How Do People with Bipolar Disorder Respond to the COVID-19 Pandemic Over Time?

What you need to know

• People with bipolar disorder showed three different patterns of symptoms during the first 6 months of the COVID-19 pandemic:
  • Most (63%) had low levels of symptoms
  • Some (24%) had symptoms that got worse over time
  • A small group (14%) had a strong initial reaction that improved
• Factors like gender, employment, and previous hospitalizations were linked to how people responded
• The study shows the importance of long-term monitoring of mental health in people with bipolar disorder during major events like pandemics

How people with bipolar disorder responded to the pandemic

The COVID-19 pandemic has been a major source of stress and disruption for people around the world. For those living with mental health conditions like bipolar disorder, the pandemic may pose unique challenges. Researchers in Italy conducted a study to understand how people with bipolar disorder responded psychologically during the first 6 months of the pandemic.

The study followed 89 people diagnosed with bipolar disorder who were receiving outpatient psychiatric care. The researchers assessed their symptoms of post-traumatic stress, depression, and anxiety at three time points:

1. During the initial lockdown in Italy (April 2020)
2. Two months later when restrictions were easing (June 2020)
3. Six months after the initial assessment (October 2020)

By looking at how symptoms changed over time, the researchers identified three distinct patterns or “trajectories” of response:

Low symptoms group (63% of participants)

The majority of people in the study showed relatively low levels of symptoms throughout the 6-month period. This suggests that many people with bipolar disorder were able to cope reasonably well with the stress of the pandemic, at least in the short term.

Increasing severity group (24% of participants)

About a quarter of participants had symptoms that got worse over time. This group started with moderate symptoms during the lockdown, but their depression, anxiety and trauma symptoms increased as the pandemic went on.

Acute reaction group (14% of participants)

A smaller group had a strong initial reaction to the pandemic, with high levels of symptoms during the lockdown. However, their symptoms improved significantly over the following months.

Factors linked to different responses

The researchers looked at various factors that might influence how people responded to the stress of the pandemic. They found several interesting patterns:

Gender differences

Women were more likely than men to be in the “acute reaction” group, showing a strong initial response that later improved. This fits with other research showing women may be more vulnerable to acute stress reactions.

Employment and financial stress

People in the “increasing severity” group were more likely to be unemployed or facing financial difficulties due to the pandemic. This highlights how economic stress can take a toll on mental health over time.

Previous hospitalizations

Those whose symptoms got worse over time were more likely to have been hospitalized for bipolar disorder in the past. This may indicate that people with more severe forms of bipolar disorder are at higher risk during times of prolonged stress.

Family risk factors

People whose symptoms increased were more likely to have family members at high risk for COVID-19 complications. Worry about loved ones’ health may have contributed to worsening mental health.

Manic symptoms

Interestingly, people in the “increasing severity” group had higher levels of manic symptoms at the start of the study. This suggests that manic or hypomanic states may make people more vulnerable to stress reactions over time.

Why this matters for patients and families

This study provides several important insights for people living with bipolar disorder and their loved ones:

1. Responses vary: There’s no single “typical” response to a major stressor like a pandemic. Some people may struggle initially but improve, while others may seem fine at first but develop problems over time.

2. Ongoing monitoring is key: Since some people’s symptoms got worse months into the pandemic, it’s important to keep track of mental health over extended periods during major life disruptions.

3. Risk factors to watch for: Things like job loss, financial stress, and worry about high-risk family members may increase the chances of worsening symptoms. Being aware of these risk factors can help people seek support early if needed.

4. Resilience is common: The fact that most participants maintained relatively low symptom levels is encouraging. Many people with bipolar disorder appear to have coping skills that help them weather major stressors.

5. Gender differences: Women may be more likely to have strong initial reactions to stress. Understanding this can help tailor support appropriately.

Conclusions

• People with bipolar disorder show different patterns of response to major stressors like the COVID-19 pandemic
• Most maintain stable mental health, but some may develop worsening symptoms over time
• Factors like gender, employment, and illness history influence how people respond
• Long-term monitoring of mental health is important during prolonged stressful events
• Understanding risk factors can help identify who may need additional support

While this study focused on the COVID-19 pandemic, its findings may apply to other types of prolonged stressful events as well. By better understanding how people with bipolar disorder respond to major life disruptions, we can develop more effective strategies to support mental health and resilience in challenging times.