise in hospital admissions for eating-excretion disorders across Europe during the CQVID-19 pandemic [12]. Other studies have also been reported elevated levels of abnormal disorders-related behaviors in patients with eating disorders, showing marked worsening of symptoms [31‐33]. However, there was also evidence that some people with eating disorders didn’t show significant worsening of symptoms due to lack of work and social stress during isolation [31]. Another study suggested that psychological and mental stress due to forced isolation affected the course of gastrointestinal symptoms in patients with functional gastrointestinal diseases, and the findings found that most of the patients’ upper gastrointestinal symptoms improved during the COVID-19 isolation period [13]. Consistent with this, the second wave of studies identified a protective effect of the COVID-19 pandemic on Eating-Excretion Disorders [34]. Therefore, whether the impact of the COVID-19 pandemic on eating-excretion disorders is good or bad prompted us to study it. We found no significant changes in the number of annual inital diagnoses and the number of growth rates of eating-excretion disorders over these 4 years. We also compared the number of the inital diagnosis for eating-excretion disorders between the two groups of the pre-epidemic group and the dur-epidemic group and found no significant difference.

Drug consumption and scale scores can reflect the speed of disease growth from different aspects, and they are more concise and objective. Therefore, we investigated drug consumption and scale scores for three common mental and psychological diseases: anxiety, depression, and sleep disorders. We found that after the COVID-19 outbreak, the consumption of anxiolytics, antidepressants, and sleeping pills, as well as the scores of HAMA, HAMD, and PSQI all increased, which once again illustrated the growth trend of related diseases. And the high correlation between drug consumption and the number of disease visits also validated the robustness of the data.

Previously, scholars reviewed research in the field of gender and mental health and found that women were disproportionately affected by common mental disorders and comorbid mental disorders [35]. A British study found that women are at a disadvantage in mental and psychological diseases, as women are more susceptible to them, and more likely to lead to crime [36]. Another study showed that the lifetime prevalence of mental and psychological diseases was higher in women and that age-sex patterns of mental and psychological diseases were observed in women before menopause [37]. In addition, the relationship between age and mental and psychological diseases has long been reported. The incidence of different mental and psychological diseases is inconsistent in different age groups. For anxiety, the incidence was higher in women than in men between adulthood and menopause, but there was no difference in the other two time periods [37]. moreover, there is a well-known age-sex difference in depression prevalence. Depression became more common in women than men after age 13 (but gender did not affect it before age 13) [37]. Sleep disorders are also linked to age, one study compared specific sleep disorders in 97 patients aged 61–81 years with specific sleep disorders in 264 middle-aged (41–60 years) and 202 young (20–40 years) patients. It was found that most young and middle-aged patients complained of excessive daytime sleepiness, and older adults complained of insomnia as frequently as excessive daytime sleepiness. One assessment showed that 93% of older patients had objective findings, but only 77% of younger patients had objective findings [38]. The prevalence of nearly all mental and psychological diseases increases with age, while the prevalence of post-traumatic stress disorder (PTSD) decreases with age [39]. The above four mental diseases are more common in middle-aged and elderly people, while eating-excretion disorders are more of a disease that young people suffer from. In summary, it was found that the incidence of these five types of mental and psychological diseases were strongly affected by gender and age, and these prevalence were not the same. Therefore, this study also investigated this, reporting the performance of mental and psychological diseases in different gender and age groups before and after the COVID-19 outbreak.

Strengths: First, the area where the research unit is located was the second most affected area in the country at the beginning of the COVID-19 outbreak, so it has the characteristics of high representativeness. Second, the research unit is the largest public medical institution in the region, so it has the characteristics of a wide range of radiation. Third, the sample size of this study is large, so the research results are more reliable. Finally, the data has a large time span, so it can illustrate the long-term impact of the COVID-19.

Limitation: This study is only a single-center study, so it cannot reflect the situation in the whole country or even the whole world. More research is still needed to focus on this.