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
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.
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BibTeX
@article{adam2026wellbeing,
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}},
author = {Till Adam and Trevor Thompson and Fabiola Peroz and Jan Heisig and Paul Gellert and Enrique Alonso-Perez and Lara Bister and Lau Caspar Thygesen and Philippe Conus and Roland von Känel and Soraya Seedat and Denisa Manková and Daniel Guinart and Eduard Vieta and Mark Millan and Diego de Leo and Michael Berk and Jess Fiedorowicz and Lin Yang and Jari Tiihonen and Harald Aschauer and Monika Schlögelhofer and Jane Hamilton and Marco Solmi and Christoph Correll and Aïcha Dahdouh},
journal = {BMJ Mental Health},
year = {2026},
month = sep,
doi = {10.1136/bmjment-2026-302777},
url = {https://hal.science/hal-05804460v1},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - 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
AU - Till Adam
AU - Trevor Thompson
AU - Fabiola Peroz
AU - Jan Heisig
AU - Paul Gellert
AU - Enrique Alonso-Perez
AU - Lara Bister
AU - Lau Caspar Thygesen
AU - Philippe Conus
AU - Roland von Känel
AU - Soraya Seedat
AU - Denisa Manková
AU - Daniel Guinart
AU - Eduard Vieta
AU - Mark Millan
AU - Diego de Leo
AU - Michael Berk
AU - Jess Fiedorowicz
AU - Lin Yang
AU - Jari Tiihonen
AU - Harald Aschauer
AU - Monika Schlögelhofer
AU - Jane Hamilton
AU - Marco Solmi
AU - Christoph Correll
AU - Aïcha Dahdouh
PY - 2026
DA - 2026/09/02
JO - BMJ Mental Health
DO - 10.1136/bmjment-2026-302777
UR - https://hal.science/hal-05804460v1
AB - 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.
SN - 2755-9734
ER -