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

Kadiatou Diallo-Montford, DrPH, MPH ; Jessica S. Schwind, PhD ; Stacy W. Smallwood, PhD ; Amenah Qotineh, MSc ; Kelly L. Sullivan, PhD

J Clin Psychiatry 2025;86(1):24m15448

Abstract

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 [x̄
± 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.

J Clin Psychiatry 2025;86(1):24m15448

Author affiliations are listed at the end of this article.

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