How did the Covid-19 pandemic affect individuals with schizophrenia from Turkey?

Left Behind: Experiences of Community Mental Health Center Clients with Serious Mental Illness During the COVID-19 Pandemic

While some international qualitative research has interviewed people with serious mental illnesses (SMI) about their experiences in the initial months of the COVID-19 pandemic, few US studies have explored their experiences and perspectives as the pandemic has continued. Drawing from disability studies perspectives, this qualitative study conducted in 2022 explored the experiences of people with SMI seeking services at community mental health centers during the COVID-19 pandemic. Fifteen clients who identified as living with an SMI and were clients during March 2020 were interviewed. Using narrative analysis, we identified an overarching tenor of client experiences: feeling left behind by institutions and society. This feeling of being left behind was conceptualized as three themes. As the literature around the COVID-19 pandemic grows and we attempt to integrate it into community mental health policy and practice, it is essential to include the experiences and perspectives of clients with lived experience of SMI.

Trends in Psychiatric Day Care Practices in Japan: An Analysis Using the National Database of Health Insurance Claims Open Data

BACKGROUND

Psychiatric day care is a key framework for outpatient rehabilitation in Japanese psychiatric treatment. It targets a wide range of diseases and performs various roles. The current status and utilization of psychiatric day care in Japan have changed owing to an increase in the availability of other social resources and the coronavirus disease 2019 (COVID-19) pandemic. However, no reports have quantitatively analyzed the trends or current situation of psychiatric day care in Japan. Therefore, this study aimed to analyze the status of the operation of psychiatric day care in Japan and its trends by sex, region, and age group.

METHODS

Based on the publicly available data from the Japanese National Database of Health Insurance Claims and Specific Health Checkups (NDB Open Data), we investigated changes in the numbers related to psychiatric day care nationwide from fiscal year (FY) 2017-2021. Furthermore, we calculated the numbers of psychiatric day care facilities use per 1,000 people by prefecture, sex, and age group in 2021. A Mann-Whitney U test was conducted to compare the total number of psychiatric day care facilities used in months during periods of emergency declarations and priority preventative measures with those used in months when there were no such periods. Pearson's correlation coefficient test was conducted to examine the correlation between the numbers of psychiatric beds per 100,000 people and the annual numbers of psychiatric day care facilities use per 1,000 people in each prefecture. A Mann-Whitney U test was conducted to compare the number per 1,000 people per year of prefectures with or without capital- and government-designated cities and compare the annual total number (FY 2017-2021) by sex.

RESULTS

Overall, the number of psychiatric day care facilities use tended to decrease. The monthly data showed a significant decrease in the total number of psychiatric day care facilities' usage during periods of emergency declarations and priority preventative measures (p=0.02). The numbers of "psychiatric short care" use increased in 2021 and those of psychiatric day-night care (>3 years / >3 days per week) use showed an increasing trend from 2020. The overall number of psychiatric day care facilities' usage per 1,000 people by prefecture was significantly lower in prefectures having cities with populations of 700,000 or more (p<0.01). A significant positive correlation was found between the number of psychiatric day care facilities use per 1,000 people by prefecture and the number of psychiatric beds per 100,000 people by prefecture (r=0.61, p<0.01). The usage of psychiatric day care facilities was significantly lower for women (p<0.01). In terms of age group, the use of psychiatric day care facilities was significantly lower for younger age groups (under 65 years of age) (p<0.01).

CONCLUSIONS

Trends in the numbers reflected differences in user attributes and regional differences. It is necessary to establish a management system tailored to individual attributes and in regions where support is difficult to reach.

Clinical Outcome in Persons with Severe Mental Disorders Attending a Mental Health Day Center during the COVID-19 Pandemic

BACKGROUND

Studies assessing the psychological impact of the COVID-19 pandemic on populations highlight the emergence of mental health difficulties, especially if a mental health disorder is already present. Patients with severe mental illnesses (SMIs) may be even more vulnerable to the psychosocial effects of the pandemic. However, little is known regarding the possible impact of the pandemic on SMI patients supported by community-based mental health day centers.

METHODS

A two-year prospective study comprising 29 individuals with SMI was conducted by the Skitali Mental Health Day Center in Ioannina, Northwest Greece. The described group of examined patients consisted mainly of psychotic patients (65.5%). Patients were assessed using the Health of Nations Outcome Scale and the Global Assessment of Functioning scale, and scores prior to and after the onset of the pandemic were compared.

RESULTS

The results indicated that participants did not present any significant decline in their overall clinical status during the COVID-19 pandemic and the national lockdown measures.

CONCLUSIONS

This finding is relevant because previous research has shown that the pandemic may negatively impact adherence to treatment and service attendance and that the symptomatology of patients with SMIs may further deteriorate. It is suggested that the operation of mental health day centers during collective stressful events should be preserved, but further research is needed to evaluate their role in maintaining continuity of care during such events.

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.

Lessons from the coronavirus disease 2019 pandemic in schizophrenia: a review

PURPOSE OF REVIEW

Multiple countries have reported increased COVID-19 mortality in patients with schizophrenia. The purpose of this review was to synthetize the consequences of the pandemic on patients with schizophrenia including vaccination data.

RECENT FINDINGS

We have synthetized data on the increased risk of infection and increased mortality, the impact of the pandemic and lockdowns on psychiatric care, vaccination policies, unwillingness to vaccine in patients and the rates of vaccination.

SUMMARY

Schizophrenia has been confirmed at increased risk of both COVID-19 infection and developing a severe/lethal form of the infection. Patients with schizophrenia should, therefore, be prioritized for vaccination whenever possible and should be prioritized for psychiatric and somatic care access. Psychotic symptomatology may be a barrier to vaccination in some patients, and heterogenous vaccination rates were identified in national databases. The COVID-19 pandemic has been also a unique opportunity to develop telehealth. A mixed face-to-face and distance model should be encouraged, whenever possible, to improve the experience of patients, relatives and healthcare professionals. No major change of long-acting antipsychotics has been reported in most countries, and there was no consistent evidence for clozapine prescription to increase the risk of COVID-19 infection or severe outcomes.