Our results showed that 31.3% of subjects with confirmed COVID-19 who could answer self-reported psychological tests received diagnoses of mental disorders, including nonorganic insomnia, acute stress reaction, panic disorder, and depressive episode during admission. We found that the previous experiences of psychiatric symptoms predicted the use of psychotropic agents during admission in isolation wards. These results supported the need for intervention by mental health professionals for patients admitted to EID treatment hospitals . These findings are similar to those of previous studies that showed among patients hospitalized for SARS or MERS with acute illness, common psychiatric symptoms included depressed mood, anxiety, and insomnia. Patients with confirmed COVID-19 may fear the consequences of infection with this potentially fatal new virus , and those in quarantine might experience boredom, loneliness, associated stigma, and anger. Furthermore, symptoms of the infection, such as fever, hypoxia, and cough, as well as adverse effects of treatment, such as corticosteroid-caused insomnia, could lead to worsening anxiety and mental distress. Moreover, the COVID-19 outbreak inevitably affected many of those patients with chronic psychotic disorders or dementia. These patients needed active management by psychiatrists, although we had excluded them from the study sample because they were not appropriate candidates for evaluation with self-reported scales. Therefore, treatment in isolation wards may precipitate new psychiatric symptoms or aggravate existing conditions in people without mental illness .
On admission to a COVID-19 hospital, 16.3% of our subjects reported depression (PHQ-9 ≥ 10, or PHQ-2 ≥ 3) and 6.3% reported PTSD symptoms (PCL-5 ≥ 33, or PC-PTSD ≥ 3). These results suggest the possibility that psychological problems in COVID-19 survivors might be relatively lower than MERS survivors. In a previous study of South Korea , at 12 months post-MERS, 42.9% of survivors reported PTSD (IES-R-K ≥ 25) and 27.0% reported depression (PHQ-9 ≥ 10). The meta-analysis  indicated that in the post-illness stage of SARS and MERS, the point prevalence of post-traumatic stress disorder was 32.2%, that of depression was 14.9%, and that of anxiety disorders was 14.8%. However, our subjects did not include psychotic, confused, or cognitively disordered patients during admission.
In this study, the self-reported PTSD scale on admission was very useful in monitoring the mental status of COVID-19 patients in isolation wards.
Because of limited access to quarantined patients, early detection and rapid relief of psychiatric or behavioral problems might be particularly important . These can be made possible by psychological tests or psychiatric consultations. Following admission, some patients suffered from later psychiatric symptoms, although their physical condition had become good. This is true because after the symptoms of COVID-19 have diminished, confirmed patients could not be discharged from the hospital until they had had two consecutive tests separated by 24 hours showing negative results. As these patients undergo this process, they are frequently apprehensive that the tests may become positive again . This can generate a lot of anxiety because it can lead to a continuation of hospitalization. Our study found that self-reported PTSD during the initial period of admission was significantly predictive of psychiatric diagnoses at discharge. which was made by psychiatrists in spite of the possibilities of changes of patients’ psychological status during whole period of admission. We did not find that self-reported depression on admission was associated with a psychiatric diagnosis or with the use of psychotropic medications.
Married subjects were at risk of being diagnosed with mental disorders in this study. They had more worries than single patients, which included worries about taking care of children, leaving home, spouses who may have also contracted COVID-19, various troublesome events occurring in families, or economic burdens suffered during hospitalization . Many clusters of infection have been found within familial households. A study in China showed that the rate of secondary transmission among household contacts of patients with SARS-CoV-2 infection was 30% . Although we did not gather exact data, a moderate portion of married patients in our sample had spouses who had also contracted COVID-19. In addition, single subjects tended to endure psychological discomforts by themselves instead of getting help from the psychiatrists, fearing the stigma of mental illness.
In this study, being forty years old or older was one of the factors associated with the use of psychotropic agents. But this was not related to being diagnosed with psychiatric disorders. We observed that elderly patients tended to want to be prescribed medications when they felt anxiety or insomnia during restriction to hospital rooms. Young patients tried to cope with boredom and inactivity by free exercises, and they were reluctant to receive medications to aid sleep.
This study has several limitations. First, the sample used in this study consisted of medical records of admitted cases in a nationally designated COVID-19 hospital. Therefore, the results could not be generalized to all patients with COVID-19 undergoing treatment. Moreover, to make hospital beds available for severely ill COVID-19 patients, the South Korean government classifies confirmed patients and provides treatment in different settings, depending on the severity of their illness. Patients confirmed to be in severe conditions were admitted in specialized infectious disease hospitals (nationally designated treatment facilities). Patients who were asymptomatic or mildly symptomatic were provided medical services and monitoring in homes or facilities (Living and Treatment Centers) .
Second, self-reported psychiatric symptoms could either be underreported or overreported. Additionally, we excluded those subjects who had chronic psychotic disorders or who suffered confusion or dementia. So, in this study, we need to exercise caution as we interpret the prevalence of PTSD or symptoms of depression suffered during the acute phase. However, one purpose of this study was to determine if patient outcomes could be predicted by considering self-reported PTSD, psychotropic drug use, or a diagnosis of depression arrived at by psychiatrists assigned to the patients.
Despite these limitations, this study gives us insights into the mental health problems of COVID-19 patients, factors related to the psychiatric disorders, the use of psychotropic drugs offered in psychiatric consultations, and mental health services needed during the acute treatment phase in isolation wards. Previous studies of the mental health effects on MERS or SARS survivors reported that EIDs could cause sustained mental morbidity. Post-discharge follow-up studies might be needed to shed light on the long-term prognoses of the psychiatric problems that COVID-19 survivors experience.