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Screening and monitoring patients at high risk for mental health issues in COVID-19: a multicenter pre-post assessment study

BMC Psychology volume 13, Article number: 226 (2025) Cite this article

Abstract

Purpose

This study aimed to present the methods for screening, monitoring, and intervening with patients at high risk for mental health issues with COVID-19 at residential treatment centers, which are isolation treatment facilities for COVID-19 patients.

Methods

We evaluated the mental health status of COVID-19 patients in three residential treatment centers. At admission and one day before discharge, patients received via their mobile a questionnaire containing one question each on anxiety, subjective psychological distress, post-traumatic stress symptoms, depression and suicidal ideation to identify those at high risk for mental health issues. High-risk patients and normal-risk participants who requested consultation were referred for psychological counseling. We evaluated the participants’ clinical and mental health characteristics and performed a logistic regression analysis to identify factors associated with worsened depression and suicide risk at discharge.

Results

Of 5,163 qualifying patients, 1,941 patients (37.6%) had their mental health assessed both at admission and discharge. In total, 661 persons (34.1%) required mental health support at admission and 648 persons (33.4%) at discharge. The patients at high risk for mental health issues at admission had an odds ratio of 5.31 (95% CI: 4.23–6.66) for depression at discharge, compared to those with normal mental health status at admission. The group that requested professional psychological counseling at admission showed an odds ratio of 2.33 (95% CI: 1.31–4.13) for depression at discharge.

Conclusions

Repeated mental health monitoring is crucial for COVID-19 patients. Additionally, a flexible intervention strategy should be developed to implement different screening methods for patients at high risk for mental health issues, depending on the status of the COVID-19 epidemic and available resources.

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Introduction

Since the World Health Organization declared the COVID-19 pandemic in March 2020 [1], over 600 million patients (January 2023) have been infected worldwide, of which over 6 million patients died [2]. Over the last 3 years, the world has made efforts to prevent the spread of COVID-19, and before the development of COVID-19 vaccines, the use of masks and social distancing to minimize interpersonal contact were the major preventive measures [3, 4]. In Republic of Korea (hereinafter Korea), the infectious disease alert level remained at the highest level from February 2020 to May 2023, and confirmed cases were required to undergo mandatory isolation for at least seven days. While these measures might have been effective against the spread of COVID-19, they considerably altered people’s daily lives. People had their freedom restricted, and concerns were continually raised about negative mental health effects [5,6,7].

The negative psychological impact of COVID-19 may appear more significantly in COVID-19 patients compared to the general population. Some infected patients may experience adverse effects on their mental health, not only due to fear of their worsening health condition but also due to isolation caused by quarantine, concerns about transmission, and social stigma [5, 8, 9]. COVID-19 patients reported various psychiatric symptoms, including depression and anxiety, sleep disorders, insomnia, and rage, more frequently than control groups [10,11,12]. Accordingly, support systems for mental health are as important as those for physical symptoms in COVID-19 patients.

Previous studies have emphasized the importance of psychological support for COVID-19 patients [10,11,12], but specific plans of how to support these patients are rare. Future discussions need to focus on mental health screening, monitoring, and intervention programs for patients with COVID-19. It must also be considered how to prioritize limited mental health resources when tens of thousands of new COVID-19 cases are diagnosed per day. That is, health care providers and policymakers need to consider the overall COVID-19 incidence rate, local health care resource conditions, and other factors when developing a plan to address mental health issues related to COVID-19.

Thus, this study aimed to report on the mental health management of patients with mild COVID-19 in select residential treatment centers in Korea at the peak of the COVID-19 epidemic. More specifically, the purpose of this study was to describe the methods of screening and monitoring and the interventions attempted for the group at high risk for mental health issues among COVID-19 patients.

Methods

This study was designed as a repeated-measures study involving a single group. To screen for individuals at high risk for mental health issues, mental health status was evaluated at two time points: upon admission (pre) and upon discharge (post). The degree of change was analyzed by comparing mental health status between these time points.

Management of the residential treatment centers

In the early stages of the COVID-19 pandemic in Korea, all patients were hospitalized in a medical institution for treatment. Following the rapid increase in the number of confirmed COVID-19 cases in March 2020, the shortage of hospital beds worsened, and the need to distribute beds based on severity was raised [13]. Thus, a system was implemented for monitoring and managing symptoms by providing inpatient treatment at medical institutions, such as hospitals specialized in infectious diseases, for patients with severe symptoms or underlying diseases, while providing separate treatment and quarantine facilities, called residential treatment centers, for patients with mild symptoms [14]. The staff at residential treatment centers checked patients’ vital signs and health condition daily while performing medical tasks including drug prescriptions for symptom management, sample collection for polymerase chain reaction testing, and chest X-rays. If a patient’s health worsened, they were rapidly transferred to a medical institution [15]. In addition, two suicides among isolated patients at residential treatment centers occurred in March and May 2021, leading to the strengthening and mandatory implementation of mental health monitoring and interventions.

Data sources and data collection

The target population of this study consisted of patients admitted to the Gyeongnam Residential Treatment Center 2, which was managed jointly by Busan Metropolitan City, Ulsan Metropolitan City, and Gyeongsangnamdo–three of Korea’s 17 administrative divisions (operating period: June 3, 2021, to April 6, 2022). Additionally, patients from Ulsan Residential Treatment Center 1 (June 3, 2021, to January 10, 2022) and Ulsan Residential Treatment Center 2 (August 17, 2021, to May 6, 2022), both managed by Ulsan Metropolitan City, were included. Patients admitted to the residential treatment centers had their overall clinical signs and condition stored in electronic medical records, and information on their demographic and clinical characteristics was standardized and organized. Additionally, the mental health status of the study participants–assessing five areas: anxiety, post-traumatic stress, subjective psychological distress, depression, and suicidal ideation–was surveyed using a structured self-administered questionnaire. The survey was conducted twice: at admission and one day before discharge. It was distributed and collected via mobile devices, as all patients in the residential treatment centers had access to a mobile phone.

The questionnaire period ranged from June 3, 2021, to May 6, 2022. In relation to the COVID-19 pandemic stages, the questionnaire period included the 3rd phase of nationwide spreading (June 3, 2021, to July 6, 2021), the 4th phase of the delta variant (July 7, 2021, to January 29, 2022), and the 5th phase of the omicron variant (January 30, 2022, to May 6, 2022) [16]. The sample for this study consisted of patients who underwent basic investigations at both admission and discharge, and whose mental health status changes were measured between these two time points. The final sample size was 1,941 persons (Gyeongnam 2 n = 750, Ulsan 1 n = 211, Ulsan 2 n = 980).

Mental health assessment and referral to psychological support

In Korea, “COVID-19 integrated psychological support teams,” formed in February 2020 and managed by national regional trauma centers, the National Mental Health Center, metropolitan districts, and basic mental health welfare centers, began to provide psychological support to COVID-19 patients, their families, and other quarantined individuals. The psychological support consisted of sending a text message providing information about psychological support, performing mental health assessments, and screening the high-risk group, then providing psychological counseling and treatment programs for this group. Depending on the patient’s course, counseling could be stopped, or they could be referred to a basic mental health welfare center or a medical institution [17].

Mental health management and psychological support at residential treatment centers

Measures to enhance psychological support for patients at residential treatment centers were introduced in May 2021. A mental health manager was designated within the center, mental health assessments were conducted, and patients requiring counseling were referred to a national regional trauma center or a regional mental health welfare center, where they received psychological counseling. Mental health and psychological support for patients admitted to the residential treatment centers in this study started on June 3, 2021.

There was a need to modify and improve assessment instruments that can reduce fatigue caused by mental health assessments in patients already experiencing mental and physical distress, that can be applied in real-world settings, and that enable rapid screening of high-risk patients. There was also a need for non-contact methods to allow healthcare workers to assess mental health without the risk of COVID-19 transmission. Therefore, we developed a mental health assessment questionnaire that could be sent by text message. The questionnaire consisted of simple questions used in existing mental health assessment systems, including one question on post-traumatic stress (4-point Likert scale), one question on depression (4-point Likert scale), one question on subjective psychological distress (visual analogue scale [VAS]), one question on suicidal ideation (4-point Likert scale), and one question on anxiety (VAS; Supplementary Tables 1,2) [18,19,20].

This questionnaire was sent to consenting patients at the participating residential treatment centers. The high-risk group was defined as patients meeting at least one of the following criteria: a score of ≥ 3 points for post-traumatic stress, ≥ 2 points for depression, ≥ 7 points for psychological distress, or ≥ 2 points for suicidal ideation. Consenting patients in the normal-risk group who applied for counseling and patients in the high-risk group who were re-evaluated by telephone regarding required mental health and psychological support were referred to either the Yeongnam Regional Trauma Center or the Ulsan Regional Mental Health Welfare Center, where they were able to receive psychological counseling. For patients who refused or were unable to complete the questionnaire, the need for referral to psychological support was re-confirmed by telephone, and if they consented, they were referred (Fig. 1). This process was conducted twice: once at admission and once before discharge. The goal was to reduce the risk level for high-risk patients at admission by providing psychosocial support services from specialists, and to manage risks by continuing to offer necessary psychosocial support at discharge. Additionally, for all patients, psychosocial support services from specialists were made available during the isolation period if the patient voluntarily requested it.

Fig. 1
figure 1

Stages and recipients of mental health and psychological support

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At the Yeongnam Regional Trauma Center and the Ulsan Regional Mental Health Welfare Center, telephone counseling was provided to patients quarantined at residential treatment centers, and depending on their mental health condition, regular monitoring continued or counseling was initiated. For patients requiring continual management, relevant information was shared with the staff-in-charge at the residential treatment center, and if it was considered to be a psychiatric emergency, the patient was referred as an inpatient to a medical institution. If necessary, the patient’s course was monitored for a certain period after discharge.

Statistical analysis

We investigated the clinical characteristics and the distribution of mental health conditions among participants before and after admission, and in different phases of the pandemic. Patients were categorized into the normal-risk or high-risk group depending on their mental health condition, and a test of homogeneity was performed to assess changes over time. We performed logistic regression analysis to investigate the factors related to the worsening risk of depression and suicidal ideation at discharge. Here, the mental health risk at admission (a composite of the four domains of psychological distress, post-traumatic stress, depression, and suicidal ideation), as well as anxiety, psychological distress, post-traumatic stress, and other clinical characteristics at discharge were included as independent variables. Depression risk at discharge was added as an independent variable to the suicidal ideation model. For each analysis, we differentiated between Model 1, in which all variables were included, and Model 2, which was designed using backward variable selection. We used SAS (Version 9.4, SAS Institute, Cary, NC, USA) for all statistical analyses. All tests were performed at a significance level of 5%.

Results

Patient characteristics

Of the patients admitted to the participating residential treatment centers, we excluded 319 children aged < 10 years and 381 patients who had been transferred from another center, resulting in 5,163 potential participants (Fig. 1). Mental health was assessed in 2,812 persons (54.5%) at admission, 2,682 persons (51.9%) at discharge, and 1,941 persons (37.6%) at both admission and discharge. When these 1,941 study participants were divided by the phase of the pandemic, 246 persons (12.7%) were from the 3rd phase, 999 persons (51.5%) from the 4th phase, and 696 persons (35.9%) from the 5th phase (Table 1). Although not reported in the table, the mean (± standard deviation) length of stay for the patients was 8.48 (± 2.12) days. The mean time between data collection at admission and discharge was 7.48 days.

Table 1 Socio-demographic characteristics of participants in this study
Full size table

Of all study participants, 62.9% were male, 53.6% were aged 20–39 years, and 30.8% were aged 40–59 years, comprising a large proportion of the participants. Non-psychiatric underlying diseases, such as respiratory disease, were reported by 13.4% of the participants, whereas 1.3% of the participants reported previous diagnoses with a psychiatric illness, such as anxiety, panic attacks, sleep disorders, depression, social avoidance, or ADHD. COVID-19-related symptoms, such as coughing, fever, headaches, and sore throat were observed in 74.4% of participants.

Of all participants, 635 persons (32.7%) were in the group at high risk for mental health issues at admission, and 631 persons (32.5%) were in this group at discharge. Specifically, 27.4% of the participants were in the high depression risk group at admission and 31.4% at discharge, whereas 6.0% were in the high suicidal ideation risk group at admission and 4.0% at discharge. After checking for consent, 661 persons (34.1%) at admission were referred to mental health and psychological support and 648 persons (33.4%) at discharge (Fig. 1). Of these participants, 39 persons actually received mental health and psychological support from the Ulsan Regional Mental Health Welfare Center. The number of participants who received psychological support at the Yeongnam Regional Trauma Center could not be confirmed.

Changes in mental health condition

Based on the mental health assessments at admission and discharge, the changes in mental health are shown in Table 2. The risk of depression increased from 27.4% (531 persons) at admission to 31.4% (609 persons) at discharge. Of the patients who were at high risk at admission, 60.1% maintained their status at discharge, whereas only 39.9% improved to normal risk. Furthermore, 20.6% of patients who were at normal risk at admission worsened to high risk at discharge. Conversely, the risk of psychological distress decreased from 10.1% (196 persons) at admission to 3.5% (68 persons) at discharge. The proportion of high-risk patients who maintained their status was 8.2%, and the proportion of normal-risk patients who worsened to high-risk was 1.6%.

Table 2 Changes in the mental health condition of patients quarantined at a residential treatment center
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Factors related to depression and suicidal ideation at discharge

When we analyzed the factors related to depression at discharge (based on Model 2), sex, age, high risk for mental health issues at admission, requesting professional psychological counseling at admission, the phase of the pandemic, psychological distress at discharge, and post-traumatic stress at discharge were all statistically significant variables (Table 3). In particular, the group of patients at high risk for mental health issues at admission showed an odds ratio of 5.31 for depression at discharge compared to the group with normal mental health risk at admission (95% confidence interval [CI]: 4.23–6.66). Likewise, the group that requested professional psychological counseling at admission showed an odds ratio of 2.33 for depression at discharge compared to the group that did not request counseling (95% CI: 1.31–4.13). When we analyzed the factors related to suicidal ideation at discharge (based on Model 2), high risk for mental health issues at admission, requesting professional psychological counseling at admission, psychological distress at discharge, post-traumatic stress at discharge, and depression at discharge were all statistically significant variables. In particular, the group with depression at discharge showed an odds ratio of 16.36 for suicidal ideation at discharge compared to the group without depression at discharge (95% CI: 6.27–42.66).

Table 3 Factors affecting mental health at discharge in patients quarantined at a residential treatment center
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Discussion

In this study, we explored our monitoring and intervention experiences regarding patients with mild COVID-19 symptoms who were at high risk for mental health issues. We assessed anxiety, subjective psychological distress, post-traumatic stress symptoms, depression and suicidal ideation in 5,163 COVID-19 patients at residential treatment centers in Korea before and after admission to identify those at high risk for mental health issues. At admission, one-third of patients were categorized as being at high risk for mental health issues, and this figure remained stable at discharge. Among these, 39 individuals were referred to and received mental health and psychological support. While prior studies underscored the importance of psychological support for COVID-19 patients [10,11,12], discussion of how to design mental health intervention models for these patients is rare. This study's key contribution lies in its efforts to develop effective mental health intervention models for COVID-19 patients.

A limitation of the proposed model is that only some identified high-risk COVID-19 patients were connected to mental health and psychological support systems. Despite screening the group at high risk for mental health issues through various psychological assessments, additional efforts are required beyond screening to ensure these patients receive the necessary support. Mental health issues cannot be resolved solely through simple online questionnaires; repeated assessments and guidance from specialists are essential. Even if a high-risk COVID-19 patient is identified, their utilization of support services cannot be enforced if they refuse. To enhance comprehensive psychological support, future efforts should focus on constructing an intervention model that includes management for patients resistant to psychological support and improving patients’ health literacy [21, 22].

Another crucial aspect of this study is the identification of changes in the mental health of COVID-19 patients before and after admission. Unlike previous studies limited to one-time measurements [10,11,12], we observed changes in mental health, highlighting the necessity for repeated assessments in these patients. For instance, the majority of patients with high depression risk at admission maintained their status at discharge, whereas only one-fifth of those initially categorized with normal depression risk shifted to the high-risk group. These findings underscore the importance of continuous mental health monitoring for COVID-19 patients. However, it will be necessary to agree through future research how often to monitor mental health in COVID-19 patients (e.g., 1 week, 1 month, etc.) [23].

When designing and implementing an intervention model, it is crucial to consider the need for monitoring mental health and providing psychological support services, especially with daily rates of tens of thousands of new COVID-19 patients. Limited public healthcare resources necessitate prioritizing mental health services based on the incidence, social perception of the disease, and disease severity and risk [24]. The study results revealed a significantly higher rate of high-risk patients in phases 3 and 4 compared to phase 5. Considering these results, comprehensive evaluation and intensive intervention for mental symptoms will be necessary in the early stages of an infectious disease epidemic when fear and stigma about infectious diseases are high. On the other hand, in situations where a large number of patients occur, there will be a need to focus more on screening high-risk groups.

We conducted a logistic regression analysis to identify factors related to depression or suicidal ideation at discharge, providing a useful reference for screening patients at high risk for mental health issues among COVID-19 cases. Depression at discharge was associated not only with sex, age, and pandemic phase but also with psychological distress and post-traumatic stress at discharge, indicating that psychiatric symptoms may often cluster with other chronic diseases or health behaviors [25,26,27]. We assessed four domains (post-traumatic stress, depression, psychological distress, and suicidal ideation), but should psychiatric symptoms cluster, it might be more efficient to focus on monitoring urgent symptoms like depression and suicidal ideation. Requesting professional psychological counseling at admission was also associated with depression at discharge, emphasizing that direct patient requests for psychological support can be crucial signals [28]. If separate screening for mental health in COVID-19 patients is challenging, providing information about psychological support services and monitoring patients who request these services might be an effective strategy for identifying high-risk patients.

One limitation of the current study is that, instead of using complete mental health monitoring scales, we only employed a subset of questions. This approach was chosen to facilitate rapid monitoring and interventions. However, further research is needed to confirm the validity of using a question subset to identify and monitor patients at high risk for mental health issues. Meanwhile, various countries have developed and utilized assessment tools to evaluate the mental health impact of COVID-19, such as anxiety and fear [29,30,31]. To prepare for future public health emergencies caused by infectious diseases, the need to proactively develop tailored mental health assessment tools designed for patients in clinical settings and for the general population is being raised. Another limitation is the inability to investigate long-term effects in COVID-19 patients who received mental health interventions. Given the need for repeated mental health assessments in COVID-19 patients, it is important to follow up with patients for at least 3 months after discharge to determine whether their symptoms have improved [32]. This follow-up may contribute to the development of an effective intervention model for mental health in COVID-19 patients.

Conclusion

COVID-19 still causes a considerable disease burden in several countries, and various interventions need to be explored to reduce its impact. Treating not only physical health but also mental health of COVID-19 patients is an essential consideration to reduce the disease burden due to COVID-19. In the event of a large-scale infectious disease outbreak, such as the COVID-19 pandemic, it will be crucial to continuously assess the mental health symptoms of affected individuals in order to identify those at high risk. Additionally, establishing a comprehensive and multi-tiered system for the provision of mental health support will be essential for effectively addressing the needs of high-risk groups. We anticipate that our experiences in managing the mental health of COVID-19 patients will support the development of programs to manage the mental health of COVID-19 patients in other countries as well. Moreover, our findings might serve as a reference to facilitate a more rapid development of mental health management and intervention models should an outbreak of an infectious disease other than COVID-19 occur.

Data availability

The data supporting all the findings in this study are available from the corresponding author with reasonable request.

Abbreviations

CI:

Confidence interval

References

  1. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta bio medica: Atenei parmensis. 2020;91(1):157.

    PubMed  Google Scholar 

  2. World Health Organization. WHO Coronavirus (COVID-19) Dashboard. Global Situation. [cited 2024 Jan 15]. Available from: https://covid19.who.int/.

  3. Howard J, Huang A, Li Z, Tufekci Z, Zdimal V, Van Der Westhuizen H-M, et al. An evidence review of face masks against COVID-19. Proc Natl Acad Sci. 2021;118(4):e2014564118.

    Article  PubMed  PubMed Central  Google Scholar 

  4. VoPham T, Weaver MD, Hart JE, Ton M, White E, Newcomb PA. Effect of social distancing on COVID-19 incidence and mortality in the US. medRxiv [Preprint]. 2020:2020.06.10.20127589.

  5. Chamaa F, Bahmad HF, Darwish B, Kobeissi JM, Hoballah M, Nassif SB, et al. PTSD in the COVID-19 Era. Curr Neuropharmacol. 2021;19(12):2164.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Serafini G, Parmigiani B, Amerio A, Aguglia A, Sher L, Amore M. The psychological impact of COVID-19 on the mental health in the general population. QJM. 2020;113(8):531–7.

    Article  PubMed  Google Scholar 

  7. Brailovskaia J, Margraf J. The relationship between burden caused by coronavirus (Covid-19), addictive social media use, sense of control and anxiety. Comput Human Behav. 2021;119:106720.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S, et al. Psychosocial impact of COVID-19. Diabetes Metab Syndr. 2020;14(5):779–88.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Li W, Yang Y, Ng CH, Zhang L, Zhang Q, Cheung T, et al. Global imperative to combat stigma associated with the coronavirus disease 2019 pandemic. Psychol Med. 2021;51(11):1957–8.

    Article  PubMed  Google Scholar 

  10. Lu X, Xie Y, Feng H, Liu Z, Ouyang K, Hou B, et al. Psychological impact on COVID-19 patients during the outbreak in China: A case-control study. Psychiatry Res. 2021;305:114180.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kim SB, Choi TY, Kim JW, Yoon SY, Won GH, Bong SH, et al. The Psychological Impact of Quarantine during COVID-19 Pandemic: A Cross-Sectional Study. J Korean Soc Biol Ther Psychiatry. 2022;28(1):27–39.

    Google Scholar 

  12. Wang M, Hu C, Zhao Q, Feng R, Wang Q, Cai H, et al. Acute psychological impact on COVID-19 patients in Hubei: a multicenter observational study. Transl Psychiatry. 2021;11(1):133.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Choi J, Park H, Kim S, Kim A, Park C-S. A Review of COVID-19 Initial Response Systems and A Proposal to Adjust the Operation of Residential treatment centers. Pub Health Affairs. 2021;5(1):e13.

  14. Kim SW, Lee KS, Kim K, Lee JJ, Kim JY; Daegu Medical Association. A Brief Telephone Severity Scoring System and Therapeutic Living Centers Solved Acute Hospital-Bed Shortage during the COVID-19 Outbreak in Daegu, Korea. J Korean Med Sci. 2020;35(15):e152.

  15. Korea Ministry of Health and Welfare. Guidelines for Operating Community Treatment Centers for Coronavirus Disease-19 (COVID-19) Response. [cited 2024 Jan 15]. Available from: https://policy.nl.go.kr/search/searchDetail.do?rec_key=SH2_PLC20210259443.

  16. Korea Disease Control and Prevention Agency. Outbreak report of COVID-19 during designation of class 1 infectious disease in the Republic of Korea (January 20, 2020 and April 24, 2022). Public Health Weekly Report. 2021;15(25):1759–72.

    Google Scholar 

  17. Korea Ministry of Health and Welfare. Guidelines for Psychological Support on COVID-19. [cited 2024 Jan 15]. Available from: https://nct.go.kr/serviceCenter/formatReferenceDetail.do?currentPageNo=1&refnceSeq=473&refnceCd=0006&searchCondition2=&searchKeyword1=%EC%8B%AC%EB%A6%AC%EC%A7%80%EC%9B%90.

  18. Jung YE, Kim D, Kim WH, Roh D, Chae JH, Park JE. A brief screening tool for PTSD: Validation of the Korean version of the primary care PTSD screen for DSM-5 (K-PC-PTSD-5). J Korean Med Sci. 2018;33(52):e338.

  19. Prins A, Bovin MJ, Smolenski DJ, Marx BP, Kimerling R, Jenkins-Guarnieri MA, et al. The primary care PTSD screen for DSM-5 (PC-PTSD-5): development and evaluation within a veteran primary care sample. J Gen Intern Med. 2016;31(10):1206–11.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Spitzer R, Kroenke K, Williams J. Patient Health Questionnaire Primary Care Study Group, & Patient Health Questionnaire Primary Care Study Group. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Jama. 1999;282(18):1737–1744.

  21. Hermans L, Van den Broucke S, Gisle L, Demarest S, Charafeddine R. Mental health, compliance with measures and health prospects during the COVID-19 epidemic: the role of health literacy. BMC Public Health. 2021;21:1–9.

    Article  Google Scholar 

  22. O’Cionnaith C, Wand AP, Peisah C. Navigating the minefield: managing refusal of medical care in older adults with chronic symptoms of mental illness. Clin Interv Aging. 2021;16:1315–25.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Maillet L, Goudet A, Godbout I, Ntanda GM, Laliberté G, Desjardins F, et al. Measuring the Optimal Time Interval Between Arrival and First Mental Health Evaluation’s for Refugees in Québec: A Scoping Review. Adm Policy Mental Health Mental Health Serv Res. 2023;50:1–13. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s10488-023-01257-y.

  24. Williams I, Essue B, Nouvet E, Sandman L, Razavi SD, Noorulhuda M, et al. Priority setting during the COVID-19 pandemic: going beyond vaccines. BMJ Glob Health. 2021;6(1):e004686.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Choi EY, Park YK, Ock M. Comparison of low-salt preference trends and regional variations between patients with major non-communicable diseases and the general population. PLoS ONE. 2022;17(10):e0276655.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Jeon YJ, Pyo J, Park YK, Ock M. Health behaviors in major chronic diseases patients: trends and regional variations analysis, 2008–2017. Korea BMC Public Health. 2020;20:1–10.

    Google Scholar 

  27. World Health Organization. Addressing comorbidity between mental disorders and major noncommunicable diseases. 2017.

  28. Rudd MD, Berman AL, Joiner TE Jr, Nock MK, Silverman MM, Mandrusiak M, et al. Warning signs for suicide: theory, research, and clinical applications. Suicide Life Threat Behav. 2006;36(3):255–62.

    Article  PubMed  Google Scholar 

  29. Mansueto G, Palmieri S, Marino C, Caselli G, Sassaroli S, Ruggiero GM, et al. The Italian COVID-19 Anxiety Syndrome Scale: Investigation of the COVID-19 anxiety syndrome and its association with psychological symptoms in an Italian population. Clin Psychol Psychother. 2022;29(6):1972–90.

    Article  PubMed  Google Scholar 

  30. Alhakami A, Salem V, Alateeq D, Nikčević AV, Marci T, Palmieri S, et al. The Arab COVID-19 Anxiety Syndrome Scale (C-19ASS): COVID-19 anxiety syndrome and psychological symptoms in the Saudi Arabian population. Clin Psychol Psychother. 2023;30(5):1083–94.

    Article  PubMed  Google Scholar 

  31. Mansueto G, Ruggiero GM, Palmieri S. The Relationship Between COVID-19 Fear, Affective Symptoms and Well-being: The Mediating Role of Psychological Flexibility. J Rational-Emot Cognitive-Behav Ther. 2024;42(4):945–63.

    Article  Google Scholar 

  32. Bourmistrova NW, Solomon T, Braude P, Strawbridge R, Carter B. Long-term effects of COVID-19 on mental health: A systematic review. J Affect Disord. 2022;299:118–25.

    Article  PubMed  Google Scholar 

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Acknowledgements

Not applicable.

Funding

This work was supported by the Ulsan Regional Accountable Care Hospital and Task Forces to Support Public Health and Medical Services in Ulsan Metropolitan City.

Author information

Author notes

  1. Jeonga Yoo and Jeong-Wook Seo contributed equally as first authors.

  2. Minsu Ock and Jin Yong Jun contributed equally as corresponding authors.

Authors and Affiliations

  1. Ulsan Center for Infectious Disease Control & Prevention, Ulsan, Republic of Korea

    Jeonga Yoo

  2. Public Health and Medical Services Team, Ulsan University Hospital, Ulsan, Republic of Korea

    Jeong-Wook Seo

  3. Task Forces to Support Public Health and Medical Services in Ulsan Metropolitan City, Ulsan, Republic of Korea

    Minsu Ock

  4. Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea

    Minsu Ock

  5. Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Minsu Ock

  6. Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

    Jin Yong Jun

  7. Ulsan University Hospital, University of Ulsan College of Medicine, Daehagbyeongwon-ro 25, Dong-gu, Ulsan, 44033, Republic of Korea

    Minsu Ock & Jin Yong Jun

Authors
  1. Jeonga Yoo
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  2. Jeong-Wook Seo
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  3. Minsu Ock
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Contributions

Conceptualization: Yoo J, Seo JW, Ock M, Jun JY. Data curation: Yoo J, Seo JW, Ock M. Formal analysis: Seo JW, Ock M Investigation: Yoo J, Seo JW, Jun JY. Methodology: Seo JW, Ock M, Jun JY. Validation: Ock M, Jun JY. Writing - original draft: Yoo J, Seo JW, Ock M, Jun JY Writing - review & editing: Yoo J, Seo JW, Ock M, Jun JY.

Corresponding authors

Correspondence to Minsu Ock or Jin Yong Jun.

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This study was approved by the Ulsan University Hospital institutional review board (IRB No. 2023–02-025). All the methods in this study were performed in accordance with the relevant guidelines and regulations (Declaration of Helsinki). Prior to enrollment, we explained the objectives and procedures of this study to the participants and obtained written informed consent from them.

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Yoo, J., Seo, JW., Ock, M. et al. Screening and monitoring patients at high risk for mental health issues in COVID-19: a multicenter pre-post assessment study. BMC Psychol 13, 226 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40359-025-02514-5

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40359-025-02514-5

Keywords

BMC Psychology

ISSN: 2050-7283

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