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COVID-19: The Hidden Impact on Mental Health and Drug Addiction

July 2020
Frontiers in Psychiatry 11(767):1-4

DOI:10.3389/fpsyt.2020.00767

Project: Implications of COVID-19

Authors:

Amira Guirguis

Swansea University

Stefania Chiappini

University of Hertfordshire

John Corkery

University of Hertfordshire

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COVID-19: The Hidden Impact on

Mental Health and Drug Addiction

Stefania Chiappini

*, Amira Guirguis

1,2

*, Ann John

, John Martin Corkery

and Fabrizio Schifano

Psychopharmacology, Drug Misuse & Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences,

University of Hertfordshire, Hatﬁeld, United Kingdom,

Swansea University Medical School, Swansea University, Swansea,

United Kingdom

Keywords: COVID-19, addiction, mental health, drug abuse, prescription drug misuse

INTRODUCTION

There is concern the Coronavirus Disease (COVID)-19 pandemic is having a negative impact on the

mental health of the general population through a range of suggested mechanisms: fear, uncertainty,

and anxiety; social distancing/isolation; loneliness; and economic repercussions (1–3). Previous

disasters such as the Severe Acute Respiratory Syndrome (SARS) in 2003 (4–6) contributed to

increased anxiety, mood, and thought disorders, adjustment disorders, and post-traumatic stress

disorders (PTSD) (1,7–15), resulting, in extreme cases, in suicidal behaviours (e.g., suicidal ideation,

suicide attempts, and actual suicide) (10,16), especially in cases of concomitant Substance Use

Disorder (SUD) (17,18). According to a recent study from the Well Being Trust (18) the high levels

of stress, isolation and unemployment due to the COVID-19 pandemic could cause up to 75,000

“deaths of despair”related to deaths to drug, alcohol, and suicide (18). High risk of mental illness

was previously identiﬁed in individuals with existing or history of mental illnesses (1,9,12,14,19),

but also vulnerable categories might be considered the elderly (>80 years old), children/adolescents,

individuals from deprived areas, peri-natal women and BAME (Black, Asian and minority

ethnicities) (1,12,14,19). Finally, healthcare workers have been experiencing emotional

overload due to several reasons, including both organizational issues relating to the shortage of

suitable personal protective equipment, reduction in human resources and relentless work shifts

(20–23), but also the burden developed by the fear of becoming infected and infecting relatives, high

mortality rates, grieving the loss of patients and colleagues, separation from families (22–24).

Speciﬁcally, according to Huang et al. (25), among the ﬁrst-line medical staff of a Tertiary Infectious

Disease Hospital for COVID-19 in China, the incidence of anxiety and post traumatic symptoms in

female medical staff was higher than that in male, and in nurses more represented than that in

doctors (25).

DISCUSSION

Often overlooked in this scenario are those with SUD (26,27), who may experience: (a) changes in

levels of drug use—an increase is often seen as a reactive behaviour to negative impact of disasters;

(b) a shift to other substances if access to those previously used become limited; (c) a relapse, if they

had already recovered from alcohol/drug addiction. Risks of severe COVID and intensiﬁed mental

Frontiers in Psychiatry | www.frontiersin.org July 2020 | Volume 11 | Article 7671

Edited by:

Fernando Barbosa,

University of Porto, Portugal

Reviewed by:

Domenico De Berardis,

Azienda Usl Teramo, Italy

Mercedes Lovrecic,

National Institute for Public Health,

Slovenia

*Correspondence:

Stefania Chiappini

stefaniachiappini9@gmail.com

Amira Guirguis

amira.guirguis@swansea.ac.uk

Specialty section:

This article was submitted to

Addictive Disorders,

a section of the journal

Frontiers in Psychiatry

Received: 13 June 2020

Accepted: 20 July 2020

Published: 29 July 2020

Citation:

Chiappini S, Guirguis A, John A,

Corkery JM and Schifano F (2020)

COVID-19: The Hidden Impact on

Mental Health and Drug Addiction.

Front. Psychiatry 11:767.

doi: 10.3389/fpsyt.2020.00767

OPINION

published: 29 July 2020

doi: 10.3389/fpsyt.2020.00767

health issues in people who use drugs (PWUD) include: physical

comorbidity, e.g., lung or cardiovascular disease, HIV, viral

hepatitis infections; psychological comorbidity, e.g., general

distress, sleep disorders, anxiety/mood disorders, psychotic

symptoms; and homelessness, incarceration, economic

difﬁculties, and socioeconomic issues deriving from drug

addiction (8,11,27,28). Overdose risk for addicted people

who are home-isolating, and hence with typically no one to

inject them with naloxone, should be considered in a time of

overloaded emergency services and healthcare systems in general

(27,29). The COVID-19 pandemic is already impacting drug

markets, including shortages of numerous types of drugs at the

street level, price increases for consumers on the black market

and reductions in purity. Synthetic drugs’availability, such as

methamphetamine, is drastically reduced due to air travel

restrictions and ﬂight cancellations, while cocaine, mostly

trafﬁcked by sea, continues to be detected in European ports

during the pandemic (30). Heroin and opioids seem to be

pushed toward being trafﬁcked along maritime routes. Finally,

cannabis appears to be less available, due to restrictions on

movement across regions and borders under coronavirus

lockdown. These disruptions are likely to grow and further

increase risks for people who use drugs, for example by

increasing variability in drug purity, the likelihood of

adulteration, and contamination of heroin supply with

synthetic opioids, such as fentanyl. These issues can also

encourage shifts to more at-risk drug using behaviours such as

use of drugs such as street benzodiazepines, and synthetic

cannabinoids (31). Additionally, the COVID-19 crisis is likely

to increase the need to access drug treatment and services, e.g.,

extra demand for opioid substitution therapy and other

medication. Access to drug services is being disrupted by self-

quarantine, social distancing and other public health measures

adopted for dealing with COVID-19 (27,29,31). Similarly,

community pharmacies are challenged by staff shortages,

service disorganisation, and self-isolation (27,29,32).

In response to the long-lasting and wide-ranging challenging

effects of the pandemic (5,12,19,27,29), some harm-avoiding

interventions have been adopted, including: more ﬂexible take-

home-medication treatment programmes for opioid addicted

patients (33,34); guidance for facilitating controlled substance

prescribing (26,29,35); tele-health for monitoring drug-

dependent patients; and access to virtual support groups

through online meetings (15,26,32). Conversely, both peer-

support groups and rehabilitation facilities have suspended

programmes and limited new admissions (27,32). Hollander &

Carr (36) compared and contrasted the acceptability and impact

of telemedicine versus in-person consultations. During the

COVID pandemic, telehealth has demonstrated to enable

continuity of services, while protecting service providers from

infection. However, in-person consultations are still needed for

certain groups of patients where maintenance in treatment is

at risk.

In this context, due to the disruption of drug markets,

reduced supply and access to illicit drugs, internet drug-

seeking activities may be on the increase. In line with this,

rogue/illicit pharmaceutical products, such as benzodiazepines,

has also reportedly doubled their prices in some areas (24).

Alternative drugs or medications might be considered by users

including quetiapine, gabapentinoids, Z-drugs (e.g., zolpidem)

(37–39) and some Over-The-Counter (OTC) medications (37,

38), such as codeine; ephedrine and pseudoephedrine; and the

antidiarrhoeal loperamide (“poor man’s methadone”).

IMPLICATIONS IN PRACTICE

Interventions addressing the health, psychological, and social

effects of the pandemic are required. Healthcare professionals

have an important role in educating patients about the common

psychological effects of a pandemic. COVID-19, together with

general environmental factors, such as stress or trauma, may

contribute to both a mental illness and a SUD developing. A

proactive approach to upscale our mental health care, emergency

preparedness and response for people with SUDs is urgently

needed; mental health services should develop and evaluate: clear

remote assessment; care pathways for people at risk; psycho-

education strategies, regarding self-harm/suicide, overdoses, and

domestic violence; and staff training to support new ways of

working (1,7,12). Healthcare providers, including pharmacists,

and public health policies are challenged to: develop strategies to

implement prevention measures against transmission of COVID-19

in drug users settings, such as preventing overcrowding or sharing

drug-using equipment; and ensure continuity of care for drug-users

and people with SUDs. Speciﬁcally, access to community

maintenance, e.g., expand methadone delivery via mobile teams

for quarantined patients should be facilitated (40,41). Monitoring

psychosocial needs and delivering psychosocial support to

vulnerable patients as well as healthcare workers should be

provided (2,3,8,42,43). It is crucial to strengthen telemedicine

and support it with appropriate governance and funding in order to

be able to monitor the mental health situation post-pandemic.

Supporting healthcare workers with appropriate equipment,

training on telehealth and caring for their safety with respect to

protection against infection and spread of infection, preventing

violence and burglary in drug treatment services, pharmacies would

enable robust support against a possible mental health wave post-

pandemic. Prescribers and pharmacists should be warned about:

possible requests to prescribe more drugs than needed to take home;

excessive sales of prescription/OTC products which might be

diverted and abused; and aggression toward staff. Developing

multidisciplinary support platforms could be helpful in reducing

the mental distress due to misinformation and teaching problem-

solving strategies to cope with the pandemic (13).

AUTHOR CONTRIBUTIONS

The opinion was developed by all authors. SC drafted the ﬁrst

version of the manuscript with input from all authors. All authors

contributed to the article and approved the submitted version.

Chiappini et al. COVID-19: Impact on Mental Health and Drug

Frontiers in Psychiatry | www.frontiersin.org July 2020 | Volume 11 | Article 7672

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Conﬂict of Interest: The authors declare that the research was conducted in the

absence of any commercial or ﬁnancial relationships that could be construed as a

potential conﬂict of interest.

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Full-text available

Jun 2022

The United States (U.S.) has a long history of racism and xenophobia, especially around infectious outbreaks. Recently, the associations of COVID-19 to China and Chinese people have been reflected in a surge of anti-Asian sentiment and hate crimes. Therefore, the present study examines the perceived change in everyday racism among Asians in the U.S. during the COVID-19 outbreak. This study used self-report surveys to assess the perceptions of everyday racism before and during the pandemic among Asians, Latinxs, and Whites residing in the U.S. We tested a 3 (race [Asians vs. Latinxs vs. Whites]) × 2 (perceptions [before vs. during pandemic]) analysis of covariance with repeated measures for perceptions to determine whether there were differences between racial groups for everyday racism before and during the COVID-19 pandemic. Findings strongly indicate that Asians in the U.S. perceived a change in everyday racism during the COVID-19 pandemic compared to Latinxs and Whites. Exploratory findings show that East and Southeast Asians, in particular, experienced the steepest perceived increase in everyday racism. Anti-Asian sentiment seems to have intensified in the U.S. during the COVID-19 pandemic, as evident in the rise of everyday racism against Asians. These experiences may serve as additional stressors for Asians in the U.S. during these already distressing times and disproportionately impact East and Southeast Asians. Implications for theory, research, and practice are discussed.

Atypical antipsychotic drugs in dual disorders: current evidence and clinical guidelines

Article

Jun 2022
CURR PHARM DESIGN

Background Concurrent disorder or dual diagnosis refers to a combination of substance use disorders and mental disorders that occur in the same patient simultaneously. These conditions pose significant clinical and healthcare impacts and are often underdiagnosed, undertreated, and complex to manage. Objective We assessed the quality of current pharmacological recommendations for the management of dual diagnosis, particularly by evaluating the use of second-generation antipsychotics (SGA). Method A literature search was performed using the PubMed and Scopus databases for publications up to September 21, 2021, without any time restrictions. The following search strings were used: (aripiprazole OR brexpiprazole OR cariprazine OR paliperidone OR risperidone OR quetiapine OR clozapine OR olanzapine) AND (psychosis OR schizophrenia OR schizoaffective) AND (“substance use disorder” OR cocaine OR alcohol OR cannabis OR heroin OR “double diagnosis” OR “dual diagnosis”)) NOT (animal OR rat OR mouse) NOT (review or meta-analysis). Results The search produced a final set of 41 articles. Most patients were males and were affected by schizophrenia, with cannabis the most abused substance, followed by alcohol. Aripiprazole was the most used drug, either orally or by long-acting formulations, followed by risperidone with oral and long-acting formulations, clozapine, olanzapine, and quetiapine. Conclusion The findings highlight the use of SGA for the treatment of psychotic symptoms in comorbidity with substance use. Future studies on people with dual diagnosis and focused on long-term evaluations are warranted and need to investigate the efficacy of newly introduced molecules, such as partial D2 agonists and long-acting injectable antipsychotics.

The modest impact of the COVID-19 pandemic on training expectations at internship programs offering specialization in neuropsychology

Article

May 2022

Objective: Given the decreased clinical training opportunities during the COVID-19 pandemic, this study aimed to provide insights into how training directors and supervising neuropsychologists from internships offering neuropsychology training adjusted expectations of competitive applicants. Method: Respondents (n = 50) from internships offering at least an "exposure" in neuropsychology completed questions about how training expectations of competitive applicants have changed because of the COVID-19 pandemic. Results: Most respondents reported decreased expectations for clinical hours and research productivity and increased expectations for telehealth experience and involvement in working with culturally diverse populations. Additionally, more than half of respondents from programs at university-affiliated and Veteran Affairs medical centers indicated reduced expectations for average number of integrated reports. Furthermore, compared to respondents at Veteran Affairs medical centers, respondents at university-affiliated medical centers stated decreased expectations for average number of paper presentations. Conclusions: The COVID-19 pandemic has motivated subtle changes in expectations of competitive neuropsychology-oriented internship applicants, specific to clinical experience, research productivity, and prioritization of certain application materials. Qualitative responses suggest that many respondents endeavored to improve applicant screening rather than lower expectations for applicants. As a result, consistent with previous recommendations, the importance of fit between trainee and training program should continue to be emphasized by prospective applicants. These findings have important implications for trainees for the next several years, as graduate students at all stages of training ultimately progress to the internship application stage.

UNETHICAL PRICING PRACTICES TOWARDS CONSUMERS

Article

Mar 2022

İşletmelerin adil satış fiyatlarıyla satışlarını artırarak karlılığa ulaşması istenen ve beklenen bir durumdur. Aksi durumda haksız ve yanıltıcı birtakım yöntemlerle etik dışı fiyat uygulamaları tüketicilere zarar vermektedir. Birçok ülkede bu tür durumların tespit edilmesi halinde satıcılara yönelik hukuki yaptırımlar bulunmaktadır. Bu çalışmanın amacı, tüketicilere uygulanan etik dışı fiyat uygulama yöntemleri ve bu konuda Türkiye’de mevcut olan hukuki düzenlemeler hakkında okuyucuların dikkatini çekmek ve farkındalık düzeylerini arttırmaktır. Bu çalışmada etik dışı fiyat uygulamaları kapsamında sıklıkla karşılaşılan raf ve kasa fiyatı uyumsuzluğu, yalancı indirimler, aşırı fiyatlamalar, küsuratlı fiyatlamalar, fiyat farklılaştırması, birim fiyatlandırma, gramaj hileleri, karaborsacılık hakkında ikincil kaynaklar Belge Tarama yöntemi ile toplanarak doküman ve söylem analizine tabi tutulmuştur. Bu çalışma tüketicilerin alışveriş esnasında fiyat, kalite, gramaj, etiket, indirim vb. hususlarda dikkatli olmaları gerektiğine işaret etmektedir. Tüketicilerin iddia edilenlerin ne kadar doğru ve güvenilir olduğuna ikna olmaları gerektiği ilgili literatürden anlaşılmaktadır. Bu çalışmada, tüketicilerin satın aldıkları ürünler konusundaki bilinçlerinin yüksek olmasının ne kadar önemli olduğu bir kez daha ortaya çıkmıştır. Bu yönüyle araştırmanın alışveriş yapan tüketicilere yararlı olacağı beklenmektedir. Tüketicilerin ürünlerin fiyatları konusunda dikkatli davranmaları, aceleci olmamaları şüphelendikleri durumlarda kendi denetimlerini kendilerinin yapması gerektiğine işaret edilmiştir.

Changes in the Care Activity in Addiction Centers with Dual Pathology Patients during the COVID-19 Pandemic

Article

Jul 2022

Background: Health care provision during the COVID-19 pandemic and confinement has led to significant changes in the activity of addiction centers. These changes in healthcare activity may have had a greater impact on patients with dual pathology. The aim of this study is to compare the treatment indicators of patients with dual pathology in addiction centers during the pre-confinement, confinement, and post-confinement periods. Methods: A retrospective observational study was conducted for the period between 1 February 2019 and 30 June 2021. A total of 2785 patients treated in specialized addiction services were divided into three periods according to their time of admission: pre-confinement, confinement, and post-confinement. Results: During the pre-pandemic period, the addiction centers attended to an average of 121.3 (SD = 23.58) patients, decreasing to 53 patients during confinement (SD = 19.47), and 80.69 during the post-confinement period (SD = 15.33). The number of appointments scheduled monthly for each patient decreased during the confinement period, although this number increased after confinement. There was a reduction in the number of toxicological tests carried out both during and after confinement (except for alcohol). Conclusions: The results show a reduction in the number of patients seen and the care activity delivered to dual diagnosis patients. These results, which were caused by the COVID-preventive measures, may affect the progress and recovery of dual patients. A greater investment is needed to bring the care activity up to the standards of the years prior to confinement.

Support and Aid to Families Electronically (SAFE): Addressing Intersecting Academic and Community Needs

Article

Jul 2022
J SOC WORK EDUC

Stress and sleep: A survey based on wearable sleep trackers among medical and nursing staff in Wuhan during the COVID-19 pandemic

Article

Full-text available

Jun 2020

Backgroud COVID-19 pandemic has significantly affected the sleep health of local medical and nursing staff. Aim We used wearable pulse oximeters to monitor and screen the medical and nursing staff working in hospitals designated for COVID-19 in the Wuhan area. This study aimed to establish a reliable basis to provide sleep intervention for the medical and nursing staff. Methods Thirty medical and nursing staff members with symptoms of insomnia were instructed to wear medical ring-shaped pulse oximeters to monitor their sleep overnight. We also used the Insomnia Severity Index (ISI) and the Chinese version of the Self-Reporting Questionnaire (SRQ-20) to evaluate the severity of insomnia and mental health status, respectively, for each participant. Results Among the 30 participants, only 26 completed the screening. Ten cases (38.5%) demonstrated moderate to severe sleep apnoea–hypopnea syndrome (SAHS) when using an oxygen desaturation index ≥15 times/hour as the cut-off value. Participants with comorbid moderate to severe SAHS had significantly higher ISI and SRQ scores (p values 0.034 and 0.016, respectively) than those in the insomnia group. Correlation analysis revealed that ISI was positively correlated with total sleep time (TST) (r=0.435, p=0.026), and negatively correlated with deep sleep (r=−0.495, p=0.010); furthermore, patient SRQ scores were positively correlated with TST, sleep efficiency (SE) and REM (rapid eyes movement) sleep % (r=0.454 and 0.389, 0.512; p=0.020, 0.050 and 0.008, respectively). Stepwise logistic regression indicated that SRQ-20 and sex were risk factors for insomnia with comorbid SAHS, and their OR values were 1.516 and 11.56 (95% CI 1.053 to 2.180 and 1.037 to 128.9), respectively. Conclusion Medical and nursing staff with insomnia showed clear signs of comorbid sleep apnoea attributable to stress. The wearable pulse oximeters accurately monitored the participants’ breathing when asleep.

Analysis of Psychological and Sleep Status and Exercise Rehabilitation of Front-Line Clinical Staff in the Fight Against COVID-19 in China

Article

Full-text available

May 2020

BACKGROUND The aim of this study was to understand the changes in psychological factors and sleep status of front-line medical staff in the fight against COVID-19 and provide evidence of exercise interventions to relieve psychological stress and improve sleep status for medical staff. MATERIAL AND METHODS A survey study was conducted among 120 front-line medical staff in the fight against COVID-19, of which 60 medical staff worked at the designated hospital (experimental group) and 60 medical staff worked at the non-designated hospital (control group). The Symptom Checklist 90 (SCL-90), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and PTSD Checklist-Civilian Version (PCL-C) were used to assess mental status. Sleep status was assessed using the Pittsburgh Sleep Quality Index (PSQI). RESULTS SCL-90 scores of somatization, depression, anxiety, and terror were higher than normal in front-line medical staff at the designated hospital. The SAS (45.89±1.117), SDS (50.13±1.813), and PCL-C (50.13±1.813) scores in the experimental group were higher than the normal control group, and were significantly different from those in the control group on SDS and PCL-C scales (P<0.05). The total average PSQI of the experimental group was 16.07±3.761, indicating that the sleep quality was poor. Among them, participants with moderate insomnia reached 61.67%, and participants with severe insomnia reached 26.67%. CONCLUSIONS There are psychological symptoms and sleep symptoms in front-line medical staff who participate in the fight against COVID-19, and they affect each other. Hospitals should improve emergency management measures, strengthen psychological counseling for clinical front-line medical staff, strengthen exercise intervention, and improve their sleep quality and mental health.

COVID-19: the implications for suicide in older adults

Article

Full-text available

Apr 2020

Covid-19: The implications for suicide in older adults - Anne Pamela Frances Wand, Bao-Liang Zhong, Helen Fung Kum Chiu, Brian Draper, Diego De Leo

Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic

Article

Full-text available

Apr 2020

The COVID-19 pandemic is an unprecedented challenge for society. Supporting the mental health of medical staff and affiliated healthcare workers (staff) is a critical part of the public health response. This paper details the effects on staff and addresses some of the organisational, team and individual considerations for supporting staff (pragmatically) during this pandemic. Leaders at all levels of health care organisations will find this a valuable resource.

Aggregated COVID-19 suicide incidences in India: Fear of COVID-19 infection is the prominent causative factor

Article

Aug 2020
PSYCHIAT RES

Many Indian COVID-19 suicide cases are turning the press-media attentions and flooding social media platforms although, no particular studies assessed the COVID-19 suicide causative factors to a large extent. Therefore, the present study presents 72 COVID-19 suicide cases (aged 19 to 65 years; 55 cases were males). The suicide causalities are included as follows – fear of infection (16-cases), quarantine related issues (whereas no specific reasons were reported in 9 cases and rest causalities were heterogenous), COVID-19 related stress (n=9), tested positive for COVID-19 (n=7), isolation related issues (n=5) and migrant unable to return home (n=3) etc. Considering the extreme psychological impacts related to COVID-19, there emerges a need for countrywide extensive tele-mental health care services.

COVID-19 suicidal behavior among couples and suicide pacts: Case study evidence from press reports

Article

Jul 2020
PSYCHIAT RES

There are many reasons for COVID-19-related suicides including the fear of getting the disease, the fear of passing the disease onto others, mental instability (e.g., depression, anxiety and/or stress) as a consequence quarantine, isolation, economic hardship, and the unavailability of food and alcohol based on published reports (Dsouza et al., 2020; Goyal et al., 2020; Mamun & Griffiths, 2020a; Mamun & Ullah, 2020; Thakur & Jain, 2020). However, another worrying type of suicide cases concerns couples dying together that are related to COVID-19, the majority of which concern suicide pacts by couples. Here, we present six cases in chronological order of couple suicides and attempted suicides relating to COVID-19 comprising 12 individuals from four countries (i.e., Bangladesh, India, Malaysia, and the US).

COVID-19, unemployment, and suicide

Article

May 2020

Suicide prevention during the COVID-19 outbreak

Article

May 2020

Anat Brunstein Klomek

Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A Case-Control Study with Service and Research Implications for Immunopsychiatry

Article

Apr 2020

This study aimed to assess and compare the immediate stress and psychological impact experienced by people with and without psychiatric illnesses during the peak of 2019 coronavirus disease (COVID-19) epidemic with strict lockdown measures. Seventy-six psychiatric patients and 109 healthy control subjects were recruited from Chongqing, China and completed a survey on demographic data, physical symptoms during the past 14 days and a range of psychiatric symptoms using the Impact of Event Scale- Revised (IES-R), Depression, Anxiety and Stress Scale (DASS-21) and Insomnia Severity Index (ISI). IES-R measures PTSD symptoms in survivorship after an event. DASS -21 is based on tripartite model of psychopathology that comprise a general distress construct with distinct characteristics. The mean IES-R, DASS-21 anxiety, depression and stress subscale and ISI scores were higher in psychiatric patients than healthy controls (p<0.001). Serious worries about their physical health, anger and impulsivity and intense suicidal ideation were significantly higher in psychiatric patients than healthy controls (p<0.05). More than one-third of psychiatric patients might fulfil the diagnostic criteria post-traumatic stress disorder (PTSD). More than one-quarter of psychiatric patients suffered from moderately severe to severe insomnia. Respondents who reported no change, poor or worse physical health status and had a psychiatric illness were significantly more likely to have higher mean IES-R, DASS depression, anxiety and stress subscale scores and ISI scores (p<0.05). This study confirms the severity of negative psychological impact on psychiatric patients during the COVID-19 epidemic with strict lockdown measures. Understanding the psychological impact on psychiatric patients during the COVID-19 pandemic has the potential to provide insight into how to develop a new immunopsychiatry service. Further research is required to compare pro-inflammatory cytokines between psychiatric patients and healthy controls during the pandemic.

COVID 2019-Suicides: A global psychological pandemic

Article