COVID-19-related psychological distress and engagement in preventative behaviors among individuals with severe mental illnesses

Abstract

Individuals with severe mental illnesses (SMIs) may be disproportionately vulnerable to COVID-19 infection and psychological distress. This study investigated the prevalence of engagement in COVID-19 preventative behaviors, predictors of these behaviors, and COVID-19-related psychological distress. One hundred and sixty-three individuals with SMIs (94 with schizophrenia spectrum illnesses and 69 with affective disorders) and 27 psychiatrically healthy comparison participants were recruited from ongoing studies across 3 sites, to complete a phone survey querying implementation of 8 specific COVID-19 preventative behaviors that participants engaged in at least once in the past month as well as standard assessments of depression, anxiety, perceived stress, loneliness, and coping. Data were collected between 3 April 2020 and 4 June 2020. The large majority of our SMI sample, which consisted of outpatients with relatively mild symptom severity, endorsed engaging in multiple preventative behaviors. Relatively few differences were found between groups; however, individuals with SMI were less likely to work remotely than healthy individuals and individuals with schizophrenia spectrum illness were less likely to stay home as a preventative measure, wear face masks, and work remotely than individuals with affective disorders. Differences in staying home remained after controlling for potential confounds. Although individuals with SMI reported more psychological distress related to COVID-19, this distress was largely unrelated to engagement in preventative behaviors. The large majority of individuals with SMI in this outpatient sample, regardless of broad diagnostic category, reported performing multiple behaviors intended to prevent COVID-19 infection at least once a month and reported distress associated with the pandemic. These findings suggest a good level of awareness of COVID-19 among stable outpatients with SMI. The degree to which more acutely ill persons with SMI engage in such preventative behaviors, however, remains to be examined.

Implications of the COVID-19 pandemic for people with bipolar disorders: A scoping review

“…Of these, 440 studies were excluded at the title/abstract level, and an additional 198 records were excluded following full-text review, as detailed in the supplementary material n.2. A total of 14 studies ( Ackerman et al, 2020 , 2021 ; Carmassi et al, 2020 ; Carta et al, 2021 ; Dattoli et al, 2020 ; Karantonis et al, 2021 ; Korten et al, 2021 ; Lazzari et al, 2020 ; McBride et al, 2021 ; Tundo et al, 2021 ; Uvais, 2020 ; Wang et al, 2021 ; Yin et al, 2020 ; Yocum et al, 2021 ) were eligible for inclusion. Please refer to figure 1 (study flow) and table 1 for additional details.…”

“…Please refer to figure 1 (study flow) and table 1 for additional details. Among the included studies, 6 studies ( Ackerman et al, 2020 ; Carmassi et al, 2020 ; Dattoli et al, 2020 ; Lazzari et al, 2020 ; Uvais, 2020 ; Yin et al, 2020 ) were published in 2020, and 8 studies ( Ackerman et al, 2021 ; Carta et al, 2021 ; Karantonis et al, 2021 ; Korten et al, 2021 ; McBride et al, 2021 ; Tundo et al, 2021 ; Wang et al, 2021 ; Yocum et al, 2021 ) were published in the year 2021. A total of 6 studies ( Carmassi et al, 2020 ; Dattoli et al, 2020 ; Korten et al, 2021 ; Lazzari et al, 2020 ; McBride et al, 2021 ; Tundo et al, 2021 ) were conducted in Europe, 4 studies ( Ackerman et al, 2020 , 2021 ; Wang et al, 2021 ; Yocum et al, 2021 ) in North America, 2 studies ( Uvais, 2020 ; Yin et al, 2020 ) in Asia, one study ( Karantonis et al, 2021 ) in Oceania, and one study included two different samples from independent geographical regions (Europe and Africa) ( Carta et al, 2021 ).…”

“…Among the included studies, 6 studies ( Ackerman et al, 2020 ; Carmassi et al, 2020 ; Dattoli et al, 2020 ; Lazzari et al, 2020 ; Uvais, 2020 ; Yin et al, 2020 ) were published in 2020, and 8 studies ( Ackerman et al, 2021 ; Carta et al, 2021 ; Karantonis et al, 2021 ; Korten et al, 2021 ; McBride et al, 2021 ; Tundo et al, 2021 ; Wang et al, 2021 ; Yocum et al, 2021 ) were published in the year 2021. A total of 6 studies ( Carmassi et al, 2020 ; Dattoli et al, 2020 ; Korten et al, 2021 ; Lazzari et al, 2020 ; McBride et al, 2021 ; Tundo et al, 2021 ) were conducted in Europe, 4 studies ( Ackerman et al, 2020 , 2021 ; Wang et al, 2021 ; Yocum et al, 2021 ) in North America, 2 studies ( Uvais, 2020 ; Yin et al, 2020 ) in Asia, one study ( Karantonis et al, 2021 ) in Oceania, and one study included two different samples from independent geographical regions (Europe and Africa) ( Carta et al, 2021 ). Concerning study designs, 6 studies ( Ackerman et al, 2021 ; Carmassi et al, 2020 ; Dattoli et al, 2020 ; Karantonis et al, 2021 ; McBride et al, 2021 ; Tundo et al, 2021 ) were cross-sectional, 3 studies ( Carta et al, 2021 ; Korten et al, 2021 ; Yocum et al, 2021 ) were prospective cohort studies, one study( Ackerman et al, 2020 ) was a retrospective cohort study, and one study( Wang et al, 2021 ) was a case-control study, and 3 studies ( Lazzari et al, 2020 ; Uvais, 2020 ; Yin et al, 2020 ) were case reports/series.…”

“…A total of 6 studies ( Carmassi et al, 2020 ; Dattoli et al, 2020 ; Korten et al, 2021 ; Lazzari et al, 2020 ; McBride et al, 2021 ; Tundo et al, 2021 ) were conducted in Europe, 4 studies ( Ackerman et al, 2020 , 2021 ; Wang et al, 2021 ; Yocum et al, 2021 ) in North America, 2 studies ( Uvais, 2020 ; Yin et al, 2020 ) in Asia, one study ( Karantonis et al, 2021 ) in Oceania, and one study included two different samples from independent geographical regions (Europe and Africa) ( Carta et al, 2021 ). Concerning study designs, 6 studies ( Ackerman et al, 2021 ; Carmassi et al, 2020 ; Dattoli et al, 2020 ; Karantonis et al, 2021 ; McBride et al, 2021 ; Tundo et al, 2021 ) were cross-sectional, 3 studies ( Carta et al, 2021 ; Korten et al, 2021 ; Yocum et al, 2021 ) were prospective cohort studies, one study( Ackerman et al, 2020 ) was a retrospective cohort study, and one study( Wang et al, 2021 ) was a case-control study, and 3 studies ( Lazzari et al, 2020 ; Uvais, 2020 ; Yin et al, 2020 ) were case reports/series. The diagnosis of BD was validated according to the DSM-5 by 8 studies( Ackerman et al, 2020 , 2021 ; Carmassi et al, 2020 ; Carta et al, 2021 ; Dattoli et al, 2020 ; Tundo et al, 2021 ; Uvais, 2020 ; Yin et al, 2020 ), the DSM-IV or DSM-IV-TR in 3 studies ( Karantonis et al, 2021 ; Korten et al, 2021 ; Yocum et al, 2021 ), and the ICD-10 in 3 studies ( Lazzari et al, 2020 ; McBride et al, 2021 ; Wang et al, 2021 ); additionally, the Mini-International Neuropsychiatric Interview (MINI) was adopted in 4 studies ( Ackerman et al, 2020 , 2021 ; Karantonis et al, 2021 ; Korten et al, 2021 ), and the Structured Clinical Interview for DSM-5 (SCID-5) was used in one st...…”

“…Concerning study designs, 6 studies ( Ackerman et al, 2021 ; Carmassi et al, 2020 ; Dattoli et al, 2020 ; Karantonis et al, 2021 ; McBride et al, 2021 ; Tundo et al, 2021 ) were cross-sectional, 3 studies ( Carta et al, 2021 ; Korten et al, 2021 ; Yocum et al, 2021 ) were prospective cohort studies, one study( Ackerman et al, 2020 ) was a retrospective cohort study, and one study( Wang et al, 2021 ) was a case-control study, and 3 studies ( Lazzari et al, 2020 ; Uvais, 2020 ; Yin et al, 2020 ) were case reports/series. The diagnosis of BD was validated according to the DSM-5 by 8 studies( Ackerman et al, 2020 , 2021 ; Carmassi et al, 2020 ; Carta et al, 2021 ; Dattoli et al, 2020 ; Tundo et al, 2021 ; Uvais, 2020 ; Yin et al, 2020 ), the DSM-IV or DSM-IV-TR in 3 studies ( Karantonis et al, 2021 ; Korten et al, 2021 ; Yocum et al, 2021 ), and the ICD-10 in 3 studies ( Lazzari et al, 2020 ; McBride et al, 2021 ; Wang et al, 2021 ); additionally, the Mini-International Neuropsychiatric Interview (MINI) was adopted in 4 studies ( Ackerman et al, 2020 , 2021 ; Karantonis et al, 2021 ; Korten et al, 2021 ), and the Structured Clinical Interview for DSM-5 (SCID-5) was used in one study ( Tundo et al, 2021 ). The majority of the studies ( Ackerman et al, 2020 , 2021 ; Carmassi et al, 2020 ; Carta et al, 2021 ; Dattoli et al, 2020 ; Karantonis et al, 2021 ; Korten et al, 2021 ; Tundo et al, 2021 ; Uvais, 2020 ; Yocum et al, 2021 ) were conducted on outpatients, 3 studies ( Lazzari et al, 2020 ; McBride et al, 2021 ; Yin et al, 2020 ) were conducted among hospitalized patients, and one study ( Wang et al, 2021 ) has enrolled a mix...…”