The COVID-19 Global Pandemic: Implications for People With Schizophrenia and Related Disorders

Nicole Kozloff; Benoit H. Mulsant; Vicky Stergiopoulos; Aristotle N. Voineskos


Schizophr Bull. 2020;46(4):752-757. 

In This Article

Mental Health Impact of COVID-19 on Schizophrenia

Previous outbreaks have had persistent mental health effects: following the 2003 Severe Acute Respiratory Syndrome (SARS) pandemic, significantly elevated rates of psychiatric disorders and psychological distress were present.[28] Researchers have already sounded the alarm on how the COVID-19 pandemic may affect the mental health of the general population, and more specifically patients with mental disorders.[10] If the stress related to the COVID-19 pandemic and corresponding public health measures worsens mental health in the general population, one would expect that their impact might be even higher in people living with schizophrenia.[29] In addition, COVID-19 infection itself may exacerbate symptoms in people with schizophrenia, as coronaviruses may be associated with psychotic symptoms through an immune-related mechanism.[30] Furthermore, symptoms associated with coronaviruses and their treatment have been associated with distress related to symptom severity and isolation, as well as psychosis secondary to steroids and other interventions.[31]

Social distancing, whereby governments have discouraged and imposed restrictions to reduce physical proximity, has been widely adopted in order to decrease community transmission of COVID-19. Fears of contracting COVID-19, along with significant social isolation, have led to more than half of the general public surveyed in China to report that the outbreak had a moderate or severe psychological impact on them.[32] Social distancing practices could have a particularly negative impact on individuals with schizophrenia. Typically, individuals with schizophrenia on average have smaller and poorer-quality social networks than the general population.[33] Thus, they may be more able to comply with, and tolerate, social distancing directives. However, social support has been associated with higher scores on recovery measures in schizophrenia,[34] and broad community supports, including casual contacts at pharmacies, grocery stores, and cafes, have also been associated with improved recovery and community integration scores in schizophrenia.[35] These casual contacts will be disrupted by social distancing, putting patients at risk. Among people with schizophrenia, social isolation may increase the risk for suicide,[36] and stress has been associated with aggressive behavior.[37] Social distancing may also disproportionately impact the ability of people with schizophrenia to maintain their basic needs, given their high reliance on income support and other community services that become more difficult to access.[38] For those with substance dependence, changes in the ability to access substances and their treatments, including agonist therapies, can precipitate crises. Thus, developing approaches to maintain social connection to instrumental supports in the face of social distancing may be especially crucial for people with schizophrenia. Video conferencing apps are widely used to maintain face-to-face connection during the outbreak. Similarly, programs and government agencies that provide essential services to the community should strive to find ways to maintain their efforts to ensure continued and safe delivery of services to vulnerable populations.