{
  "abstract": "Background Somatic and psychiatric illnesses and multimorbidities increase stress-vulnerability and decrease well-being. Objective We aimed to identify high-risk disorder profiles for lower well-being and well-being decline under stress, modelling COVID-19 as a natural experiment. Methods The global Collaborative Outcomes Study on Health and Functioning during Infection Times survey assessed the World Health Organization-Five Well-being Index (WHO-5) (0–100) retrospectively pre-pandemic and intra-pandemically. Mixed-effects models, controlling for demographic/pandemic-related covariates, examined coprimary outcomes: total pre-pandemic WHO-5 and pre-to-intra-pandemic change (estimating β); pre-pandemic WHO-5 <50, new pre-to-intra-pandemic WHO-5 <50 and WHO-5 decrease ≥10 (estimating ORs±95% CIs). Fixed effects were self-reported somatic and psychiatric diagnoses and within-and-across multimorbidities. Findings Altogether, 121 066 adults (female=64.0%, white=69.0%, age=42.0±15.9 years, countries=155) with illnesses (any=49.8%/somatic=44.8%/psychiatric=16.3%) and multimorbidities (any=32.8%/somatic=27.3%/psychiatric=7.4%/somatic-psychiatric=10.8%) were analysed. Well-being was 2–3-fold worse with psychiatric disorders ( pre-pandemic: autism-spectrum disorder (β=−7.00±2.93/OR=1.27–2.65), schizophrenia/schizoaffective disorder (β=−5.39±3.42/OR=1.09–2.64); pre-to-intra-pandemic: major depressive disorder (β=−2.45±0.89/OR=1.25–1.55), post-traumatic stress disorder (β=−1.98±1.42/OR=1.19–1.67)) versus somatic disorders ( pre-pandemic: diarrhoea (β=−3.29±2.49/OR=1.11–2.15), chronic skin disease (CSD) (β=−2.53±1.44/OR=1.11–1.65); pre-to-intra-pandemic: CSD (β=−2.31±1.47/OR=1.23–1.75), injury (β=−2.22±0.99/OR=1.11–1.40)). Multimorbidities were associated with non-linear/supra-additive adverse outcomes beyond single disorders ( pre-pandemic: anorexia nervosa+schizophrenia/schizoaffective disorder (β=−27.58±12.71/OR=1.41–19.94), inflammatory bowel disease+psychosis (β=−24.89±10.59/OR=2.68–24.25), stroke+osteoarthritis (β=−13.68±7.33/OR=1.23–6.48); pre-to-intra-pandemic: haemorrhoids+obsessive-compulsive disorder (β=−8.86±6.54/OR=1.22–5.21), binge-eating disorder/bulimia nervosa+social anxiety disorder (β=−6.87±5.49/OR=0.78–2.85), back pain+retinopathy (β=−6.55±6.54/OR=1.04–4.69)). Dose–response relationships were observed between the number of disorders and poorer well-being ( pre-pandemic per diagnosis: psychiatric (β=−1.22±0.23/OR=1.11–1.17), somatic (β=−0.21±0.13/OR=1.02–1.05); pre-to-intra-pandemic per diagnosis: psychiatric (β=−0.37±0.24/OR=1.04–1.10)). Conclusions Poor well-being and further decline under stress were observed particularly with psychiatric illnesses and complex psychiatric and mixed psychiatric-somatic multimorbidity. Clinical implications The finding of supra-additive multimorbidity burden highlights a need for targeted care models, beyond individual conditions. Vulnerable groups require support during crises, beyond COVID-19.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 26,
  "authors": [
    {
      "name": "Till Adam"
    },
    {
      "name": "Trevor Thompson"
    },
    {
      "name": "Fabiola Peroz"
    },
    {
      "name": "Jan Heisig"
    },
    {
      "name": "Paul Gellert"
    },
    {
      "name": "Enrique Alonso-Perez"
    },
    {
      "name": "Lara Bister"
    },
    {
      "name": "Lau Caspar Thygesen"
    },
    {
      "name": "Philippe Conus"
    },
    {
      "name": "Roland von Känel"
    },
    {
      "name": "Soraya Seedat"
    },
    {
      "name": "Denisa Manková"
    },
    {
      "name": "Daniel Guinart"
    },
    {
      "name": "Eduard Vieta"
    },
    {
      "name": "Mark Millan"
    },
    {
      "name": "Diego de Leo"
    },
    {
      "name": "Michael Berk"
    },
    {
      "name": "Jess Fiedorowicz"
    },
    {
      "name": "Lin Yang"
    },
    {
      "name": "Jari Tiihonen"
    },
    {
      "name": "Harald Aschauer"
    },
    {
      "name": "Monika Schlögelhofer"
    },
    {
      "name": "Jane Hamilton"
    },
    {
      "name": "Marco Solmi"
    },
    {
      "name": "Christoph Correll"
    },
    {
      "name": "Aïcha Dahdouh"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7xsfkzbb6qpwe.bib",
  "cited_by": 0,
  "doi": "10.1136/bmjment-2026-302777",
  "fulltext_url": null,
  "id": "7xsfkzbb6qpwe",
  "issns": [
    "2755-9734"
  ],
  "landing_url": "https://hal.science/hal-05804460v1",
  "language": "en",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "hal",
      "0.sdv"
    ],
    [
      "hal",
      "1.sdv.mhep"
    ],
    [
      "hal",
      "2.sdv.mhep.psm"
    ],
    [
      "openalex",
      "3203|COVID-19 and Mental Health"
    ]
  ],
  "openalex": "W7205013917",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-02",
  "publisher": "BMJ",
  "ris": "https://research.draconitic.com/paper/7xsfkzbb6qpwe.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:58Z",
      "native_id": "hal-05804460",
      "source": "hal",
      "url": "https://hal.science/hal-05804460v1"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "hal:0.sdv",
      "subfield": "general"
    },
    {
      "field": "medicine",
      "origin": "hal:2.sdv.mhep.psm",
      "subfield": "psychiatry"
    }
  ],
  "title": "Well-being differences and changes in people with somatic and psychiatric disorders or multimorbidities: modelling COVID-19 as a global natural experiment of stress vulnerability",
  "title_text": "Well-being differences and changes in people with somatic and psychiatric disorders or multimorbidities: modelling COVID-19 as a global natural experiment of stress vulnerability",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:58Z",
  "url": "https://research.draconitic.com/paper/7xsfkzbb6qpwe",
  "venue": "BMJ Mental Health",
  "versions": []
}