Digital archive of theses discussed at the University of Pisa


Thesis etd-10262022-143838

Thesis type
Tesi di specializzazione (4 anni)
Thesis title
Psychpathological trajectories in patients with mental disorders during the COVID-19 pandemic: a national multicenter naturalistic longitudinal study
Course of study
relatore Prof.ssa Carmassi, Claudia
  • Covid-19
  • Trauma
  • Mental disorders
  • Confinement
Graduation session start date
Release date

The global COVID-19 pandemic represented a traumatic condition never previously experienced in history, in terms of severity and extent, to which the entire world population has been subjected. It has generated major mental and psychological health problems worldwide. In particular, the restrictive measures of confinement generated a climate of isolation and severe personal, social and work limitations. The constant threat of contagion, fear of running into serious economic difficulties, and the potential loss of loved ones, allows us to frame the pandemic as a true traumatic event. Moreover, anxiety and depression following a traumatic event is an extremely common occurrence. These symptoms are in frequent comorbidity with PTSD and, if present, can give rise to complications of the clinical picture. The objective of the study is to prospectively examine psychopathological and functioning trajectories in a sample of subjects with mental disorder followed on an outpatient basis at nine Italian psychiatric clinics.
Material and method: This study was coordinated by Azienda Ospedaliera Universitaria Pisana included a sample of 300 subjects with an heterogeneous range of mental disorders, diagnosed according DSM-5-TR criteria. The study assessments were conducted at three time points, namely T0, T1 and T2. The enrollment period and the first assessment (T0) started on March 15th and ended on 15th November 2021 (T2). A K-Means Cluster Analysis was used to identify four different groups based on the trend of work and social functioning impairment, according to the WSAS mean scores. Furthemore, anxiety, depressive and post-traumatic symptoms were assessed by means of Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-9) and IES respectively, in the total sample and in the four functioning groups. Socio-demographic and COVID-19 related variables were collected through a specially formulated case report form (CRF).
The sample included 186 (62.0%) females and 114 males (38.0%). The mean age was 42.70 ± 16.84. We defined 4 groups of subjects determined by the second K-means Cluster Analysis: the Resilience group (N= 77), the Improvement Functioning group (N=62), the Progressive Impairment group (N=83) and the Persistent Severe Impairment group (N=78) respectively. The four group resulted to be quite homogeneous in terms of sociodemographic and Covid-19 related variables. In addition, significant differences were found among the four functioning groups in the pattern on anxiety, depressive and post-traumatic symptoms.
The longitudinal design of the study identified three groups, distinguished by the trajectories observed with respect to the above symptoms: a group characterized by a lower symptom burden and a stable good functioning (Resilience group), a group characterized by a marked improvement in functioning and psychiatric symptoms over time (Improvement Functioning group), a group with a progressive deterioration in functioning and a slight improvement in anxiety, depressive, and post-traumatic symptoms (Progressive Impairment group) and a group that has maintained consistently high levels of social and psychological impairment (Persistent Severe Impairment group). The groups identified on the basis of functioning appeared homogeneous for most of the variables analyzed, and among the different groups, the Resilience group was most associated with variables related to lower risk of developing psychological consequences during the pandemic. As the widespread concern about the pandemic COVID-19 impact on people with mental disorders is well grounded, further longitudinal studies are required to define the long-term evolution of the psychopathological reaction and develop specific intervention strategies.