Vulnerability of people with schizophrenia to COVID-19

To the Editor

People with schizophrenia are a particularly vulnerable group during the COVID-19 pandemic, due to increased rates of medical comorbidity (especially chronic obstructive pulmonary disease [COPD], ischemic heart disease [IHD] and diabetes mellitus type 2 [DMT2]) (Leucht et al., 2007); disadvantageous lifestyle behaviours (smoking, obesity, alcohol and illicit substance use); antipsychotic medication contributing to obesity; and poor engagement with general health services. These factors increase the risk of poor medical outcomes from COVID-19.

An effective response plan to a viral pandemic includes (1) communication of best available information to the public and (2) minimisation of viral transmission. Therefore, it is important to have knowledge of how people with schizophrenia obtain health information, and their willingness and perceived barriers to carry out recommended protective measures, including increased handwashing and social distancing/isolation. The results from research carried out during the H1N109 (‘swine flu’) pandemic are relevant to the current viral pandemic. The most commonly used health information sources for people with schizophrenia (Maguire et al., 2011) were doctor (59.2%), family/friends (53.5%) and television (52.1%), followed by radio (37.1%), Internet (35.2%), magazines (25.4%) and newspaper (19.7%). However, regression analysis revealed that, compared with the general population, they were less likely to obtain health information from their doctor (adjusted odds ratio [AOR] = 0.27) and the Internet (AOR = 0.43) and less likely to trust their doctor as a source of information on health matters (AOR = 0.22). The majority of people with schizophrenia reported willingness to increase handwashing (88.6%) if advised to by government authorities, but were less willing (AOR = 0.41) to self-isolate (73.2%) compared with the general population (86.1%) (Maguire et al., 2019). Fear of contracting influenza was the best predictor of willingness to increase handwashing (AOR = 15.2), whereas perceived efficacy (AOR = 5.23) and self-efficacy (AOR = 4.89) were best predictors for social distancing/isolation. Perceived barriers for handwashing were access to ‘facilities’, concerns about skin irritation and time, and perceived barriers for social isolation were loneliness, difficulties accessing food/groceries and boredom.

Accordingly, clear public messaging, especially on television, about the importance of handwashing and social distancing, and specific consideration of provision of alcohol-based antiseptic gels as a handwashing facility are important for people with schizophrenia during COVID-19. Targeted strategies to facilitate access to supplies and to reduce loneliness and boredom during periods of social isolation are needed in commonality with the general public. For persons with schizophrenia, reinforcement of these messages and strategies by general practitioners, psychiatrists, community mental health teams and carers/family/friends is recommended.