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Preplanned Studies: Change of Disease Spectrum Characteristics of Psychiatric Inpatients Before and After Lockdown Lifted During the COVID-19 Pandemic — Wuhan City, Hubei Province, China, 2021

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  • Summary

    What is already known about this topic?

    The coronavirus disease 2019 (COVID-19) pandemic poses a significant threat to mental health globally and may change the proportion of hospitalized patients.

    What is added by this report?

    This report analyzed and compared the disease characteristics of psychiatric inpatients one year before and after Wuhan lifted lockdown during COVID-19. About 50% of the inpatients were diagnosed with bipolar disorder; females and adolescents had a higher prevalence of mental disorders.

    What are the implications for public health practice?

    More attention should be paid to the mental health of children, adolescents, and females.

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  • [1] Wang CY, Pan RY, Wan XY, Tan YL, Xu LK, McIntyre RS, et al. A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain Behav Immun 2020;87:40 − 8. http://dx.doi.org/10.1016/j.bbi.2020.04.028CrossRef
    [2] Shi L, Lu ZA, Que JY, Huang XL, Liu L, Ran MS, et al. Prevalence of and risk factors associated with mental health symptoms among the general population in china during the coronavirus disease 2019 pandemic. JAMA Netw Open 2020;3(7):e2014053. http://dx.doi.org/10.1001/jamanetworkopen.2020.14053CrossRef
    [3] Blashfield RK, Keeley JW, Flanagan EH, Miles SR. The cycle of classification: DSM-I through DSM-5. Annu Rev Clin Psychol 2014;10:25 − 51. http://dx.doi.org/10.1146/annurev-clinpsy-032813-153639CrossRef
    [4] Yang D, Yang XL, Liu K, Dong ZY. Admission management of patients with severe mental illness during COVID-19. J Int Psychiatry 2020;47(4):650 − 52,665. http://dx.doi.org/10.13479/j.cnki.jip.2020.04.004 (In Chinese). CrossRef
    [5] Rowland T, Perry BI, Upthegrove R, Barnes N, Chatterjee J, Gallacher D, et al. Neurotrophins, cytokines, oxidative stress mediators and mood state in bipolar disorder: systematic review and meta-analyses. Br J Psychiatry 2018;213(3):514 − 25. http://dx.doi.org/10.1192/bjp.2018.144CrossRef
    [6] Dagani J, Signorini G, Nielssen O, Bani M, Pastore A, de Girolamo G, et al. Meta-analysis of the interval between the onset and management of bipolar disorder. Can J Psychiatry 2017;62(4):247 − 58. http://dx.doi.org/10.1177/0706743716656607CrossRef
    [7] Rodriguez-Paris D, Remlinger-Molenda A, Kurzawa R, Głowińska A, Spaczyński R, Rybakowski F, et al. Psychiatric disorders in women with polycystic ovary syndrome. Psychiatr Pol 2019;53(4):955 − 66. http://dx.doi.org/10.12740/PP/OnlineFirst/93105CrossRef
    [8] Nowrouzi B, McIntyre RS, MacQueen G, Kennedy SH, Kennedy JL, Ravindran A, et al. Admixture analysis of age at onset in first episode bipolar disorder. J Affect Disord 2016;201:88 − 94. http://dx.doi.org/10.1016/j.jad.2016.04.006CrossRef
    [9] Shah K, Mann S, Singh R, Bangar R, Kulkarni R. Impact of COVID-19 on the mental health of children and adolescents. Cureus 2020;12(8):e10051. http://dx.doi.org/10.7759/cureus.10051CrossRef
    [10] Brown SM, Doom JR, Lechuga-Peña S, Watamura SE, Koppels T. Stress and parenting during the global COVID-19 pandemic. Child Abuse Negl 2020;110(Pt 2):104699. http://dx.doi.org/10.1016/j.chiabu.2020.104699.http://dx.doi.org/10.1016/j.chiabu.2020.104699
  • FIGURE 1.  Disease distribution of inpatients by gender and age in Phase 1 and Phase 2. (A) Male in Phase 1; (B) Female in Phase 1; (C) Male in Phase 2; (D) Female in Phase 2.

    TABLE 1.  Inpatients’ disease diagnosis distribution in Phase 1 and Phase 2.

    Variety of diseasePhase 1 (n=6,664)Phase 2 (n=4,199)χ2P-value
    Somatoform disorders
     Yes
     No
    84 (1.3%)
    6,580 (98.7%)
    53 (1.3%)
    4,146 (98.7%)
    0.000.994
    Bipolar disorder
     Yes
     No
    2,975 (44.6%)
    3,689 (55.4%)
    1,959 (46.7%)
    2,240 (53.3%)
    4.200.040
    Sleep Disorders
     Yes
     No
    59 (0.9%)
    6,605 (99.1%)
    29 (0.7%)
    4,170 (99.3%)
    1.220.270
    Depressive disorders
     Yes
     No
    1,196 (17.9%)
    5,468 (82.1%)
    696 (16.6%)
    3,503 (83.4%)
    3.370.066
    Stress-related disorder
     Yes
     No
    36 (0.5%)
    6,628 (99.5%)
    15 (0.4%)
    4,184 (99.6%)
    1.850.174
    Emotional and behavioral disorders in children and adolescents
     Yes
     No
    107 (1.6%)
    6,557 (98.4%)
    144 (3.4%)
    4,055 (96.6%)
    37.96<0.001
    Anxiety disorders
     Yes
     No
    417 (6.3%)
    6,247 (93.7%)
    298 (7.1%)
    3,901 (92.9%)
    2.950.086
    Schizophrenia spectrum disorder
     Yes
     No
    1,315 (19.7%)
    5,349 (80.3%)
    711 (16.9%)
    3,488 (83.1%)
    13.31<0.001
    Psychoactive substances-induced mental disorders
     Yes
     No
    46 (0.7%)
    6,618 (99.3%)
    23 (0.5%)
    4,176 (99.5%)
    0.830.363
    Organic mental disorder
     Yes
     No
    232 (3.5%)
    6,432 (96.5%)
    169 (4.0%)
    4,030 (96.0%)
    2.140.144
    Obsessive-compulsive disorder
     Yes
     No
    65 (1.0%)
    6,599 (99%)
    37 (0.9%)
    4,162 (99.1%)
    0.250.620
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Change of Disease Spectrum Characteristics of Psychiatric Inpatients Before and After Lockdown Lifted During the COVID-19 Pandemic — Wuhan City, Hubei Province, China, 2021

View author affiliations

Summary

What is already known about this topic?

The coronavirus disease 2019 (COVID-19) pandemic poses a significant threat to mental health globally and may change the proportion of hospitalized patients.

What is added by this report?

This report analyzed and compared the disease characteristics of psychiatric inpatients one year before and after Wuhan lifted lockdown during COVID-19. About 50% of the inpatients were diagnosed with bipolar disorder; females and adolescents had a higher prevalence of mental disorders.

What are the implications for public health practice?

More attention should be paid to the mental health of children, adolescents, and females.

  • 1. Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China
  • 2. Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), National Center for Mental Health, Chinese Center for Disease Control and Prevention, Beijing, China
  • Corresponding authors:

    Zhiying Wan, 1032242656@qq.com

    Hongqiang Sun, Sunhq@bjmu.edu.cn

    Online Date: May 06 2022
    Issue Date: May 06 2022
    doi: 10.46234/ccdcw2022.088
  • In recent decades, the prevalence of mental disorders has increased in China and worldwide. The coronavirus disease 2019 (COVID-19) spread worldwide in less than 2 months from late December 2019. Numerous studies have shown that COVID-19 poses a significant threat to physical and mental health among the general population (1). Factors such as chronic stress and social isolation may increase the risk of emotional deterioration for some people (2), which may increase psychosis risk and proportion of inpatients. We conducted a retrospective cohort study of analyzing and comparing the disease characteristics of psychiatric inpatients 1 year before and after Wuhan lifted lockdown during COVID-19. The data were extracted from the information management system of the mental health center of the third-level hospital in Wuhan City, Hubei Province, China, from April 8, 2019 to April 9, 2021, which included gender, age, Wuhan residential registration (hukou), and disease diagnosis. Taking the date of lifting lockdown in Wuhan (April 8, 2020) as the cut-off point, the disease characteristics of psychiatric inpatients before and after one year were compared. Results showed that nearly half of inpatients were diagnosed with bipolar disorder, and most tended to be younger and female. This study suggests that more attention should be paid to the mental health of females and adolescents, and it is necessary to conduct studies that are multicenter and have more extended observation periods.

    On January 23, 2020, Wuhan was under lockdown to control the pandemic, significantly reducing access to services. Renmin Hospital of Wuhan University was appointed as a designated hospital for ordinary and severe COVID-19 patients. No new inpatients were admitted to other departments except emergency and fever clinics. With the effort of the whole society, Wuhan was lifted from lockdown on April 8, 2020 into the period of normalized epidemic prevention and control. All departments only began to receive new inpatients after strict disinfection. Therefore, in this study, April 8, 2020 was taken as the time node to compare the disease spectrum characteristics of psychiatric inpatients before and after one year and provide references for mental health assessment and prevention over the coming years.

    This retrospective cohort analysis was conducted on patients with mental disorders hospitalized between April 8, 2019 and April 9, 2021 in the mental health center of the third-level hospital in Wuhan, Hubei, China. This period was divided into two phases. “Phase 1” (i.e., from April 8, 2019 to April 8, 2020) represents the period before Wuhan lifted the lockdown. “Phase 2” (i.e., from April 9, 2020 to April 9, 2021) was Wuhan’s normalized epidemic prevention and control stage. Data from the electronic medical record in the information management system were used, which contained information on demographic characteristics (gender, age, Wuhan hukou) and disease diagnosis (somatoform disorders, bipolar disorder, sleep disorders, depressive disorder, stress-related disorder, emotional and behavioral disorders in children and adolescents, anxiety disorder, schizophrenia spectrum disorder, psychoactive substances-induced mental disorders, organic mental disorder, obsessive-compulsive disorder, and other mental disorders). Qualified psychiatrists were responsible for defining and classifying the diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) (3).

    Continuous data were expressed as mean and standard deviation, categorical data regarding the number of patients (percentage). Continuous data were analyzed using the two-sample t-test. Differences between categorical data were evaluated using the Fisher’s Exact test or the Pearson chi-squared test. Statistical analysis was performed using IBM SPSS Statistics for Windows (version 21.0, IBM Corp., Armonk, NY, USA). And P<0.05 was considered statistically significant.

    Between April 8, 2019 and April 9, 2021, 10,863 inpatients were treated in the Department of Psychiatry at Renmin Hospital of Wuhan University. The total number of inpatients in Phase 1 and Phase 2 was 6,664 (61.3%), 4,199 (38.7%), respectively, with a 36.98% reduction in Phase 2 compared to Phase 1. Comparison of demographic characteristics between both phases: the prevalence of female inpatients in Phase 2 was higher than that in Phase 1 (61.1% vs. 55.9%; P<0.01); the average age in Phase 2 was younger than that in Phase 1 (33.52$ \pm $16.52 vs. 34.55$ \pm $16.10; P<0.01); the prevalence of inpatients with non-Wuhan hukou in Phase 2 was higher than that in Phase 1 (61.5% vs. 59.0%; P<0.05) (Supplementary Table S1).

    The top 3 disease diagnoses in both phases were bipolar disorder (44.6% vs. 46.7%), schizophrenia spectrum disorder (19.7% vs. 16.9%), and depressive disorder (17.9% vs. 16.6%). The distribution of disease diagnosis among inpatients in the Phase 2 was compared with the Phase 1: the proportion of inpatients with bipolar disorder increased (46.7% vs. 44.6%, P<0.05); emotional and behavioral disorders in children and adolescents increased (3.4% vs. 1.6%; P<0.01); schizophrenia spectrum disorder decreased (16.9% vs. 19.7%; P<0.01) (Table 1). The disease diagnoses distribution by gender at different age groups in Phases 1 and 2 is shown in Figure 1. The disease distribution proportion of inpatients by gender in Phase 1 and Phase 2 are separately shown in Supplementary Figures S1S2. A detailed comparison of the two stages of disease diagnosis distribution among demographic characteristics is presented in Supplementary Table S2.

    Variety of diseasePhase 1 (n=6,664)Phase 2 (n=4,199)χ2P-value
    Somatoform disorders
     Yes
     No
    84 (1.3%)
    6,580 (98.7%)
    53 (1.3%)
    4,146 (98.7%)
    0.000.994
    Bipolar disorder
     Yes
     No
    2,975 (44.6%)
    3,689 (55.4%)
    1,959 (46.7%)
    2,240 (53.3%)
    4.200.040
    Sleep Disorders
     Yes
     No
    59 (0.9%)
    6,605 (99.1%)
    29 (0.7%)
    4,170 (99.3%)
    1.220.270
    Depressive disorders
     Yes
     No
    1,196 (17.9%)
    5,468 (82.1%)
    696 (16.6%)
    3,503 (83.4%)
    3.370.066
    Stress-related disorder
     Yes
     No
    36 (0.5%)
    6,628 (99.5%)
    15 (0.4%)
    4,184 (99.6%)
    1.850.174
    Emotional and behavioral disorders in children and adolescents
     Yes
     No
    107 (1.6%)
    6,557 (98.4%)
    144 (3.4%)
    4,055 (96.6%)
    37.96<0.001
    Anxiety disorders
     Yes
     No
    417 (6.3%)
    6,247 (93.7%)
    298 (7.1%)
    3,901 (92.9%)
    2.950.086
    Schizophrenia spectrum disorder
     Yes
     No
    1,315 (19.7%)
    5,349 (80.3%)
    711 (16.9%)
    3,488 (83.1%)
    13.31<0.001
    Psychoactive substances-induced mental disorders
     Yes
     No
    46 (0.7%)
    6,618 (99.3%)
    23 (0.5%)
    4,176 (99.5%)
    0.830.363
    Organic mental disorder
     Yes
     No
    232 (3.5%)
    6,432 (96.5%)
    169 (4.0%)
    4,030 (96.0%)
    2.140.144
    Obsessive-compulsive disorder
     Yes
     No
    65 (1.0%)
    6,599 (99%)
    37 (0.9%)
    4,162 (99.1%)
    0.250.620

    Table 1.  Inpatients’ disease diagnosis distribution in Phase 1 and Phase 2.

    Figure 1. 

    Disease distribution of inpatients by gender and age in Phase 1 and Phase 2. (A) Male in Phase 1; (B) Female in Phase 1; (C) Male in Phase 2; (D) Female in Phase 2.

  • The disease characteristics of psychiatric inpatients were changed after Wuhan lifted lockdown during the COVID-19 pandemic. This study showed that nearly half of the inpatients were diagnosed with bipolar disorder, and the overall average age tended to be younger.

    Inpatients with mental disorders have significantly decreased since epidemic prevention and control were implemented. COVID-19 poses a tremendous challenge to healthcare systems around the world. When sporadic cases of the virus occurred in local areas, most medical procedures and related tests were highly restricted or more complex than before to reduce the risk of spreading the virus. Some patients with mental disorders in stable condition who preferred regular outpatient review or online consultation were not hospitalized for treatment until out of control (4). On the other hand, with the support of the state and government in recent decades, many local mental health institutions have been rapidly established to undertake the treatment and management of some patients with psychiatric disorders.

    This study showed that the top three mental disorders were bipolar disorder, schizophrenia spectrum disorder, and depressive disorder. However, the prevalence of bipolar disorder has increased significantly, and females had a higher prevalence than males. The pathogenesis of bipolar disorder has been unknown and may be related to genetic, lifestyle, and environmental exposures (e.g., poor diet, physical inactivity, and childhood trauma) (5). Most individuals with bipolar disorders are easily misdiagnosed or not accurately diagnosed until years later (6). Females had higher psychiatric disorders than the general population, which may be related to endocrine factors, such as polycystic ovary syndrome (7). More than 70% of individuals with bipolar disorders have been onset before 25-year-old (8). It is emphasized that early detection, timely diagnosis and treatment, and family and social support are the need for illness outcomes.

    The prevalence of emotional and behavioral disorders in children and adolescents has increased significantly after the outbreak. Many schools and educational institutions changed teaching methods since the COVID-19 pandemic, and students began to study by home-based learning or online training. Peer activities and communication were hindered, and the unexpected situation changed their typical growth, learning, playing, and interacting. It impeded the growth and development of young human minds, especially the brain development of the youngest ones (9). Secondary school students faced more academic pressure from the entrance examination. Meanwhile, their parents also faced many challenges such as their work, family income, and children’s education, increasing the risk of their stress. Parental stress was associated with children’s emotional and behavioral problems (10). Therefore, the uncertainty of their future academics, individual relationships, inactivity, and parent-child relationship posed some severe threats to their mental health. More attention should be paid to the mental health of children and adolescents by the collaboration of parents, teachers, psychologists, and psychiatrists.

    This study was subject to several limitations. First, data for this study were only obtained from one hospital, so the small sample size limited the representativeness. Second, the lack of information about patients may have influenced the analysis. Third, a relatively short period, just one year, was observed in this study. Future studies, especially multicenter and more extended observation period studies, are needed.

    Conflicts of interest: No conflicts of interest.

    Acknowledgments: The information center staff of the People’s Hospital of Wuhan University.

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