Health
Impact of Covid-19 on people affected by bipolar disorder – early findings

By Simon Kitchen - Integrated Care Journal

Covid-19 has had a profound impact on the UK both in terms of the virus and the measures taken to contain it. Bipolar disorder is a severe mental illness characterised by extreme highs that can result in psychosis and hospitalisation, and extreme lows that can result in suicide. There are 1.3 million people living with the condition in the UK.

Bipolar UK conducted an online survey between 30 April and 13 May, which collected 1,751 responses from people affected by bipolar. Ninety per cent of respondents were living with a diagnosis, with the remaining 10 per cent either pre-diagnosis or directly impacted by the condition as close family and friends. The survey asked a range of questions from access to services and mental health.

Exposure to Covid-19

The direct physical impact of the virus has been limited with only 13 (0.75 per cent) testing positive and five (0.75 per cent) requiring hospitalisation. Possible exposure has been a lot broader, with 15 per cent having had Covid-19 symptoms and 16 per cent with close friends and family with symptoms. Thirty-one per cent in total know someone who has had Covid-19, indicating that it is a real concern and danger.


Impact on mental health

To assess people’s mental health the survey used a Mood Scale to help people track their moods. The scale ranges from extremely low (recurring suicidal thoughts) at 0 through to extremely high (mania, psychosis, hallucinations) at 10. Five is a balanced mood and normal range for people not living with bipolar or people with bipolar managing effectively is between 4 and 6. Participants were asked to retrospectively rate their mood pre-pandemic (mid-March) and then again during the pandemic (late April/early May).

The research highlights a marked deterioration of people’s mental health. The number of people in a stable mood (5) more than halved from 35 per cent to 16 per cent. Those in normal mood range (4 to 6) decreased from 69 per cent to 42 per cent. This suggests that around 58 per cent of people living with bipolar are now unwell and require additional support. There has been a slight increase in mania, although the biggest shift has been in rising anxiety and depression, with those rating themselves 0 to 3 more than doubling from 21 per cent to 45 per cent.

Increasing suicide and self-harm

When asked about suicide, of the 1,484 people who responded to the question, 31.06 per cent said they had had more suicidal thoughts since the start of the pandemic, 17 (1.15 per cent) people had attempted suicide and 9 (0.61 per cent) required hospitalisation. Just as worryingly, 117 people (7.88 per cent) reported self-harming. Tragically, four people completing the survey about a close family member or friend reported that their loved one had committed suicide.

What’s driving the mental health crisis?

The Covid-19 pandemic is clearly having a devastating impact on the mental health of people affected by bipolar, with big increases in anxiety, depression and suicidal thoughts. But what’s driving it? When asked what their greatest worry was, 48.76 per cent of respondents said it was catching coronavirus. In comparison 22.09 per cent feared relapsing (entering a serious manic or depressive episode), 16.19 per cent worried about the financial impact and 13.12 per cent were concerned about the wider impact on the country.

When asked about the lockdown (Q4 below), 58.50 per cent said they wanted it to continue, 14.63 per cent wanted lighter restrictions and only 26.87 per cent wanted much greater freedom. This is particularly remarkable given that people with bipolar are disproportionately impacted by the lockdown as it is much harder for them to access the health services needed to stay well, such as psychiatrists, GPs and pharmacists, and they have seen significant disruption to their self-management routines.


Conclusions

Covid-19 has had a severe impact on the mental health of people affected by bipolar disorder, particularly those living with the condition. Levels of anxiety and depression have more than doubled and there has been a potentially devastating rise in suicides. It appears to be the fear of the virus which is driving this, rather than the consequences of the lockdown. It is therefore likely that, even after the lockdown is gradually lifted, the mental health crisis for people affected by bipolar will continue until the prevalence of the virus is dramatically reduced.

It is worth noting that, despite widespread exposure to the virus (31 per cent know someone who thinks they have had it), more respondents have reported attempted suicide than have tested positive for the virus. Almost twice the number of people have been hospitalised for suicide attempts as have been hospitalised for coronavirus itself. Four people have also committed suicide.

Further research will need to be undertaken, but it appears that fear of the virus is proving as deadly to people living with bipolar as the virus itself.


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