Psychological implications of coronavirus disease 2019 outbreak in patients with chronic diseases: A systematic review

Farzin Bagheri Sheykhangafshe, Maryam Esmaeilinasab

DOI: 10.22122/cdj.v9i3.629


BACKGROUND: During the coronavirus 2019 (Covid-19) pandemic, patients with chronic diseases faced many challenges like greater risk of Covid-19 and delay in treatment which increase the possibility of psychological problems in these individuals. In this regard, the present study was conducted to investigate the psychological consequences of the Covid-19 epidemic in this group of patients.

METHODS: In this systematic review study, published articles on the psychological consequences of the Covid-19 outbreak in 2020 were reviewed. Keywords including Coronavirus 2019 (COVID-19), Psychological Implications, Epidemic, Mental Health, and Chronic diseases were searched in the title and abstract of articles published in reputable international scientific databases and all related English articles were listed and 30 qualified articles were reviewed.

RESULTS: According to the collected data, loneliness increased stress and anxiety, and decreased sleep quality. Moreover, post-traumatic stress, panic attacks, and depressive and anxiety symptoms were the most important psychological consequences of the Covid-19 epidemic for people with chronic diseases. Female gender, old age, longer history of chronic disease, and lack of social support were associated with increased psychological problems. Increased fear and anxiety in caregivers and related health personnel were other results of the study.

CONCLUSION: Many people with chronic illnesses have suffered from psychological problems during the outbreak of
COVID-19. Furthermore, the extent of these problems depends on the characteristics of the chronic disease, and individuals’ demographic and ecological characteristics, which emphasizes the need for designing individualized programs.


COVID-19; Chronic diseases; Mental Health; Psychological Implications

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World Health Organization. Laboratory testing for coronavirus disease 2019 (COVID-19) in suspected human cases: interim guidance [Online]. [cited 2020]; Available from: URL:

Basile C, Combe C, Pizzarelli F, Covic A, Davenport A, Kanbay M, et al. Recommendations for the prevention, mitigation and containment of the emerging SARS-CoV-2 (COVID-19) pandemic in haemodialysis centres. Nephrol Dial Transplant 2020; 35(5): 737-41.

Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al. Characteristics and outcomes of 21 critically Ill patients with COVID-19 in Washington State. JAMA 2020; 323(16): 1612-4.

Phan LT, Nguyen TV, Luong QC, Nguyen TV, Nguyen HT, Le HQ, et al. Importation and human-to-human transmission of a novel coronavirus in vietnam. N Engl J Med 2020; 382(9): 872-4.

Pellino G, Spinelli A. How Coronavirus Disease 2019 Outbreak is impacting colorectal cancer patients in Italy: A long shadow beyond infection. Dis Colon Rectum 2020; 63(6): 720-2.

World Health Organization. Noncommunicable diseases [Online]. [cited 2018]; Available from: URL:

Pryor L, Da Silva MA, Melchior M. Mental health and global strategies to reduce NCDs and premature mortality. Lancet Public Health 2017; 2(8): e350-e351.

Addis SG, Nega AD, Miretu DG. Psychological impact of COVID-19 pandemic on chronic disease patients in Dessie town government and private hospitals, Northeast Ethiopia. Diabetes Metab Syndr 2021; 15(1): 129-35.

Ngo VK, Rubinstein A, Ganju V, Kanellis P, Loza N, Rabadan-Diehl C, et al. Grand challenges: Integrating mental health care into the non-communicable disease agenda. PLoS Med 2013; 10(5): e1001443.

Yao H, Chen JH, Xu YF. Rethinking online mental health services in China during the COVID-19 epidemic. Asian J Psychiatr 2020; 50: 102015.

Guo Y, Li Y, Monroe-Wise A, Yeung SJ, Huang Y. A dynamic residential community-based quarantine strategy: China's experience in fighting COVID-19. Infect Control Hosp Epidemiol 2020; 41(11): 1363-4.

Jeong H, Yim HW, Song YJ, Ki M, Min JA, Cho J, et al. Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiol Health 2016; 38: e2016048.

Lee SM, Kang WS, Cho AR, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry 2018; 87: 123-7.

Saqib MAN, Siddiqui S, Qasim M, Jamil MA, Rafique I, Awan UA, et al. Effect of COVID-19 lockdown on patients with chronic diseases. Diabetes Metab Syndr 2020; 14(6): 1621-3.

Louvardi M, Pelekasis P, Chrousos GP, Darviri C. Mental health in chronic disease patients during the COVID-19 quarantine in Greece. Palliat Support Care 2020; 18(4): 394-9.

Sayeed A, Kundu S, Al Banna MH, Christopher E, Hasan MT, Begum MR, et al. Mental health outcomes of adults with comorbidity and chronic diseases during the COVID-19 pandemic: A matched case-control study. Psychiatr Danub 2020; 32(3-4): 491-8.

Lai AG, Pasea L, Banerjee A, Hall G, Denaxas S, Chang WH, et al. Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study. BMJ Open 2020; 10(11): e043828.

Ziade N, El Kibbi L., Hmamouchi I, Abdulateef N, Halabi H, Hamdi W, et al. Impact of the COVID-19 pandemic on patients with chronic rheumatic diseases: A study in 15 Arab countries. Int J Rheum Dis 2020; 23(11): 1550-7.

Trindade IA, Ferreira NB. COVID-19 pandemic's effects on disease and psychological outcomes of people with inflammatory bowel disease in Portugal: A preliminary research. Inflamm Bowel Dis 2020; izaa261.

Joensen LE, Madsen KP, Holm L, Nielsen KA, Rod MH, Petersen AA, et al. Diabetes and COVID-19: Psychosocial consequences of the COVID-19 pandemic in people with diabetes in Denmark-what characterizes people with high levels of COVID-19-related worries? Diabet Med 2020; 37(7): 1146-54.

Alessi J, de Oliveira GB, Franco DW, Brino do Amaral B, Becker AS, Knijnik CP, et al. Mental health in the era of COVID-19: Prevalence of psychiatric disorders in a cohort of patients with type 1 and type 2 diabetes during the social distancing. Diabetol Metab Syndr 2020; 12: 76.

Al-Hashel JY, Ismail II. Impact of coronavirus disease 2019 (COVID-19) pandemic on patients with migraine: A web-based survey study. J Headache Pain 2020; 21(1): 115.

Ma M, Fang J, Li C, Bao J, Zhang Y, Chen N, et al. The status and high risk factors of severe psychological distress in migraine patients during nCOV-2019 outbreak in Southwest China: A cross-sectional study. J Headache Pain 2020; 21(1): 100.

Teixeira L, de Freitas RL, Abad A, da Silva JA, Antonelli-Ponti M, Bastos S, et al. Anxiety-related psychological impacts in the COVID-19 pandemic on cardiovascular diseases and diabetes. 2020.

Marbaniang I, Sangle S, Nimkar S, Zarekar K, Salvi S, Chavan A, et al. The burden of anxiety during the COVID-19 pandemic among people living with HIV (PLHIV) in Pune, India. Res Sq 2020;

Sun S, Hou J, Chen Y, Lu Y, Brown L, Operario D. Challenges to HIV care and psychological health during the COVID-19 pandemic among people living with HIV in China. AIDS Behav 2020; 24(10): 2764-5.

Kuman Tuncel O., Pullukcu H, Erdem HA, Kurtaran B, Tasbakan SE, Tasbakan M. COVID-19-related anxiety in people living with HIV: An online cross-sectional study. Turk J Med Sci 2020; 50(8): 1792-800.

Kosir U, Loades M, Wild J, Wiedemann M, Krajnc A, Roskar S, et al. The impact of COVID-19 on the cancer care of adolescents and young adults and their well-being: Results from an online survey conducted in the early stages of the pandemic. Cancer 2020; 126(19): 4414-22.

Chen G, Wu Q, Jiang H, Zhang H, Peng J, Hu J, et al. Fear of disease progression and psychological stress in cancer patients under the outbreak of COVID-19. Psychooncology 2020; 29(9): 1395-8.

Seyahi E, Poyraz BC, Sut N, Akdogan S, Hamuryudan V. The psychological state and changes in the routine of the patients with rheumatic diseases during the coronavirus disease (COVID-19) outbreak in Turkey: A web-based cross-sectional survey. Rheumatol Int 2020; 40(8): 1229-38.

Brady SM, Fenton SAM, Metsios GS, Bosworth A, Duda JL, Kitas GD, et al. Different types of physical activity are positively associated with indicators of mental health and psychological wellbeing in rheumatoid arthritis during COVID-19. Rheumatol Int 2021; 41(2): 335-44.

Picchianti Diamanti A., Cattaruzza MS, Di Rosa R., Del Porto F., Salemi S, Sorgi ML, et al. Psychological distress in patients with autoimmune arthritis during the COVID-19 Induced Lockdown in Italy. Microorganisms 2020; 8(11).

Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72314 cases from the Chinese center for disease control and prevention. JAMA 2020; 323(13): 1239-42.

Willis MD, Robertson NP. Multiple sclerosis and the risk of infection: Considerations in the threat of the novel coronavirus, COVID-19/SARS-CoV-2. J Neurol 2020; 267(5): 1567-9.

Moujaess E, Kourie HR, Ghosn M. Cancer patients and research during COVID-19 pandemic: A systematic review of current evidence. Crit Rev Oncol Hematol 2020; 150: 102972.

Banerjee D. The COVID-19 outbreak: Crucial role the psychiatrists can play. Asian J Psychiatr 2020; 50: 102014.

Gifford W, Davies B, Edwards N, Griffin P, Lybanon V. Managerial leadership for nurses' use of research evidence: An integrative review of the literature. Worldviews Evid Based Nurs 2007; 4(3): 126-45.

Mosli M, Alourfi M, Alamoudi A, Hashim A, Saadah O, Al Sulais E, et al. A cross-sectional survey on the psychological impact of the COVID-19 pandemic on inflammatory bowel disease patients in Saudi Arabia. Saudi J Gastroenterol 2020; 26(5): 263-71.

Swainston J, Chapman B, Grunfeld EA, Derakshan N. COVID-19 lockdown and its adverse impact on psychological health in breast cancer. Front Psychol 2020; 11: 2033.

Tee CA, Salido EO, Reyes PWC, Ho RC, Tee ML. Psychological state and associated factors during the 2019 coronavirus disease (COVID-19) pandemic among Filipinos with rheumatoid arthritis or systemic lupus erythematosus. Open Access Rheumatol 2020; 12: 215-22.

Garutti M, Cortiula F, Puglisi F. Seven Shades of Black Thoughts: COVID-19 and Its Psychological Consequences on Cancer Patients. Front Oncol 2020; 10: 1357.

Cui Q, Cai Z, Li J, Liu Z, Sun S, Chen C, et al. The Psychological Pressures of Breast Cancer Patients During the COVID-19 Outbreak in China-A Comparison with Frontline Female Nurses. Front Psychiatry 2020; 11: 559701.

Gebbia V, Piazza D, Valerio MR, Borsellino N, Firenze A. Patients with cancer and COVID-19: A whatsapp messenger-based survey of patients' queries, needs, fears, and actions taken. JCO Glob Oncol 2020; 6: 722-9.

Ng KYY, Zhou S, Tan SH, Ishak NDB, Goh ZZS, Chua ZY, et al. Understanding the psychological impact of COVID-19 pandemic on patients with cancer, their caregivers, and health care workers in singapore. JCO Glob Oncol 2020; 6: 1494-509.

Wang Y, Duan Z, Ma Z, Mao Y, Li X, Wilson A, et al. Epidemiology of mental health problems among patients with cancer during COVID-19 pandemic. Transl Psychiatry 2020; 10(1): 263.

Mukona DM. Diabetes mellitus and depression amid the COVID-19 pandemic: Possible solutions for resource limited settings. African J Diabetes Med 2020; 28(1): 1-3.

Dodesini AR, Caffi A, Spada MS, Trevisan R. Resilience in pregnant women with pre-gestational diabetes during COVID-19 pandemic: The experience of the Papa Giovanni XXIII Hospital in Bergamo, Italy. Acta Diabetol 2021; 58(3): 397-9.

Singhai K, Swami MK, Nebhinani N, Rastogi A, Jude E. Psychological adaptive difficulties and their management during COVID-19 pandemic in people with diabetes mellitus. Diabetes Metab Syndr 2020; 14(6): 1603-5.

Koppert TY, Jacobs JWG, Geenen R. The psychological impact of the COVID-19 pandemic on Dutch people with and without an inflammatory rheumatic disease. Rheumatology (Oxford) 2020; keaa842.


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