It has been more than 2 years since the COVID-19 pandemic swept across the globe and, predictably, it has had its ebbs and flows. Less predictable are the mental health consequences that the pandemic will leave behind, even when the world has truly achieved endemicity. 

Scientists, psychiatrists, and sociologists agree the pandemic has resulted in unprecedented levels of mental health disorders. The pandemic was truly a once-in-a-century event, upending life as we know it and throwing economic markets into turmoil. For probably the first time in human history, millions of people had their movement restricted and monitored. In high-density cities, this often entailed quarantining in a tiny home for weeks on end. 

Clinicians are also wringing their hands over the long-term implications of what has been coined “long COVID.” This refers to pathological signs and symptoms that continue even after an individual tests negative for COVID-19.

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The fact is we still know precious little about COVID-19. This means the medical community is right to be worried about both its psychiatric implications and consequences to long-term health. 

An Influence on Attacks in HAE 

In Allergy, Karabacak and colleagues conducted a study on the impact of anxiety, stress, and depression on the course of hereditary angioedema (HAE) with C1-inhibitor deficiency. This condition is characterized by potentially life-threatening episodes of swelling in parts of the body such as the face, larynx, abdomen, extremities, and genitalia. These edema attacks often occur spontaneously, although potential triggers have been identified, such as stress, depression, infection, and mechanical trauma. 

Read more about hereditary angioedema etiology 

Note that disturbances to one’s mental health can be a trigger for an angioedema attack. In fact, “stress and anxiety are the most frequent emotional factors influencing patients’ attacks,” Karabacak and colleagues wrote. 

These scientists proposed that the emotional disturbances resulting from COVID-19 infection affect the disease course of hereditary angioedema; conversely, having hereditary angioedema predisposes a person to developing more severe forms of mental distress as a result of COVID-19 lockdowns. 

Karabacak and colleagues investigated this by sending questionnaires to patients (N=139) on their experiences and opinions on COVID-19. The patients were asked to fill in a 4-point Likert scale questionnaire consisting of 21 items on feelings of depression, anxiety, and stress. Their medical information was also collected with consent.

The results demonstrated that the majority of patients experienced anxiety regarding the possibility of having an edema attack during the pandemic and what that would mean for their long-term health. In addition, a majority of patients were afraid of hospital admissions due to fears of catching the virus. 

In addition, the research team discovered that the median number of hereditary angioedema attacks were higher during “quarantine periods” compared to “return to normal periods” and “before pandemic periods.” However, the severity of attacks during “quarantine periods” were similar to those occurring during “return to normal periods.” 

Read more about hereditary angioedema treatments 

“[This study] indicates that psychological factors including anxiety, depression, stress and fear can negatively influence the activity of the disease in [hereditary angioedema] patients and this effect can be higher during the application of strict social restrictions to reduce the transmission of the viral infection among populations,” Karabacak and colleagues wrote. 

The Broader Mental Health Picture 

Hereditary angioedema is not the only disease that has been studied in terms of how pandemic anxiety aggravates the symptoms of chronic illnesses. In almost every major disease area, scientists have conducted studies to better understand how COVID-19 and existing illness interact to alter the mental health landscape. 

In F1000 Research, Houssain and colleagues conducted a study on the epidemiology of mental health problems in COVID-19. Medical literature suggests that cases of mental illness rise following major crises, such as an unexpected economic downturn or a natural disaster. Hence, it comes as no surprise that the pandemic has similarly resulted in historic levels of mental illness. 

“The disruption of a normal life as a result of a government-imposed lockdown or stay home orders has significantly impacted the mental health of the affected individuals,” Houssain and colleagues wrote. 

In addition, the constant feed of bad news regarding the pandemic created a heightened sense of concern should an individual be tested positive for the virus, even if symptoms were mild or absent. During the height of the pandemic, some governments mandated that people who tested positive for the virus be isolated for 1 to 2 weeks, which can be difficult to cope with for some. 

The study conducted by Karabacak and colleagues demonstrated how mental illness and hereditary angioedema are intricately linked. Houssain and colleagues likewise found studies suggesting that existing illness is a risk factor for mental illness during the pandemic. 

“Another study by Chew and colleagues found that comorbid physical symptoms experienced in the preceding month were significantly associated with depression, anxiety, stress, and PTSD among the study participants,” that study team wrote. 

The lessons contained in these studies go beyond understanding best practices in treating patients during a pandemic. At their core is a message that mental illness and physical health are inexorably linked, and that both deserve equal attention during treatment. 


Eyice Karabacak D, Demir S, Yeğit OO, et al. Impact of anxiety, stress and depression related to COVID-19 pandemic on the course of hereditary angioedema with C1-inhibitor deficiencyAllergy. 2021;76(8):2535-2543. doi:10.1111/all.14796

Hossain MM, Tasnim S, Sultana A, et al. Epidemiology of mental health problems in COVID-19: a reviewF1000Res. 2020;9:636. doi:10.12688/f1000research.24457.1

Chew NWS, Lee GKH, Tan BYQ, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreakBrain Behav Immun. 2020;88:559-565. doi:10.1016/j.bbi.2020.04.049