How does the COVID-19 pandemic affect the personal lives and care realities of people with a schizophrenia spectrum disorder? A qualitative interview study
Abstract: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 id… Show more
“…The retrospective and exploratory nature of this study and the multiple possibilities for interpretation make it difficult to draw direct conclusions and recommendations for clinical practice. However, studies of the perceptions of care of people with severe mental disorders such as schizophrenia suggest that they experienced significant changes and loss of relevant psychosocial care, particularly during lockdown periods, 32 highlighting the need to provide the best possible biopsychosocial support to vulnerable groups during pandemic periods and associated restrictions.…”
Background
Coercive measures such as involuntary psychiatric admission are considered a last resort in the treatment of people with psychiatric disorders. So far, numerous factors have been identified that influence their use. However, the link between a pandemic – in particular, restrictions such as lockdowns – and the use of involuntary psychiatric admission is unclear.
Aim
To examine the association between COVID-19 lockdowns and involuntary psychiatric admissions in Austria.
Method
This retrospective exploratory study assessed all involuntary psychiatric admissions and use of mechanical restraint in Austria, except for the federal state of Vorarlberg, between 1 January 2018 and 31 December 2020. Descriptive statistics and regression models were used.
Results
During the 3-year study period, 40 012 individuals (45.9% females, mean age 51.3 years) had 66 124 involuntary psychiatric admissions for an average of 10.9 days. Mechanical restraint was used during 33.9% of these admissions. In weeks of nationwide COVID-19 lockdowns (2020 v. 2018/2019), involuntary psychiatric admissions were significantly fewer (odds ratio = 0.93, P = 0.0001) but longer (11.6 (s.d.: 16) v. 10.9 (s.d.: 15.8) days). The likelihood of involuntary admission during lockdowns was associated with year (2020 v. 2018–2019; adjusted odds ratio = 0.92; P = 0.0002) but not with sex (P = 0.814), age (P = 0.310), use of mechanical restraint (P = 0.653) or type of ward (P = 0.843).
Conclusions
Restrictions such as lockdowns affect coercive measures and resulted in fewer but longer involuntary psychiatric admissions during weeks of lockdown in Austria. These results strengthen previous findings that showed the dependence of coercive measures on external factors, highlighting the need to further clarify causality and desired prevention effects when using coercive measures.
“…The retrospective and exploratory nature of this study and the multiple possibilities for interpretation make it difficult to draw direct conclusions and recommendations for clinical practice. However, studies of the perceptions of care of people with severe mental disorders such as schizophrenia suggest that they experienced significant changes and loss of relevant psychosocial care, particularly during lockdown periods, 32 highlighting the need to provide the best possible biopsychosocial support to vulnerable groups during pandemic periods and associated restrictions.…”
Background
Coercive measures such as involuntary psychiatric admission are considered a last resort in the treatment of people with psychiatric disorders. So far, numerous factors have been identified that influence their use. However, the link between a pandemic – in particular, restrictions such as lockdowns – and the use of involuntary psychiatric admission is unclear.
Aim
To examine the association between COVID-19 lockdowns and involuntary psychiatric admissions in Austria.
Method
This retrospective exploratory study assessed all involuntary psychiatric admissions and use of mechanical restraint in Austria, except for the federal state of Vorarlberg, between 1 January 2018 and 31 December 2020. Descriptive statistics and regression models were used.
Results
During the 3-year study period, 40 012 individuals (45.9% females, mean age 51.3 years) had 66 124 involuntary psychiatric admissions for an average of 10.9 days. Mechanical restraint was used during 33.9% of these admissions. In weeks of nationwide COVID-19 lockdowns (2020 v. 2018/2019), involuntary psychiatric admissions were significantly fewer (odds ratio = 0.93, P = 0.0001) but longer (11.6 (s.d.: 16) v. 10.9 (s.d.: 15.8) days). The likelihood of involuntary admission during lockdowns was associated with year (2020 v. 2018–2019; adjusted odds ratio = 0.92; P = 0.0002) but not with sex (P = 0.814), age (P = 0.310), use of mechanical restraint (P = 0.653) or type of ward (P = 0.843).
Conclusions
Restrictions such as lockdowns affect coercive measures and resulted in fewer but longer involuntary psychiatric admissions during weeks of lockdown in Austria. These results strengthen previous findings that showed the dependence of coercive measures on external factors, highlighting the need to further clarify causality and desired prevention effects when using coercive measures.
The COVID-19 pandemic has presented those with experience of psychosis with a number of additional challenges. In the present study, we extend previous literature on this subject to explore experiences of COVID-19 vaccination in those with psychosis or schizophrenia. We analysed 38 posts from three popular Reddit sites for individuals with experiences of psychosis and schizophrenia. We employed reflexive, inductive thematic analysis and identified the following two themes: (i) facilitators for COVID-19 vaccination uptake, and (ii) barriers to COVID-19 vaccination uptake. The facilitators consisted of (i) trust in science/fact-checking, (ii) fear of the virus/vulnerable status/personal experience, (iii) help from trusted people, (iv) others becoming vaccinated, (v) rationalising fears/paranoia, and (vi) moral decision/contact with vulnerable people. The barriers consisted of (i) lack of trust (in doctors, government, science), (ii) psychosis about things inserted into the body/fear of adverse reactions, and (iii) and increased paranoia because of the coercive tone of discussions around the vaccination. It is clear that public health guidance can be problematic for individuals who have lived experience of psychosis. We recommend employing experts by experience in the design of public health campaigns that aim to reduce the fear around COVID-19 vaccinations.
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