Adam, Till J ORCID: https://orcid.org/0009-0004-6609-3462, Thompson, Trevor ORCID: https://orcid.org/0000-0001-9880-782X, Peroz, Fabiola H ORCID: https://orcid.org/0000-0003-2798-580X, Heisig, Jan P ORCID: https://orcid.org/0000-0001-8228-1907, Gellert, Paul ORCID: https://orcid.org/0000-0001-7492-7210, Alonso-Perez, Enrique ORCID: https://orcid.org/0000-0002-0228-5084, Bister, Lara ORCID: https://orcid.org/0000-0001-5915-757X, Thygesen, Lau Caspar ORCID: https://orcid.org/0000-0001-8375-5211, Conus, Philippe ORCID: https://orcid.org/0000-0002-5832-1910, von Känel, Roland ORCID: https://orcid.org/0000-0002-8929-5129, Seedat, Soraya ORCID: https://orcid.org/0000-0002-5118-786X, Manková, Denisa ORCID: https://orcid.org/0000-0002-9705-9361, Guinart, Daniel ORCID: https://orcid.org/0000-0001-5078-6716, Vieta, Eduard ORCID: https://orcid.org/0000-0002-0548-0053, Millan, Mark J, De Leo, Diego ORCID: https://orcid.org/0000-0001-8255-6480, Berk, Michael ORCID: https://orcid.org/0000-0002-5554-6946, Fiedorowicz, Jess ORCID: https://orcid.org/0000-0003-2057-4071, Yang, Lin ORCID: https://orcid.org/0000-0002-1698-6666, Tiihonen, Jari ORCID: https://orcid.org/0000-0002-0400-6798, Aschauer, Harald ORCID: https://orcid.org/0000-0002-4449-372X, Schlögelhofer, Monika ORCID: https://orcid.org/0000-0003-0434-5527, Hamilton, Jane E ORCID: https://orcid.org/0000-0003-2109-1506, Solmi, Marco ORCID: https://orcid.org/0000-0003-4877-7233 and Correll, Christoph U ORCID: https://orcid.org/0000-0002-7254-5646 (2026) 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. BMJ Mental Health, 29 (1):e302777. pp. 1-13. ISSN 2755-9734 (Online) (doi:10.1136/bmjment-2026-302777)

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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.

Item Type:	Article
Additional Information:	All authors thank all respondents who took the survey, funding agencies and all professional and scientific national and international associations supporting or endorsing the COH- FIT project. We would also like to acknowledge the contributions made by Friedrich Leisch, Björn Gerdle and John Wells to the success of this project.
Uncontrolled Keywords:	COVID, mental health, risk factors
Subjects:	B Philosophy. Psychology. Religion > BF Psychology Q Science > Q Science (General) R Medicine > R Medicine (General)
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Chronic Illness and Ageing Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified:	03 Sep 2026 15:49
URI:	https://gala.gre.ac.uk/id/eprint/54334

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