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.
Highlights
The novel coronavirus disease (COVID-19) has been reported in almost every country worldwide[1] and has profoundly disrupted all aspects of society
Individuals with severe mental illnesses (SMIs) may be less aware of the pandemic and less likely to engage in preventative behaviors, which could lead to greater risk
The key aims of this report are to identify the prevalence of engaging in specific preventative behaviors among individuals with SMI and to examine demographic and psychological factors (e.g., COVID-19-related anxiety), which may contribute to preventative actions
Summary
The novel coronavirus disease (COVID-19) has been reported in almost every country worldwide[1] and has profoundly disrupted all aspects of society. Individuals with schizophrenia or bipolar disorder may be more susceptible to COVID-19 infection[4,5] and, if infected, those with schizophrenia appear to be more than three times as likely than persons without schizophrenia to experience a severe clinical course[6] Reasons for these disparities are many and varied but likely include greater vulnerability to stress[7,8], reduced access to healthcare services[9,10], increased prevalence of high risk factors such as obesity or diabetes[11,12], and/or greater likelihood of communal living situations[13] where rates of transmission could be increased. Socioeconomic status, and social support, as well as younger age, were all associated with greater COVID-19 knowledge[14]
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