Transdiagnostic considerations of mental health for the post-COVID era:Lessons from the first surge of the pandemic

摘要

BACKGROUND The Coronavirus disease 19(COVID-19)-related psychiatric burden partly results from prolonged social stress world-wide.Studies have examined the psychiatric impact of COVID-19 on Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM 5)and International Classification of Diseases 11th Revision(ICD-11)categories,implicating multiple diagnoses,complicating clinical management.AIM To verify whether COVID-19-related psychopathology spans multiple DSM-5 and ICD-11 diagnoses,but not in a random pattern.Consequently,empirical analysis of the multiple associated symptoms will better describe COVID-19-related psychopathology.METHODS We conducted a bi-national study during the first surge of the pandemic:an Italian sample(n=21217,studied March-April 2020);and three representative longitudinal samples from Israel(n=1276,1189,and 1432 respectively,studied May-July 2020).Data in Italy were collected by a national internet-based survey with an initially approached sample of about one million persons and in Israel by the Israeli Central Bureau of Statistics using probability-based national representative sampling.Data analysis focused on the frequency and patterns of reported multiple mental health symptoms.RESULTS Combinations with all symptoms were more prevalent than combinations with fewer symptoms,with no majorities-minorities differences in both countries,demonstrating the generalizability of the transdiagnostic pattern of mental health issues in both nations.A history of previous mental disorder(Italian study)and an increase in symptom prevalence over time(Israel study)were associated with an increased number of symptoms.Conclusions:Based on finding correlated symptom diversity spanning conventional diagnostic categories,we suggest that the pattern of mental health issues associated with the COVID-19 pandemic is transdiagnostic.CONCLUSION The findings have implications for improving prevention and treatment of COVID-19 related psychopathology and for post-pandemic times in conditions resulting from multiplicity of stressors with mixed symptomatology in the clinical picture.