How are OCD patients and their families coping with the COVID-19 pandemic? A qualitative study

Long-term impact of the COVID-19 pandemic on obsessive-compulsive disorder

There is limited data on the long-term effect of the COVID-19 pandemic on obsessive-compulsive disorder (OCD). We report on the course of a cohort of individuals with OCD followed-up over a period of one year during the first wave of the COVID-19 pandemic in India. A cohort of 240 individuals registered at a specialty OCD clinic was regularly followed-up using standardized rating tools at three months, six months, and one year into the onset of the COVID-19 pandemic in India. These were compared with clinical ratings recorded in a comparable historical cohort of 207 individuals with OCD, followed up during a non-pandemic year. The pandemic and non-pandemic (historical control) cohorts did not differ in illness severity and rate of relapse. It was found that COVID-19-related anxiety declined over time. Among those patients who were treatment responders prior to the pandemic, COVID-19-related anxiety and non-adherence to medication predicted a relapse of symptoms. Contrary to our expectations, the rate of relapse and illness trajectory in the pandemic cohort did not differ from the non-pandemic cohort, suggesting that the pandemic did not impact our largely medication-adherent cohort. Adherence to treatment seemed to have a protective effect during the pandemic.

Dignified Resources and Coping Strategies During the COVID-19 Pandemic: a Qualitative Study of Racially and Economically Marginalized Communities

INTRODUCTION

Amid the spread of the novel coronavirus (COVID-19), racially and economically marginalized communities experienced a disproportionate burden of disease and social consequences (e.g., unemployment, increased exposure). This study seeks to understand strategies that these communities employed to cope with unequal burdens of the pandemic.

METHODS

We utilized qualitative data collected between 2020 and 2021 from a mobile mapping platform designed to facilitate real-time, geocoded data collection on individual's experiences and perceptions of their neighborhoods. Reports were iteratively coded by an academic researcher and community partner. We employed an inductive approach to analysis, which allowed findings to emerge organically without constraint of researcher hypotheses.

RESULTS

A total of 19 respondents (14 under the age of 45, 16 non-White, 15 with less than half a year of emergency savings) provided 236 qualitative reports. Participants described innovative strategies for exchanging resources as a means of informally networking and building community, the importance of tailored programming (e.g., for specific racial/ethnic groups) in fostering belonging and comfort, and the importance of two specific dimensions of services-interactions with service providers and the quality of goods or services-in providing dignified care.

DISCUSSION

Amidst exacerbated racial and economic disparities emerging from the COVID-19 pandemic, our study highlights the need for investment in mutual aid, the importance of tailored services and support, and promoting dignity in social services. As other macro-level social stressors become more prevalent as the pandemic continues, these findings can inform how we examine and address them.

How does the COVID-19 pandemic affect the personal lives and care realities of people with a schizophrenia spectrum disorder? A qualitative interview study

BACKGROUND

The COVID-19 pandemic constitutes one of the greatest recent public crises. This study explored its influence on the lives and care realities of people with a schizophrenia spectrum disorder (SSD).

METHODS

Between October 2020 and April 2021, semi-structured in-depth interviews were conducted with 30 volunteers with SSDs receiving inpatient or outpatient treatment in Vienna (Austria). Interviews were audio-recorded, transcribed verbatim and analysed thematically.

RESULTS

Three main themes were identified. First, 'Pandemic life is deprived, lonely and surreal - though certain aspects can be perceived as positive'. Second, 'Bio-psycho-social support systems were struck at their core by the pandemic and were left severely compromised'. Last, 'There is a complex interplay between one's prior experience of psychosis and the experience of the COVID-19 pandemic'. The pandemic situation affected interviewees in various ways. For many, it led to a drastic reduction in day-to-day and social activities and contributed to an atmosphere of strangeness and threat. Bio-psycho-social support providers frequently suspended their services and offered alternatives were not always helpful. Participants indicated that whilst having an SSD might render them vulnerable to the pandemic situation, prior experience with psychotic crises can also provide knowledge, skills and self-confidence which enable better coping. Some interviewees also perceived aspects of the pandemic situation as helpful for recovering from psychosis.

CONCLUSION

Healthcare providers must acknowledge the perspectives and needs of people with SSDs in present and future public health crises to ensure proper clinical support.

The perceived long-term impact of COVID-19 on OCD symptomology

A pandemic outbreak can lead to excessive, maladaptive levels of anxiety, particularly among individuals who already suffer from obsessive-compulsive disorder (OCD). The Coronavirus Disease 2019 (COVID-19) provided a novel opportunity to examine the possibility that individuals with OCD, compared to those without OCD, might experience greater distress from this common stressor. The present study examined the lasting effects of COVID-19 in the year after the outbreak. Additionally, there is limited research regarding the stability of OCD dimensions; therefore, this study examined whether the COVID-19 pandemic impacted the stability of OCD dimensions. One hundred and forty-three adults who reported they had been diagnosed with OCD and ninety-eight adults without OCD, completed an online survey assessing the impact the COVID-19 pandemic had on symptoms of OCD in the year after the initial outbreak. The OCD group showed greater concern about the pandemic and greater concern about future pandemics compared to the comparison group. In addition, COVID-19 related distress differentially related to OCD symptoms dimensions, showing the strongest association with the contamination dimension. Lastly, results showed that many individuals reported that their OCD dimension shifted to obsessions about COVID-19 from their pre-existing OCD dimension.

[Psychological Burden in Relatives of People with Mental Illness During the COVID-19 Pandemic]

CONCERN

 The COVID-19 pandemic is a burden for most people - particular for those with mental illness and their families. The aim of the present study was to investigate specific burdens as well as coping strategies among relatives of people with mental illness.

METHODS

 A questionnaire to assess Corona pandemic-related influences on burdens of relatives of people with mental illness was developed. A total of 228 relatives participated in the survey between March and June 2021.

RESULTS

 More than 87% of the relatives surveyed reported that they were burdened by the mental illness of their ill relatives. Many of the respondents subjectively described helpful coping strategies such as appreciation of healthy parts.

CONCLUSION

 In times of crisis, such as the COVID-19 pandemic, care structures and support services should also be sensitively aligned and continuously provided for relatives of people with mental illness.

Obsessive-Compulsive Disorder During the COVID-19 Pandemic Process: A Narrative Review

This study aimed to review all empirical contributions published between March 2020 and June 2022, addressing the impact of the COVID-19 pandemic on obsessive-compulsive disorder in adults. We searched the literature in PubMed, Google Scholar, and Web of Science. A total of 543 articles were scanned and 73 full-text articles were identified. Reviews, comments, letters to the editor, and case reports (except case series) were excluded. It was determined that 42 articles met the inclusion criteria, 6 studies involving only children and adolescents were excluded, and 36 were decided on their suitability for our study. The analysis determined that COVID-19 had an impact on obsessive-compulsive disorder. Characteristics such as liability for harm and unacceptable thoughts influenced the symptoms as well as contamination and washing. Some studies showed an increase in the severity of obsessive-compulsive symptoms, while some reported no worsening but improvement with treatment and follow-up. While some reported variations in outcomes related to sociodemographic characteristics and subtypes, some focused on the risk of suicide. There were also studies conducted on special groups such as pregnant women or healthcare workers. The results were controversial. While available data contain more information on worsening obsessive-compulsive disorder symptoms, data on the status of patients under treatment were scarce. There were not enough studies evaluating follow-up results. Influencing factors such as sociodemographic characteristics, subtypes, comorbid conditions, treatment, and support did not seem to have been adequately addressed.

Hand Washing: When Ritual Behavior Protects! Obsessive-Compulsive Symptoms in Young People during the COVID-19 Pandemic: A Narrative Review

The Coronavirus Disease 2019 (COVID-19) pandemic had a profound impact on the lifestyles and mental health of young people. It has been hypothesized that the focus on hygiene and the fear of contamination/infection during the pandemic may have exacerbated obsessive–compulsive (OC) symptoms in this population. OC symptoms are widespread in the general population, with varying degrees of intensity. At their most extreme, they manifest in obsessive–compulsive disorder (OCD), which is characterized by obsessive thoughts and compulsive behaviors. The present narrative review aimed at evaluating the relationship between the COVID-19 pandemic and OCD and OC symptoms in young people, especially children and adolescents with and without OCD, focusing on vulnerability and risk factors and the impact of lockdown measures. Of the six studies identified, four examined clinical samples diagnosed with OCD and two looked at community-based adolescent samples. Five of the six studies found that OC symptoms increased during the pandemic. Additionally, vulnerability to anxiety may constitute a risk condition and the lockdown measures and personal stressful life events can constitute potential triggers of OC symptoms, while ongoing treatment for OCD had a protective effect. The results suggest that, during the COVID-19 pandemic, obsessive and compulsive behavior (e.g., hand washing) in young people at the greatest risk should be monitored, and the intervention of mental health services should be maintained. More research is needed in this area.

Clinician Perspectives on the Impact of COVID-19 on the Treatment of Adults and Youth with Anxiety

We describe the perceptions of mental health clinicians practicing in the United States about the effects of the COVID-19 pandemic on the presentation and treatment course of active clients with anxiety. Clinician participants reported on client symptomology at the beginning of treatment, just before (prior to March 2020), and at a mid-pandemic timepoint (December 2020/January 2021). An initial sample of 70 clinicians responded to a survey assessing their clients' overall anxiety severity, anxiety sensitivity, pathological uncertainty, family accommodation, and avoidance levels. Of these, 54 clinician responses were included in study analyses, providing detailed clinical information on 81 clients. Findings suggest that the COVID-19 pandemic was associated with increases in anxiety severity in the majority of clients; overall, clinicians reported that 53% of clients had symptoms worsen due to COVID-19 and that only 16% experienced improvement of symptoms during treatment. Those who had lower levels of avoidance pre-pandemic and those who increased their frequency of treatment were more likely to experience increases in anxiety severity by the mid-pandemic timepoint. Further research is needed to understand the extended effects of the COVID-19 pandemic on anxiety symptomology and treatment.

How are OCD Patients and Family Members Dealing with the Waxing and Waning Pattern of the COVID-19 Pandemic? Results of a Longitudinal Observational Study

The current study aimed to investigate the impact of the COVID-19 pandemic on the mental health of people with OCD and the degree of family accommodation (FA) by live-in family members across phases of the lockdown measures imposed by the Belgian government. Forty-nine OCD patients and 26 live-in family members participated in the study. We assessed OCD symptom severity and FA of the live-in family members, as well as depressive symptoms, anxiety and stress levels and COVID-19 related psychological distress of patients and family members at four different timepoints: one month after the start of the lockdown (T₁), during the gradual relaxation (T₂), between the two waves (T₃) and during the second wave (T₄). Results showed that although COVID-19 related stress increased and decreased in accordance with the waxing and waning pattern of the pandemic, OCD symptoms showed an initial slight increase followed by a decrease at T₃ and again at T₄. Changes in family members' accommodation of symptoms followed the same course as the OCD symptoms. Furthermore, OCD symptoms correlated with depressive symptoms, anxiety and stress levels and COVID-19 related distress at all timepoints. It is important to involve family members in the treatment of OCD even during a pandemic. Clinicians should also pay attention to symptoms of depression, anxiety and stress during OCD treatment. Further research is necessary to entangle the causal relationship between OCD symptoms, FA and symptoms of depression, anxiety and stress.

"COVID-19 spreads round the planet, and so do paranoid thoughts". A qualitative investigation into personal experiences of psychosis during the COVID-19 pandemic

The COVID-19 pandemic is likely to affect people who have had previous experiences of psychosis - either positively or negatively. A research gap exists in looking at qualitative experiences of the pandemic. In the present study, we address the research gap in those who self-identified as having psychosis via Reddit discussion forum posts, collecting data from a popular online community. Sixty-five posts were analysed using inductive thematic analysis. Five overarching themes were identifie; declining mental health, changed psychosis experiences, personal coping experiences, social connectedness and disconnectedness, and COVID-19 as a metaphor. The data show that there are varied experiences associated with the pandemic. People who have experiences of psychosis do not only have vulnerabilities but may also perceive themselves as having strengths that allow them to cope better.

Obsessive-Compulsive Disorder During the COVID-19 Pandemic: a Systematic Review

PURPOSE OF REVIEW

This systematic review evaluated the impact of the COVID-19 pandemic on obsessive-compulsive symptoms.

RECENT FINDINGS

Most studies showed that obsessive-compulsive symptoms worsened during the early stages of the pandemic, particularly for individuals with contamination-related obsessive-compulsive disorder (OCD), though other symptoms dimensions were found to worsen as well. Many patients and individuals in the general population experienced new obsessive-compulsive-like symptoms centered on COVID-19. Self-reported rates of symptom exacerbation and COVID-19-focused symptoms were consistently lower in studies that recruited patients from specialty clinics (compared to online samples). Most studies were conducted in Spring/Summer, 2020. The COVID-19 pandemic has been an enormous stressor for individuals with OCD, especially for those with contamination symptoms. Regardless, there is strong reason to believe gold standard treatment approaches for OCD have maintained strong efficacy. Disseminating and effectively delivering evidence-based treatments for OCD is an urgent public health priority.

Feelings of Entrapment during the COVID-19 Pandemic Based on ACE Star Model: A Concept Analysis

This study aimed to analyze the concept of the "feelings of entrapment" during the COVID-19 (coronavirus disease 2019) pandemic using a systematic review. We included literature based on content and outcomes related to feelings of entrapment, such as antecedents, attributes, and consequences. The exclusion criteria were studies that did not have inappropriate subject, content, conceptual definition, and degree thesis was excluded. Walker and Avant's process of concept analysis was used in this systematic literature review. The attributes of the concept of feelings of entrapment during the COVID-19 pandemic were found to be feelings of: (1) being out of control, (2) no escape, (3) being trapped, (4) being robbed, and (5) hopelessness. The causes for these were identified as (1) the COVID-19 pandemic, (2) lockdown system, (3) restricted situation, (4) uncertain future, (5) economic hardship, and (6) poor coping abilities. Consequences of the concept were: (1) increased suicide, (2) decreased mental health, and (3) decreased well-being. In situations such as COVID-19, it is important need to know what feelings of entrapment's antecedents and attributes are to prevent suicide and enhance mental health and well-being. Based on the results of this study, counseling services, policies, and systems for relieving feelings of entrapment in the COVID-19 situation are recommended.