BMJ mental health · 2026
Well-being differences and changes in people with somatic and psychiatric disorders or multimorbidities: modelling COVID-19 as a global natural experiment of stress vulnerability.
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Adam Till J, Thompson Trevor, Peroz Fabiola H, Heisig Jan P, Gellert Paul, Alonso-Perez Enrique, Bister Lara, Thygesen Lau Caspar, Conus Philippe, von Känel Roland, Seedat Soraya, Manková Denisa, Guinart Daniel, Vieta Eduard, Millan Mark J, De Leo Diego, Berk Michael, Fiedorowicz Jess, Yang Lin, Tiihonen Jari, Aschauer Harald, Schlögelhofer Monika, Hamilton Jane E, Solmi Marco, Correll Christoph U, COH-FIT Consortium
Аннотация
BACKGROUND: Somatic and psychiatric illnesses and multimorbidities increase stress-vulnerability and decrease well-being.
OBJECTIVE: We aimed to identify high-risk disorder profiles for lower well-being and well-being decline under stress, modelling COVID-19 as a natural experiment.
METHODS: The global Collaborative Outcomes Study on Health and Functioning during Infection Times survey assessed the World Health Organization-Five Well-being Index (WHO-5) (0-100) retrospectively pre-pandemic and intra-pandemically. Mixed-effects models, controlling for demographic/pandemic-related covariates, examined coprimary outcomes: total pre-pandemic WHO-5 and pre-to-intra-pandemic change (estimating β); pre-pandemic WHO-5 <50, new pre-to-intra-pandemic WHO-5 <50 and WHO-5 decrease ≥10 (estimating ORs±95% CIs). Fixed effects were self-reported somatic and psychiatric diagnoses and within-and-across multimorbidities.
FINDINGS: Altogether, 121 066 adults (female=64.0%, white=69.0%, age=42.0±15.9 years, countries=155) with illnesses (any=49.8%/somatic=44.8%/psychiatric=16.3%) and multimorbidities (any=32.8%/somatic=27.3%/psychiatric=7.4%/somatic-psychiatric=10.8%) were analysed. Well-being was 2-3-fold worse with psychiatric disorders (pre-pandemic: autism-spectrum disorder (β=-7.00±2.93/OR=1.27-2.65), schizophrenia/schizoaffective disorder (β=-5.39±3.42/OR=1.09-2.64); pre-to-intra-pandemic: major depressive disorder (β=-2.45±0.89/OR=1.25-1.55), post-traumatic stress disorder (β=-1.98±1.42/OR=1.19-1.67)) versus somatic disorders (pre-pandemic: diarrhoea (β=-3.29±2.49/OR=1.11-2.15), chronic skin disease (CSD) (β=-2.53±1.44/OR=1.11-1.65); pre-to-intra-pandemic: CSD (β=-2.31±1.47/OR=1.23-1.75), injury (β=-2.22±0.99/OR=1.11-1.40)). Multimorbidities were associated with non-linear/supra-additive adverse outcomes beyond single disorders (pre-pandemic: anorexia nervosa+schizophrenia/schizoaffective disorder (β=-27.58±12.71/OR=1.41-19.94), inflammatory bowel disease+psychosis (β=-24.89±10.59/OR=2.68-24.25), stroke+osteoarthritis (β=-13.68±7.33/OR=1.23-6.48); pre-to-intra-pandemic: haemorrhoids+obsessive-compulsive disorder (β=-8.86±6.54/OR=1.22-5.21), binge-eating disorder/bulimia nervosa+social anxiety disorder (β=-6.87±5.49/OR=0.78-2.85), back pain+retinopathy (β=-6.55±6.54/OR=1.04-4.69)). Dose-response relationships were observed between the number of disorders and poorer well-being (pre-pandemic per diagnosis: psychiatric (β=-1.22±0.23/OR=1.11-1.17), somatic (β=-0.21±0.13/OR=1.02-1.05); pre-to-intra-pandemic per diagnosis: psychiatric (β=-0.37±0.24/OR=1.04-1.10)).
CONCLUSIONS: Poor well-being and further decline under stress were observed particularly with psychiatric illnesses and complex psychiatric and mixed psychiatric-somatic multimorbidity.
CLINICAL IMPLICATIONS: The finding of supra-additive multimorbidity burden highlights a need for targeted care models, beyond individual conditions. Vulnerable groups require support during crises, beyond COVID-19.
OBJECTIVE: We aimed to identify high-risk disorder profiles for lower well-being and well-being decline under stress, modelling COVID-19 as a natural experiment.
METHODS: The global Collaborative Outcomes Study on Health and Functioning during Infection Times survey assessed the World Health Organization-Five Well-being Index (WHO-5) (0-100) retrospectively pre-pandemic and intra-pandemically. Mixed-effects models, controlling for demographic/pandemic-related covariates, examined coprimary outcomes: total pre-pandemic WHO-5 and pre-to-intra-pandemic change (estimating β); pre-pandemic WHO-5 <50, new pre-to-intra-pandemic WHO-5 <50 and WHO-5 decrease ≥10 (estimating ORs±95% CIs). Fixed effects were self-reported somatic and psychiatric diagnoses and within-and-across multimorbidities.
FINDINGS: Altogether, 121 066 adults (female=64.0%, white=69.0%, age=42.0±15.9 years, countries=155) with illnesses (any=49.8%/somatic=44.8%/psychiatric=16.3%) and multimorbidities (any=32.8%/somatic=27.3%/psychiatric=7.4%/somatic-psychiatric=10.8%) were analysed. Well-being was 2-3-fold worse with psychiatric disorders (pre-pandemic: autism-spectrum disorder (β=-7.00±2.93/OR=1.27-2.65), schizophrenia/schizoaffective disorder (β=-5.39±3.42/OR=1.09-2.64); pre-to-intra-pandemic: major depressive disorder (β=-2.45±0.89/OR=1.25-1.55), post-traumatic stress disorder (β=-1.98±1.42/OR=1.19-1.67)) versus somatic disorders (pre-pandemic: diarrhoea (β=-3.29±2.49/OR=1.11-2.15), chronic skin disease (CSD) (β=-2.53±1.44/OR=1.11-1.65); pre-to-intra-pandemic: CSD (β=-2.31±1.47/OR=1.23-1.75), injury (β=-2.22±0.99/OR=1.11-1.40)). Multimorbidities were associated with non-linear/supra-additive adverse outcomes beyond single disorders (pre-pandemic: anorexia nervosa+schizophrenia/schizoaffective disorder (β=-27.58±12.71/OR=1.41-19.94), inflammatory bowel disease+psychosis (β=-24.89±10.59/OR=2.68-24.25), stroke+osteoarthritis (β=-13.68±7.33/OR=1.23-6.48); pre-to-intra-pandemic: haemorrhoids+obsessive-compulsive disorder (β=-8.86±6.54/OR=1.22-5.21), binge-eating disorder/bulimia nervosa+social anxiety disorder (β=-6.87±5.49/OR=0.78-2.85), back pain+retinopathy (β=-6.55±6.54/OR=1.04-4.69)). Dose-response relationships were observed between the number of disorders and poorer well-being (pre-pandemic per diagnosis: psychiatric (β=-1.22±0.23/OR=1.11-1.17), somatic (β=-0.21±0.13/OR=1.02-1.05); pre-to-intra-pandemic per diagnosis: psychiatric (β=-0.37±0.24/OR=1.04-1.10)).
CONCLUSIONS: Poor well-being and further decline under stress were observed particularly with psychiatric illnesses and complex psychiatric and mixed psychiatric-somatic multimorbidity.
CLINICAL IMPLICATIONS: The finding of supra-additive multimorbidity burden highlights a need for targeted care models, beyond individual conditions. Vulnerable groups require support during crises, beyond COVID-19.