Immediate Effects of COVID-19 Outbreak on Psychiatric Outpatients: Posttraumatic Stress and Influencing Factors

We aimed to investigate the effects of COVID-19 outbreak and public health measures on the psychological well-being of patients with psychiatric disorders. This cross-sectional study assessed 436 outpatients recruited from a tertiary psychiatry clinic in Istanbul, Turkey, nearly one month after the government introduced strict measures of lockdown against the ongoing outbreak. Respondents completed a web-based survey on sociodemographic data, subjective sleep quality, and a range of psychiatric symptoms using the Impact of Events Scale-Revised (IES-R), and Hospital Anxiety and Depression Scale (HADS). Respondents reported high frequencies of clinically significant posttraumatic stress disorder (PTSD) (32.6%, IES-R score ≥ 33), anxiety (36.4%, HADS anxiety score > 10), and depression (51%, HADS depression score > 10). 20.5% of respondents described that their psychological status worsened during the COVID-19 outbreak, and 12.1% of respondents described poor or very poor sleep in the prior month. Positive predictors of increased PTSD symptoms included the chronic medical diseases, knowing someone in the social vicinity diagnosed with the COVID-19 infection, job loss or being on temporary leave after the outbreak, and increased exposure time to TV or social media. In contrast, male gender, older age, higher educational attainment, and the psychiatric diagnoses of schizophrenia and (to a lesser degree) bipolar disorder were the negative predictors. Our results suggest that patients with psychiatric disorders are prone to substantial psychological distress during the COVID-19 outbreak, and various individual, behavioral, and social factors mediate this effect. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This was a non-funded study. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The procedures of this study complied with the provisions of the Declaration of Helsinki concerning research on Human participants. The Ethics Committee of Cerrahpaşa Medical Faculty approved this study. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The datasets generated during and/or analyzed during the current study are available from the corresponding on reasonable request.