Psychological Challenges of Adults With Severe Mental Illness During the COVID-19 Pandemic

Background: The COVID-19 pandemic was an unprecedented global health crisis. Vulnerable populations with preexisting mental illness have been disproportionately burdened and may experience adverse mental health outcomes related to the COVID-19 pandemic. Objectives: Our objective was to evaluate the association between COVID-19 diagnosis, known exposure to COVID-19, sheltering in place, symptom severity, psychological distress, and depression severity among adults with severe mental illness (SMI). Methods: In a cross-sectional study, participants were recruited among patients with SMI who visited an urban community health center in Georgia between February 1, 2019, and March 11, 2021. Measures included COVID-19 impacts on the symptoms of schizophrenia and other psychotic disorders, and severe mood disorders with psychotic features, depression symptoms, self-reported psychological distress, and social connectedness. Results: Adults diagnosed with COVID-19 experienced more severe psychological distress (odds ratio [OR] = 2.48, 95% CI, 1.02–6.28) compared to those not diagnosed with COVID-19. After adjusting for sex and age, adults with SMI who sheltered in place during the lockdown experienced higher psychological distress than those who did not (adjusted odds ratio [aOR] = 2.52, 95% CI, 1.02–6.48). Women experienced significantly higher SMI severity (Brief Psychiatric Rating Scale scores [x ± SD] for women = 56.7 ± 24.4 vs men = 48.5 ± 19.1; [P= .039]) and higher odds of depression (OR = 2.74, 95% CI, 1.22–6.13) during the pandemic than men. Furthermore, adults with SMI with high social support experienced higher psychological distress than those with low social support (aOR = 4.60, 95% CI, 1.82–11.8). Conclusions: The findings of this study emphasized the need to incorporate infectious disease responses with mental health interventions during a public health crisis.