Next Article in Journal
Laparoscopic Treatment of Perforated Peptic Ulcer: A Propensity Score-Matched Comparison of Interrupted Stitches Repair versus Knotless Barbed Suture
Previous Article in Journal
Electrochemotherapy in Aggressive Hemangioma of the Spine: A Case Series and Narrative Literature Review
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
JCM
Volume 13
Issue 5
10.3390/jcm13051241
jcm-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Clinical Outcome in Persons with Severe Mental Disorders Attending a Mental Health Day Center during the COVID-19 Pandemic

by
Angeliki Ninou
1,†,
Vaios Peritogiannis
1,2,†,
Sophia Maria Tzimogianni
2,
Vassiliki Fotopoulou
1,
Maria Bakola
3 and
Eleni Jelastopulu
3,*
1
Skitali Mental Health Day Center, Society for the Promotion of Mental Health in Epirus, 44445 Ioannina, Greece
2
Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, 44445 Ioannina, Greece
3
Department of Public Health, School of Medicine, University of Patras, 26500 Patras, Greece
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Clin. Med. 2024, 13(5), 1241; https://doi.org/10.3390/jcm13051241
Submission received: 20 December 2023 / Revised: 17 February 2024 / Accepted: 18 February 2024 / Published: 22 February 2024
(This article belongs to the Section Mental Health)
Browse Figure
Versions Notes

Abstract

:
Background: Studies assessing the psychological impact of the COVID-19 pandemic on populations highlight the emergence of mental health difficulties, especially if a mental health disorder is already present. Patients with severe mental illnesses (SMIs) may be even more vulnerable to the psychosocial effects of the pandemic. However, little is known regarding the possible impact of the pandemic on SMI patients supported by community-based mental health day centers. Methods: A two-year prospective study comprising 29 individuals with SMI was conducted by the Skitali Mental Health Day Center in Ioannina, Northwest Greece. The described group of examined patients consisted mainly of psychotic patients (65.5%). Patients were assessed using the Health of Nations Outcome Scale and the Global Assessment of Functioning scale, and scores prior to and after the onset of the pandemic were compared. Results: The results indicated that participants did not present any significant decline in their overall clinical status during the COVID-19 pandemic and the national lockdown measures. Conclusions: This finding is relevant because previous research has shown that the pandemic may negatively impact adherence to treatment and service attendance and that the symptomatology of patients with SMIs may further deteriorate. It is suggested that the operation of mental health day centers during collective stressful events should be preserved, but further research is needed to evaluate their role in maintaining continuity of care during such events.

Graphical Abstract

1. Introduction

Since the declaration of COVID-19 as a pandemic by the World Health Organization (WHO) in March 2020, populations have witnessed an almost radical change in everyday functioning on a global scale. Social distancing, isolation, limited socioeconomic activity, general uncertainty about the future and prolonged disease-related fear, along with excessive information with terrorizing content, constituted what seemed to be a unique stressful event [1]. Previous research has already underlined the significant correlation between stressful life events, such as changes in social relations, job insecurity, loneliness and health concerns and psychological problems, such as anxiety, depression and distress in the general population [2]. Indeed, the existing literature suggests that restrictive measures, such as quarantine and social distancing, may have a substantial impact on the psychological well-being and emotive reactions of the population. Psychological reactions to pandemics include maladaptive or avoidance behaviors, emotional distress, anxiety, fear, frustration, anger and depression [3]. Therefore, the effects of the pandemic on the mental health of the population were rapidly pointed out by a growing body of research. In the early stages of the pandemic, a study carried out in Wuhan, China, showed that more than one-fourth of the city’s population reported increased levels of anxiety and depression, and one-third reported sleep disorders [4]. Other studies identified similar psychological difficulties [5,6], along with post-traumatic stress disorder (PTSD) symptoms [7], COVID-19-related traumatic distress [8] and high levels of COVID-19-related fear [9]. It should be noted that, although most studies have been conducted in Western, high-income countries, there is emerging evidence that in low- and middle-income countries there may also be an increase in symptoms of mental health distress and a consequent increase in the prevalence of clinically significant mental health problems [10]. Such responses to the COVID-19 pandemic may be even more relevant in those countries due to the well-documented socioeconomic and health inequities they face [10]. Moreover, a study that explored mental health manifestations in people who suffered a COVID-19 infection at one year suggested that they had an increased risk of incident mental disorders, such as anxiety disorders, depression, stress and adjustment disorders, substance use disorders, neurocognitive decline and sleep disorders compared with unaffected controls [11]. It should be noted, however, that wide variability in the prevalence of mental health problems and psychosocial consequences due to the pandemic has been observed across countries [12].
Considering the above and the limited accessibility to mental healthcare imposed by the circumstances [13], it was rather expected that individuals with a pre-existing mental health disorder, especially a severe one, would suffer a greater impact. Given the cognitive, psychological and socio-economic challenges that people with mental health conditions usually face, fears were expressed about possible exacerbation of pre-existing conditions [14,15,16,17,18,19]. Evidence from around the world seems to support the aforementioned concerns. In two studies at the peak of the pandemic in Spain, participants presenting a pre-existing mental health disorder reported higher levels of anxiety [20] and depression [21] than healthy controls; similar results were obtained in Serbia [22]. At the peak of the first wave of the COVID-19 pandemic in China, with strict lockdown measures, patients with previous psychiatric diagnoses (mostly depressive and anxiety disorders) had significantly higher levels of anxiety, depression and stress compared to the general population, and more than one-quarter of them reported PTSD-like symptoms and insomnia [23]. A study in Canada involving a large sample of participants found that the rates of depressive symptoms and symptoms of generalized anxiety disorder were high. Importantly, the proportion of participants with clinically significant worsening in anxiety, depression and suicidal ideation was higher in those with pre-existing psychiatric problems than in those without a psychiatric history [24]. These findings were replicated in a subsequent, very large study with 55,589 participants from 40 countries, in which probable depression was detected in 17.8% of the sample and distress was detected in 16.7%. Notably, persons with a history of mental disorders had higher rates of current depression (31.8% vs. 13%) [25].
With regard to patients with severe mental illness (SMI), there were early concerns regarding the impact of the pandemic on those patients’ physical and mental health, as well as concerns about the continuity of care in this patient population [16]. It has been shown that patients with SMI have higher rates of physical morbidity and premature mortality due to natural and unnatural causes than the general population [26,27]. Moreover, they are more likely to suffer a COVID-19 infection and display significantly higher mortality rates than the general population [28,29]. However, less is known about the impact of the pandemic on the mental health of patients with SMIs. In a study in India, 29.5% of the participants presenting with a severe mental health disorder reported an exacerbation of symptoms during the early stages of the pandemic, and between 20% and 37.9% of them reported problems with sleep, food intake and personal care [30]. Similarly, symptom exacerbation, along with anxiety and fear, was reported by a study on psychiatric outpatients (>40% with SMI) in Italy and Paraguay [31]. In the USA, in a study carried out from July to October 2020, participants with schizophrenia or schizoaffective disorder reported an exacerbation of negative symptoms, such as anhedonia, avolition and asociality [32]. In England, a study of 34,446 patients with severe mental health disorders reported an overall deterioration in their mental health state during the first national lockdown [33]. Finally, a very recent review of the evidence suggested that the pandemic affected many aspects of schizophrenia patients’ symptomatology, mostly negative symptoms, but also adherence to treatment and service attendance [34]. It has been further suggested that patients with schizophrenia may be vulnerable to the effects of the COVID-19 pandemic due to several risk factors, such as social problems and disease-related factors [35].
Accordingly, a survey in 130 countries by the WHO suggested that the demand for mental health care had increased over the COVID-19 pandemic but also that the pandemic had negatively impacted access to mental health services. At the same time, mental health services had been disrupted in 93% of countries worldwide [36]. Patients’ treatment attendance and engagement with services had also been affected by the pandemic and had decreased, while patients were less likely to receive timely outpatient care because community and rehabilitation services had been considerably reduced or had even ceased [37].
The psychological impact of the COVID-19 pandemic on the Greek population have been highlighted by several studies involving people with common mental disorders. Being on psychiatric medication was associated with higher COVID-19-related fear [9], while a previous history of depression was associated with the development of depressive symptomatology [38]. Finally, post-traumatic stress symptoms were linked to previous psychiatric histories [39]. Less is known regarding the psychosocial impact of the pandemic on patients with SMI in Greece and the interventions that could ameliorate its negative effects on this vulnerable population. The present study is therefore relevant in that it aims to explore the psychological impact of the pandemic on patients with SMI continuing to receive support from a community-based psychosocial rehabilitation service in Greece during the pandemic. To the best of our knowledge, very few studies have specifically examined the experiences of people receiving community-based mental healthcare services during the pandemic. The question seems important, considering that it adds to the as-yet limited research on the psychological impact of a collective stressful event on a particularly vulnerable population; it also contributes to the discussion about the role of community-based mental health day centers during psychosocial stressful events. Given the organizational flexibility and personalization of the interventions delivered by community-based mental health services, it could be hypothesized that they could play a major role in an event such as the pandemic [40]. Thus, another objective of the present study was to better understand how to optimize support for people with chronic and severe mental disorders during a collective stressful event.

2. Materials and Methods

2.1. The Study Setting

The Skitali Mental Health Day Center (Skitali MHDC) in Ioannina, Northwest Greece, is a community-based psychosocial rehabilitation service providing free daily individual counseling, home-based interventions and group rehabilitation activities to people with severe mental disorders. Addressing its services to approximately 120,000 inhabitants in its area, the center accepts individuals referred by psychiatrists in both public and private practices. The center’s population presents a variety of psychiatric diagnoses along with significant psychosocial difficulties, with schizophrenia and related psychotic disorders being the most prevalent. People with substance abuse disorders and moderate to severe mental retardation are not treated by the center, but are referred to other services in the area.

2.2. Study Design

A prospective study was conducted in Skitali MHDC in Ioannina, Greece. As our study aimed to determine possible psychological impacts of the pandemic on the center’s population, we opted for data obtained before and after national lockdown measures issued in March 2020. Data from the end of the second semester of 2019 represented the baseline information, while data from the end of the second semester of 2020 and from that of 2021 served, respectively, as 12-month and 24-month follow-up evaluations. All patients who attended the Skitali MHDC at the end of 2019 were initially eligible for participation in the study. Patients were included in the study if they regularly attended the day center over the two-year study period. Patients who disengaged from the service and those who attended the day center only intermittently over the two-year follow-up were excluded from the analysis, since there were missing measurements of their symptomatology and functioning. Patients who first referred to the center after the onset of the pandemic were also excluded, since they had no baseline assessment.
The study was approved by the Institutional Board following the Institution’s research guidelines. The need for patients’ informed consent was waived since the study was not interventional and the measurements were regular parts of patients’ routine assessments.

2.3. Participants and Measurements

Participants in the study included all individuals with a psychiatric diagnosis according to the International Classification of Diseases, 10th Revision (ICD-10), attending the center’s program from the second semester of 2019. During the second semester of 2019, a mean monthly number of 50 individuals attended the day center’s program. Due to lockdown measures, continuity of physical attendance was not possible, and routine treatment plans were halted or significantly altered. Changes in nature and means of support were required, comprising daily distance communication and virtual group activities, as well as in-person individual consultations when considered necessary. Following the progressive relaxation of lockdown restrictions between June 2020 and November 2020, support also included in-person participation in small groups, taking place in outdoor spaces. Given the different phases of the pandemic and the constant changes in services offered, only 29 individuals who were supported continuously until the end of the second semester of 2021 were included in this study.
Data were collected from mental health assessments carried out in our center every six months, such as the Health of the Nation Outcome Scales (HoNOS) and the Global Assessment of Functioning scale (GAF). HoNOS is a 12-item instrument measuring the clinical symptoms and social functioning of people aged 18–64 years. Each item is rated on a five-point scale, with higher points indicating an increased level of impairment. GAF measures the severity of clinical and social functioning impairment on a scale ranging from 0 to 100, with a lower score indicating a more severe impairment.
Both assessment measures are routinely used by the center’s psychologists following the institution’s quality of care guidelines. Thus, instrument selection was based on measures already available in Skitali MHDC, opting for data obtained before the onset of the pandemic. The HoNOS presents good validity and, despite its variable reliability, is considered better than other measures for mental health settings, covering a wide range of areas of overall functioning [41]. The HoNOS has commonly been used to assess clinical and functional changes in patient populations over time [42]. In the United Kingdom, the use of the HoNOS is recommended for regular use in clinical practice by the authorities [43], while in some regions its collection is mandatory; accordingly, the HoNOS is widely used in service evaluation research [42]. Most importantly, it has been used in research on patients with schizophrenia-spectrum disorders being treated in community mental healthcare services [44]. The validity and reliability of the Greek version of the HoNOS [45] was tested in the Greek population and was reported to be high [46]. The GAF scale shows poor inter-rater reliability and poor discriminant validity, especially in the outpatient population [47]. However, we chose to include the GAF results in this study, as the instrument is widely used in mental health settings and may provide additional information for our research, at least at a clinical level. Moreover, it has been shown that GAF ratings can be used to measure changes and outcomes at the group level, which is relevant to the present study [48]. The GAF scale has proven validity and reliability in the Greek language [49]. Both scales have been previously used in research in community mental healthcare settings in Greece [50,51].

2.4. Statistical Analysis

Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 23.0 (SPSS Inc., Chicago, IL, USA) for Windows. Descriptive statistics were used to summarize all variables. Analysis of HoNOS results concerned the scores of both individual items and subscales due to concerns about the validity of sum scores and dimensionality of the subscales [42,52,53].
Due to the small sample size, normality tests were performed for HoNOS and GAF scores using the Shapiro–Wilk test and inspecting the level of skewness and kurtosis in data distribution. Only the total HoNOS score for 2019 and the HoNOS Social subscale and GAF scores for 2020 were normally distributed. All other data were highly skewed and the Shapiro–Wilk test presented p values below 0.05, indicating a non-normal distribution.
Due to the small sample size and the non-normal distributions, we decided to run a non-parametric repeated measures test, the Friedman test, in order to estimate differences in HoNOS and GAF scores over three time points.

3. Results

Twenty-nine individuals attending the day center’s program were enrolled according to the inclusion criteria of this study. The participants’ mean age was 43.7 years and most were men (58.6%). Most of the participants were allocated a disability pension (51.7%), a small proportion had a paid job (13.8%) and one-fifth were unemployed. The majority of the participants had a postsecondary education (86.1%). Almost half were living with their parents or siblings (48.3%) and less than one-fifth were living alone. One-fourth of the patients were residents in rehabilitation facilities. Most had been attending the day centers’ program before the second semester of 2019 (79.3%). Diagnoses of schizophrenia, schizotypal or delusional disorder were prevalent (65.5%) (Table 1).
The mean scores of HoNOS and GAF results in the second semester of 2019 were 10.4 and 64.3, respectively. The HoNOS Behavior subscale presented the lowest severity for the majority of the participants (89.6%), whereas the Social subscale presented moderate to severe problems for most of them (82.5%). The HoNOS Symptom subscale indicated a need for intervention in most of the cases (72.2%) for problems ranging from mild to severe (Table 2).
Comparing the HoNOS and GAF scores obtained before, during and after the pandemic using a Friedman test, no significant difference was found (Table 3).

4. Discussion

In the present study, we examined whether individuals attending a community-based mental health day center presented a decline in their clinical status during the COVID-19 pandemic and the national lockdown measures. The analysis shows that those who continued to receive support from the Skitali MHDC presented no significant overall symptom exacerbation or decline in their mental health status during the two years of the pandemic. In fact, none of the HoNOS scale items and none of the GAF scores changed significantly, suggesting that patients attending the Skitali MHDC remained rather stable in terms of psychopathology and daily functioning during the period examined.
At the clinical rather than the statistical level, according to the GAF mean ranks, participants showed a slight amelioration in their overall clinical status in 2020, which declined in 2021, almost reaching the pre-pandemic levels. Again, it seems that the participants maintained a rather stable overall condition. HoNOS cognitive impairment mean rank scores seem to represent an amelioration in this domain, despite what would be expected given the circumstances. Agitated behavior, on the other hand, presented a slight increase in 2020 and remained increased in 2021. The only score presenting a stable decline throughout the two-year period was that of the behavior subscale, indicating that the participants experienced increased behavior problems. However, as we have already pointed out, there are methodological concerns with the use of the HoNOS subscales due to suspected multidimensionality.
The main findings of the present study, however, do not agree with the general literature concerning the psychological impact of the pandemic on psychiatric populations, although we should consider that most of the studies reporting exacerbation of symptoms were cross-sectional [54] and concerned the first wave or the first year of the pandemic [13]. From that aspect, our finding concerning the increase of agitated behavior during the first year of the pandemic agrees with similar findings during the same time period [33]. Nevertheless, a small portion of the studies found no significant psychological impact on psychiatric patients, even during the first stages of the pandemic. Comparing pre- and post-pandemic data, two studies [54,55] not only reported a lack of significant symptom exacerbation in patients with psychotic disorders but also an amelioration in some aspects of their daily functioning. These studies seem to corroborate our findings, especially concerning the amelioration in GAF scores during 2020 and the constant amelioration of cognitive impairment.
According to the aforementioned studies, resilience factors, such as practicing religiosity, receiving formal updates about the pandemic and having the ability to draw upon pre-pandemic social networks during the pandemic, could explain their results. In the present study, participants were systematically informed about the pandemic based on official reports and guidelines of protection, especially through virtual group meetings. This could have enhanced some sense of control and maybe procured a sense of meaningfulness in this out-of-the-ordinary situation. As has already been suggested, people with mental health disorders could be significantly impacted by stressful events that they perceive as being out of their control [56].
In addition, our data concern individuals who attend, usually for years, a community-based psychosocial rehabilitation service. Attendance at such a service provides the means for building a social support network through group activities and socializing, as well as access to at-home interventions. During the lockdown measures, support continued to be provided in our center through individual or group activities at a distance, and patients regularly communicated with each other as well as with the therapists through phone and video calls. This permitted the maintenance of social support, even in an altered form. Evidence from previous research has already underlined the importance of social networks and support to recovery [57,58,59]. The authors of a study in Portugal, carried out from March to May 2021, reached the same conclusions: Participants mostly diagnosed with schizophrenia and other psychotic disorders attending psychosocial rehabilitation services and thus continuing to draw upon their rehabilitation communities during the pandemic were found to report medium to high levels of resilience and mental well-being [60].
It could be argued that modalities of social support offered by such services during the pandemic are not of the same quality as pre-pandemic realities, given the lockdown restrictions and, in many instances, the lack of at-distance means to ascertain accessibility [37]. However, interviews with patients having a schizophrenia diagnosis suggest that, despite the possible initial psychological impact of the situation, maintaining continuity of care and even a limited form of contact could help patients better adjust [61].
Another point to consider is the willingness of patients with SMI to use all available resources to protect their health and preserve their well-being during the pandemic, which could explain their attendance at day centers. A recent qualitative study addressed the experiences of coping with COVID-19 among patients with schizophrenia in Korea and found that routine care was interrupted on several occasions, while patients experienced a dual threat from their mental illness and the emerging infectious disease, along with inequity and paradoxical situations. Still, they were able to employ various strategies and self-help measures to cope with pandemic stress, and importantly, kept seeking support from mental health professionals [62]. Another recent study in Turkey concerning patients with schizophrenia found that the use of available resources, adaptation to changes in daily living, and social interaction and support were facilitators in coping with the pandemic burden [63]. These observations are indirectly supported by a recent review regarding the concerns and fears of patients with mental disorders toward COVID-19 vaccination, which highlights that, contrary to expectations at the beginning of the pandemic, SMI may positively affect attitudes toward the vaccine [64]. This finding suggests that the ability to seek support, which may influence adherence, could represent a crucial protective personality trait in these patients. Notably, patients with SMI in our catchment area displayed high rates of COVID-19 vaccination [65].
Possible confounding factors that could have affected the observed outcomes in patients should be considered. For instance, if patients received further support from services during the pandemic, this might have partly accounted for the stabilization of their clinical state. However, it is known that, globally, the response of the mental health systems to the pandemic included the reduction of outpatient appointments, the treatment of emergencies only and the minimization of caseloads [66]; this was also the case in our area. Thus, it seems highly unlikely that the present sample of patients received any additional pandemic support during the study period, and their attendance at the Skitali MHDC was probably their best opportunity to continue receiving mental health care.

4.1. Limitations and Strengths

The main strength of the present study is its prospective design and relatively long follow-up, addressing the participants’ symptomatology and functioning over different phases of the COVID-19 pandemic. However, the exploration of psychological responses to the pandemic, such as fear and worry, as well as the assessment of patients’ well-being, was beyond the scope of the study. Indeed, some studies on psychiatric patients, including those receiving community-based support, recorded increased distress, loneliness, fear and anxiety, and perceived risk to mental health and well-being, even in the absence of any exacerbation of psychiatric symptoms [67,68,69,70]. Whether these psychological effects would contribute to an eventual deterioration of patients’ mental health in the long term remains to be studied [69]. It remains an important aspect of the pandemic that needs to be taken into account, considering that the world, two years after its onset, still faces constant resurgences and relative fears.
Several other limitations are present in our study. First, it concerns a small sample of patients, who may not represent the whole patient population, and only one community-based rehabilitation service. This restricted the statistical processing of the data, and the results lack generalizability, as they may not describe the actual impact of the pandemic on people who regularly attend similar services. In addition, even though considerable effort was made to reach every person normally using our service and offer the means to receive further support (assistance in technological means use, lending relative material, etc.), some people, especially those with severe physical comorbidities and those living in distant rural areas, could not or would not access our services beyond phone-based communication, and they eventually dropped out of the program during the first year of the pandemic. This could mean that we could not assess the psychological state of people who were possibly presenting higher levels of psychosocial need than the study’s participants. Finally, the lack of a control group of patients who did not attend a community-based psychiatric rehabilitation service during the pandemic does not allow us to ascertain the role of the Skitali MHDC in the stabilization of the clinical and functional state of the participants.

4.2. Potential Implications and Future Research

The findings of the present study may be relevant to clinical practice and psychiatric rehabilitation and may have potential policy implications for mental health services in health or other crises. It has been argued that the social distancing imposed by the pandemic can cause significant emotional distress to patients with SMIs, possibly leading to a relapse of psychotic symptoms in this population and thus to an increased risk of rehospitalization [71]. It has also been shown that during the pandemic, the rate of involuntary admissions increased significantly due to patients’ non-adherence to treatment and disengagement from mental health services, both further associated with the exacerbation of symptoms and relapse [72,73,74]. It appears that a day center can effectively retain patients with SMI in a community-based, broad psychosocial rehabilitation program, even modified to conform to the pandemic, thus preventing the deterioration of their mental health and subsequent relapses and hospitalizations. Accordingly, the operation of day centers and other community-based mental health services should be preserved over periods of stressful events as a means of maintaining continuity of care in this vulnerable population.
The present study includes patients with severe and chronic mental disorders who regularly attend a community-based rehabilitation service. Those patients were eligible for the day center due to their psychosocial difficulties and modest prognosis that required rehabilitation. It is not known what the impact of the pandemic may be on remitted patients, who may have had active social and vocational lives prior to the pandemic. Such patients may not wish to be followed up [75], may not use rehabilitation services and may not participate in research. Similarly, patients with poor prognosis who do not attend treatment or rehabilitation services may have been affected by the pandemic as well, but the extent of their difficulties cannot be easily assessed. These important issues need to be addressed in future research. Since the long-term pandemic effects on patients with mental disorders are currently largely unknown, further research on this topic is warranted. The role of mental health day centers caring for patients with SMIs during other collective stressful events should also be studied.

5. Conclusions

The present study showed that individuals with chronic and severe mental disorders attending a community-based mental health day center and receiving psychosocial treatment and rehabilitation services during the two years of the COVID-19 pandemic presented no significant decline in their overall mental health status. This led us to suggest that a day center may play an important role in promoting patients’ psychosocial functioning despite general conditions. Further research is needed to assess the role of a community-based mental health day center during collective stressful events.

Author Contributions

Conceptualization, A.N. and V.P.; methodology, V.P. and A.N.; software, A.N., V.F. and M.B.; formal analysis, A.N., S.M.T. and M.B.; investigation, A.N., S.M.T. and V.F.; data curation, V.P. and A.N.; writing—original draft preparation, A.N. and V.P.; writing—review and editing, V.P., M.B. and E.J.; supervision, E.J. and V.P.; project administration, E.J. and V.P. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the Society for the Promotion of Mental Health in Epirus (Δ.12./30-6-2022).

Informed Consent Statement

Patient consent was waived due to the noninterventional design of this study.

Data Availability Statement

Data are kept in the patients’ electronic charts of the “Skitali” Mental Health Day Center and are confidential.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Biondi, M.; Iannitelli, A. COVID-19 and stress in the pandemic: “Sanity is not statistical”. Riv. Psichiatr. 2020, 55, 131–136. [Google Scholar] [CrossRef]
  2. Hassanzadeh, A.; Heidari, Z.; Feizi, A.; Hassanzadeh Keshteli, A.; Roohafza, H.; Afshar, H.; Adibi, P. Association of Stressful Life Events with Psychological Problems: A Large-Scale Community-Based Study Using Grouped Outcomes Latent Factor Regression with Latent Predictors. Comput. Math. Methods Med. 2017, 2017, 3457103. [Google Scholar] [CrossRef]
  3. Talevi, D.; Socci, V.; Carai, M.; Carnaghi, G.; Faleri, S.; Trebbi, E.; di Bernardo, A.; Capelli, F.; Pacitti, F. Mental health outcomes of the COVID-19 pandemic. Riv. Psichiatr. 2020, 55, 137–144. [Google Scholar] [CrossRef]
  4. Fu, W.; Wang, C.; Zou, L.; Guo, Y.; Lu, Z.; Yan, S.; Mao, J. Psychological health, sleep quality, and coping styles to stress facing the COVID-19 in Wuhan, China. Transl. Psychiatry 2020, 10, 225. [Google Scholar] [CrossRef]
  5. Santabárbara, J.; Lasheras, I.; Lipnicki, D.M.; Bueno-Notivol, J.; Pérez-Moreno, M.; López-Antón, R.; De la Cámara, C.; Lobo, A.; Gracia-García, P. Prevalence of anxiety in the COVID-19 pandemic: An updated meta-analysis of community-based studies. Prog. Neuro-Psychopharmacol. Biol. Psychiatry 2021, 109, 110207. [Google Scholar] [CrossRef]
  6. Fioravanti, G.; Bocci Benucci, S.; Prostamo, A.; Banchi, V.; Casale, S. Effects of the COVID-19 pandemic on psychological health in a sample of Italian adults: A three-wave longitudinal study. Psychiatry Res. 2022, 315, 114705. [Google Scholar] [CrossRef]
  7. Wang, C.; Pan, R.; Wan, X.; Tan, Y.; Xu, L.; McIntyre, R.S.; Choo, F.N.; Tran, B.; Ho, R.; Sharma, V.K.; et al. A longitudinal study on the mental health of general population during the COVID-19 pandemic in China. Brain Behav. Immun. 2020, 87, 40–48. [Google Scholar] [CrossRef]
  8. Schäfer, S.K.; Sopp, M.R.; Schanz, C.G.; Staginnus, M.; Göritz, A.S.; Michael, T. Impact of COVID-19 on Public Mental Health and the Buffering Effect of a Sense of Coherence. Psychother. Psychosom. 2020, 89, 386–392. [Google Scholar] [CrossRef]
  9. Parlapani, E.; Holeva, V.; Voitsidis, P.; Blekas, A.; Gliatas, I.; Porfyri, G.N.; Golemis, A.; Papadopoulou, K.; Dimitriadou, A.; Chatzigeorgiou, A.F.; et al. Psychological and Behavioral Responses to the COVID-19 Pandemic in Greece. Front. Psychiatry 2020, 11, 821. [Google Scholar] [CrossRef]
  10. Kola, L.; Kohrt, B.A.; Hanlon, C.; Naslund, J.A.; Sikander, S.; Balaji, M.; Benjet, C.; Cheung, E.Y.L.; Eaton, J.; Gonsalves, P.; et al. COVID-19 mental health impact and responses in low-income and middle-income countries: Reimagining global mental health. Lancet Psychiatry 2021, 8, 535–550. [Google Scholar] [CrossRef]
  11. Xie, Y.; Xu, E.; Al-Aly, Z. Risks of mental health outcomes in people with COVID-19: Cohort study. BMJ 2022, 376, e068993. [Google Scholar] [CrossRef]
  12. Nochaiwong, S.; Ruengorn, C.; Thavorn, K.; Hutton, B.; Awiphan, R.; Phosuya, C.; Ruanta, Y.; Wongpakaran, N.; Wongpakaran, T. Global prevalence of mental health issues among the general population during the coronavirus disease-2019 pandemic: A systematic review and meta-analysis. Sci. Rep. 2021, 11, 10173. [Google Scholar] [CrossRef] [PubMed]
  13. Murphy, L.; Markey, K.; O’Donnell, C.; Moloney, M.; Doody, O. The impact of the COVID-19 pandemic and its related restrictions on people with pre-existent mental health conditions: A scoping review. Arch. Psychiatr. Nurs. 2021, 35, 375–394. [Google Scholar] [CrossRef]
  14. Brown, E.; Gray, R.; Lo Monaco, S.; O’Donoghue, B.; Nelson, B.; Thompson, A.; Francey, S.; McGorry, P. The potential impact of COVID-19 on psychosis: A rapid review of contemporary epidemic and pandemic research. Schizophr. Res. 2020, 222, 79–87. [Google Scholar] [CrossRef]
  15. Chatterjee, S.S.; Malathesh, B.C.; Mukherjee, A. Letter to the Editor: Impact of COVID-19 pandemic on pre-existing mental health problems. Asian J. Psychiatry 2020, 51, 10201. [Google Scholar] [CrossRef]
  16. Kozloff, N.; Mulsant, B.H.; Stergiopoulos, V.; Voineskos, A.N. The COVID-19 Global Pandemic: Implications for People with Schizophrenia and Related Disorders. Schizophr. Bull. 2020, 46, 752–757. [Google Scholar] [CrossRef]
  17. Rohner, H.; Lenz, A.J.; Krug, A.; Philipsen, A. The Impact of the COVID-19 Pandemic on Psychoses: Rapid Review and Case Series. Health Educ. Public Health 2020, 3, 307–309. [Google Scholar] [CrossRef]
  18. Zhand, N.; Joober, R. Implications of the COVID-19 pandemic for patients with schizophrenia spectrum disorders: Narrative review. BJPsych Open 2021, 7, e35. [Google Scholar] [CrossRef]
  19. Puangsri, P.; Jinanarong, V.; Wattanapisit, A. Impacts on and Care of Psychiatric Patients during the Outbreak of COVID-19. Clin. Pract. Epidemiol. Ment. Health 2021, 17, 52–60. [Google Scholar] [CrossRef]
  20. González-Blanco, L.; Dal Santo, F.; García-Álvarez, L.; de la Fuente-Tomás, L.; Moya Lacasa, C.; Paniagua, G.; Sáiz, P.A.; García-Portilla, M.P.; Bobes, J. COVID-19 lockdown in people with severe mental disorders in Spain: Do they have a specific psychological reaction compared with other mental disorders and healthy controls? Schizophr. Res. 2020, 223, 192–198. [Google Scholar] [CrossRef]
  21. García-Fernández, L.; Romero-Ferreiro, V.; Padilla, S.; López-Roldán, P.D.; Monzó-García, M.; Rodriguez-Jimenez, R. The impact on mental health patients of COVID-19 outbreak in Spain. J. Psychiatr. Res. 2021, 136, 127–131. [Google Scholar] [CrossRef]
  22. Kuljancic, D.P. The Impact of the COVID-19 Pandemic on the Mental Health of the General Population and the Population of Psychiatric Patients. Electron. J. Gen. Med. 2020, 19, em337. [Google Scholar] [CrossRef]
  23. Hao, F.; Tan, W.; Jiang, L.; Zhang, L.; Zhao, X.; Zou, Y.; Hu, Y.; Luo, X.; Jiang, X.; McIntyre, R.S.; et al. Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry. Brain Behav. Immun. 2020, 87, 100–106. [Google Scholar] [CrossRef]
  24. Robillard, R.; Daros, A.R.; Phillips, J.L.; Porteous, M.; Saad, M.; Pennestri, M.H.; Kendzerska, T.; Edwards, J.D.; Solomonova, E.; Bhatla, R.; et al. Emerging New Psychiatric Symptoms and the Worsening of Pre-existing Mental Disorders during the COVID-19 Pandemic: A Canadian Multisite Study. Can. J. Psychiatry 2021, 66, 815–826. [Google Scholar] [CrossRef]
  25. Fountoulakis, K.N.; Karakatsoulis, G.; Abraham, S.; Adorjan, K.; Ahmed, H.U.; Alarcón, R.D.; Arai, K.; Auwal, S.S.; Berk, M.; Bjedov, S.; et al. Results of the COVID-19 mental health international for the general population (COMET-G) study. Eur. Neuropsychopharmacol. 2022, 54, 21–40. [Google Scholar] [CrossRef]
  26. Hjorthøj, C.; Stürup, A.E.; McGrath, J.; Nordentoft, M. Years of potential life lost and life expectancy in schizophrenia: A systematic review and meta-analysis. Lancet Psychiatry 2017, 4, 295–301. [Google Scholar] [CrossRef]
  27. Peritogiannis, V.; Ninou, A.; Samakouri, M. Mortality in Schizophrenia-Spectrum Disorders: Recent Advances in Understanding and Management. Healthcare 2022, 10, 2366. [Google Scholar] [CrossRef] [PubMed]
  28. Toubasi, A.; AbuAnzeh, R.; Abu Tawileh, H.; Aldebei, R.; Alryalat, S.A. A meta-analysis: The mortality and severity of COVID-19 among patients with mental disorders. Psychiatry Res. 2021, 299, 113856. [Google Scholar] [CrossRef] [PubMed]
  29. Tzur Bitan, D.; Krieger, I.; Kridin, K.; Komantscher, D.; Scheinman, Y.; Weinstein, O.; Cohen, A.D.; Cicurel, A.A.; Feingold, D. COVID-19 Prevalence and Mortality Among Schizophrenia Patients: A Large-Scale Retrospective Cohort Study. Schizophr. Bull. 2021, 47, 1211–1217. [Google Scholar] [CrossRef]
  30. Muruganandam, P.; Neelamegam, S.; Menon, V.; Alexander, J.; Chaturvedi, S.K. COVID-19 and Severe Mental Illness: Impact on patients and its relation with their awareness about COVID-19. Psychiatry Res. 2020, 291, 113265. [Google Scholar] [CrossRef]
  31. Gentile, A.; Torales, J.; O’Higgins, M.; Figueredo, P.; Castaldelli-Maia, J.M.; De Berardis, D.; Petito, A.; Bellomo, A.; Ventriglio, A. Phone-based outpatients’ follow-up in mental health centers during the COVID-19 quarantine. Int. J. Soc. Psychiatry 2022, 68, 129–133. [Google Scholar] [CrossRef]
  32. Strauss, G.P.; Macdonald, K.I.; Ruiz, I.; Raugh, I.M.; Bartolomeo, L.A.; James, S.H. The impact of the COVID19 pandemic on negative symptoms in individuals at clinical high-risk for psychosis and outpatients with chronic schizophrenia. Eur. Arch. Psychiatry Clin. Neurosci. 2022, 272, 17–27. [Google Scholar] [CrossRef] [PubMed]
  33. Penington, E.; Lennox, B.; Geulayov, G.; Hawton, K.; Tsiachristas, A. The early impact of the COVID-19 pandemic on patients with severe mental illness: An interrupted time-series study in South-East England. Eur. Psychiatry 2022, 65, e31. [Google Scholar] [CrossRef] [PubMed]
  34. Kowalski, K.; Misiak, B. Schizophrenia and the COVID-19 pandemic: A narrative review from the biomedical perspective. Rev. Psiquiatr. Salud Ment. 2023. online ahead of print. [Google Scholar] [CrossRef]
  35. Mohseni, M.; Khalafi, P.; Hajizamani, S.; Baghchi, B. Impact of COVID-19 Pandemic on Patients with Schizophrenia Spectrum Disorders: A Review Study. Clin. Schizophr. Relat. Psychoses 2022, 16, S3. [Google Scholar] [CrossRef]
  36. World Health Organization. COVID-19 Disrupting Mental Health Services in Most Countries, WHO Survey. 2020. Available online: https://www.who.int/news/item/05-10-2020-COVID-19-disrupting-mental-health-services-in-most-countries-who-survey (accessed on 30 January 2024).
  37. Duden, G.S.; Gersdorf, S.; Stengler, K. Global impact of the COVID-19 pandemic on mental health services: A systematic review. J. Psychiatr. Res. 2022, 154, 354–377. [Google Scholar] [CrossRef]
  38. Fountoulakis, K.N.; Apostolidou, M.K.; Atsiova, M.B.; Filippidou, A.K.; Florou, A.K.; Gousiou, D.S.; Katsara, A.R.; Mantzari, S.N.; Padouva-Markoulaki, M.; Papatriantafyllou, E.I.; et al. Self-reported changes in anxiety, depression and suicidality during the COVID-19 lockdown in Greece. J. Affect. Disord. 2021, 279, 624–629. [Google Scholar] [CrossRef]
  39. Karaivazoglou, K.; Konstantopoulou, G.; Kalogeropoulou, M.; Iliou, T.; Vorvolakos, T.; Assimakopoulos, K.; Gourzis, P.; Alexopoulos, P. Psychological distress in the Greek general population during the first COVID-19 lockdown. BJPsych Open 2021, 7, e59. [Google Scholar] [CrossRef]
  40. Castelpietra, G.; Colli, C.; Tossut, D.; Furlan, M.; Balestrieri, M.; Starace, F.; Beghi, M.; Barbone, F.; Perulli, A.; Salvador-Carulla, L. The impact of COVID-19 pandemic on community-oriented mental health services: The experience of Friuli Venezia Giulia region, Italy. Health Policy Technol. 2021, 10, 143–150. [Google Scholar] [CrossRef]
  41. Orrell, M.; Yard, P.; Handysides, J.; Schapira, R. Validity and reliability of the Health of the Nation Outcome Scales in psychiatric patients in the community. Br. J. Psychiatry 1999, 174, 409–412. [Google Scholar] [CrossRef]
  42. Delaffon, V.; Anwar, Z.; Noushad, F.; Ahmed, A.S.; Brugha, T.S. Use of Health of the Nation Outcome Scales in psychiatry. Adv. Psychiatr. Treat. 2012, 18, 173–179. [Google Scholar] [CrossRef]
  43. Smith, W.; Vitoratou, S.; McCrone, P.; Patel, A. Exploring the factor structure of the Health of the Nation Outcomes Scale (HoNOS) in a sample of patients with schizophrenia, schizotypal and delusional disorders. Health Qual. Life Outcomes 2017, 15, 141. [Google Scholar] [CrossRef]
  44. Laugharne, R.; Eaves, S.; Mascas, A.; Psatha, K.; Dinnis, G.; Trower, J.; Shankar, R. Desperately seeking outcomes: Quantifying the effectiveness of community mental healthcare using Health of the Nation Outcome Scales. BJPsych Open 2018, 4, 91–94. [Google Scholar] [CrossRef] [PubMed]
  45. Mavreas, V.; Fotiadou, M. Greek Version of HoNOS65þ. 2010. Available online: http://www.rcpsych.ac.uk/pdf/CETC_HoNOS%2065þ_tabulated_Greek%20v2 (accessed on 19 December 2023).
  46. Adamis, D.; Papanikolaou, V.; Michailidis, M.; Macdonald, A.J. Validation of the Greek version of the Health of the Nation Outcome Scales for Elderly People (HoNOS65+, version 3). Aging Ment. Heal. 2013, 17, 258–264. [Google Scholar] [CrossRef] [PubMed]
  47. Grootenboer, E.M.V.; Giltay, E.J.; van der Lem, R.; van Veen, T.; van der Wee, N.J.A.; Zitman, F.G. Reliability and validity of the Global Assessment of Functioning Scale in clinical outpatients with depressive disorders. J. Eval. Clin. Pract. 2012, 18, 502–507. [Google Scholar] [CrossRef] [PubMed]
  48. Söderberg, P.; Tungström, S.; Armelius, B.Å. Reliability of global assessment of functioning ratings made by clinical psychiatric staff. Psychiatr. Serv. 2005, 56, 434–438. [Google Scholar] [CrossRef] [PubMed]
  49. Madianos, M. Global assessment scale: Its reliability and validity in Greece. Encephalos 1987, 24, 97–100. (In Greek) [Google Scholar]
  50. Peritogiannis, V.; Nikolaou, P. Functioning in community-dwelling patients with schizophrenia spectrum disorders in rural Greece. Int. J. Soc. Psychiatry 2020, 66, 111–117. [Google Scholar] [CrossRef]
  51. Peritogiannis, V.; Grammeniati, A.; Gogou, A.; Gioti, P.; Mavreas, V. Very long-term outcome of community-dwelling patients with schizophrenia spectrum disorders in rural Greece. J. Nerv. Ment. Dis. 2019, 207, 1012–1018. [Google Scholar] [CrossRef]
  52. Trauer, T. The subscale structure of the Health of the Nation Outcome Scales (HoNOS). J. Ment. Health 1999, 8, 499–509. [Google Scholar] [CrossRef]
  53. Lovaglio, P.G.; Monzani, E. Validation aspects of the health of the nation outcome scales. Int. J. Ment. Health Syst. 2011, 5, 20. [Google Scholar] [CrossRef]
  54. Pinkham, A.E.; Ackerman, R.A.; Depp, C.A.; Harvey, P.D.; Moore, R.C. A Longitudinal Investigation of the Effects of the COVID-19 Pandemic on the Mental Health of Individuals with Pre-existing Severe Mental Illnesses. Psychiatry Res. 2020, 294, 113493. [Google Scholar] [CrossRef]
  55. Haddad, C.; Dib, J.E.; Akl, N.; Hallit, S.; Obeid, S. COVID-19 and psychosis, depression, obsession and quality of life in Lebanese patients with schizophrenia: Any changes after 5 months of quarantine? BMC Psychol. 2022, 10, 32. [Google Scholar] [CrossRef]
  56. Gómez Maquet, Y.; Ángel, J.D.; Cañizares, C.; Lattig, M.C.; Agudelo, D.M.; Arenas, Á.; Ferro, E. The role of stressful life events appraisal in major depressive disorder. Rev. Colomb. Psiquiatr. 2020, 49, 67–74. [Google Scholar] [CrossRef]
  57. Hendryx, M.; Green, C.A.; Perrin, N.A. Social Support, activities, and recovery from serious mental illness: STARS study findings. J. Behav. Heal. Serv. Res. 2009, 36, 320–329. [Google Scholar] [CrossRef]
  58. Green, M.F.; Horan, W.P.; Lee, J.; McCleery, A.; Reddy, L.F.; Wynn, J.K. Social Disconnection in Schizophrenia and the General Community. Schizophr Bull. 2018, 44, 242–249. [Google Scholar] [CrossRef] [PubMed]
  59. Degnan, A.; Berry, K.; Sweet, D.; Abel, Κ.; Crossley, N.; Edge, D. Social networks and symptomatic and functional outcomes in schizophrenia: A systematic review and meta-analysis. Soc. Psychiatry Psychiatr. Epidemiol. 2018, 53, 873–888. [Google Scholar] [CrossRef] [PubMed]
  60. Costa, A.; Santos, M.; Simões de Almeida, R.; Monteiro, F.; Marques, A. The Impact of the COVID-19 Pandemic on People with Lived Experience of Mental Illness Integrated into Community-Based Psychosocial Rehabilitation Structures in Portugal. COVID 2022, 2, 200–210. [Google Scholar] [CrossRef]
  61. Kotlarska, K.; Wielgus, B.; Cichocki, Ł. Phenomenology of the COVID-19 Pandemic Experience in Patients Suffering from Chronic Schizophrenia—A Qualitative Analysis. Int. J. Environ. Res. Public Health 2022, 19, 56. [Google Scholar] [CrossRef] [PubMed]
  62. Shin, S.; Joung, J. COVID-19 coping experiences of individuals with schizophrenia: A grounded theory approach in Korea. Int. J. Ment. Health Nurs. 2023, 32, 1713–1723. [Google Scholar] [CrossRef]
  63. Karanci, A.N.; Ikizer, G.; Aldemir, I.D.; Bilgehan, A.; Karagöz, C. How did the COVID-19 pandemic affect individuals with schizophrenia from Turkey? Int. J. Soc. Psychiatry 2023, 69, 277–285. [Google Scholar] [CrossRef] [PubMed]
  64. Pandolfo, G.; Genovese, G.; Iannuzzo, F.; Bruno, A.; Pioggia, G.; Gangemi, S. COVID-19 Vaccination and Mental Disorders, What Has Been Accomplished and Future Direction. Brain Sci. 2022, 12, 292. [Google Scholar] [CrossRef] [PubMed]
  65. Peritogiannis, V.; Drakatos, I.; Gioti, P.; Garbi, A. Vaccination rates against COVID-19 in patients with severe mental illness attending community mental health services in rural Greece. Int. J. Soc. Psychiatry 2023, 69, 208–215. [Google Scholar] [CrossRef] [PubMed]
  66. Moreno, C.; Wykes, T.; Galderisi, S.; Nordentoft, M.; Crossley, N.; Jones, N.; Cannon, M.; Correll, C.U.; Byrne, L.; Carr, S.; et al. How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry 2020, 7, 813–824. [Google Scholar] [CrossRef] [PubMed]
  67. Burrai, J.; Roma, P.; Barchielli, B.; Biondi, S.; Cordellieri, P.; Fraschetti, A.; Pizzimenti, A.; Mazza, C.; Ferracuti, S.; Giannini, A.M. Psychological and Emotional Impact of Patients Living in Psychiatric Treatment Communities during COVID-19 Lockdown in Italy. J. Clin. Med. 2020, 9, 3787. [Google Scholar] [CrossRef] [PubMed]
  68. Leeming, D.; Lucock, M.; Shibazaki, K.; Pilkington, N.; Scott, B. The Impact of the COVID-19 Pandemic on Those Supported in the Community with Long-Term Mental Health Problems: A Qualitative Analysis of Power, Threat, Meaning and Survival. Community Ment. Health J. 2022, 58, 1297–1309. [Google Scholar] [CrossRef] [PubMed]
  69. Grossman-Giron, A.; Tzur Bitan, D.; Medlovic, S.; Shemesh, S.; Bloch, Y. Distress and Well-Being Among Psychiatric Patients in the Aftermath of the First COVID-19 Lockdown in Israel: A Longitudinal Study. Int. J. Public Health 2022, 67, 1604326. [Google Scholar] [CrossRef]
  70. Kan, Z.; Søegaard, E.G.I.; Siqveland, J.; Hussain, A.; Hanssen-Bauer, K.; Jensen, P.; Heiervang, K.S.; Ringen, P.A.; Ekeberg, Ø.; Hem, E.; et al. Coping, Social Support and Loneliness during the COVID-19 Pandemic and Their Effect on Depression and Anxiety: Patients’ Experiences in Community Mental Health Centers in Norway. Healthcare 2022, 10, 875. [Google Scholar] [CrossRef]
  71. Hamada, K.; Fan, X. The impact of COVID-19 on individuals living with serious mental illness. Schizophr. Res. 2020, 222, 3–5. [Google Scholar] [CrossRef]
  72. Gómez-Ramiro, M.; Fico, G.; Anmella, G.; Vázquez, M.; Sagué-Vilavella, M.; Hidalgo-Mazzei, D.; Pacchiarotti, I.; Garriga, M.; Murru, A.; Parellada, E.; et al. Changing trends in psychiatric emergency service admissions during the COVID-19 outbreak: Report from a worldwide epicentre. J. Affect. Disord. 2020, 282, 26–32. [Google Scholar] [CrossRef]
  73. Boldrini, T.; Girardi, P.; Clerici, M.; Conca, A.; Creati, C.; Di Cicilia, G.; Ducci, G.; Durbano, F.; Maci, C.; Maone, A.; et al. Consequences of the COVID-19 pandemic on admissions to general hospital psychiatric wards in Italy: Reduced psychiatric hospitalizations and increased suicidality. Prog. Neuro-Psychopharmacol. Biol. Psychiatry 2021, 110, 110304. [Google Scholar] [CrossRef] [PubMed]
  74. Ambrosetti, J.; Macheret, L.; Folliet, A.; Wullschleger, A.; Amerio, A.; Aguglia, A.; Serafini, G.; Prada, P.; Kaiser, S.; Bondolfi, G.; et al. Impact of the COVID-19 Pandemic on Psychiatric Admissions to a Large Swiss Emergency Department: An Observational Study. Int. J. Environ. Res. Public Health 2021, 18, 1174. [Google Scholar] [CrossRef] [PubMed]
  75. Auslander, L.A.; Jeste, D.V. Sustained remission of schizophrenia among community-dwelling older outpatients. Am. J. Psychiatry 2004, 161, 1490–1493. [Google Scholar] [CrossRef] [PubMed]
Table 1. Participants’ demographic and clinical characteristics.
Table 1. Participants’ demographic and clinical characteristics.
VariablesN (%) or Mean ± SD
Total number of participants29
Age (years) (mean ± SD)43.72 ± 11.53
Gender (N, %)
    Male17 (58.6%)
    Female12 (41.4%)
Education (N, %)
    Secondary School4 (13.8%)
    Vocational School5 (17.2%)
    High School/College11 (37.9%)
    University9 (31.0%)
Employment (N, %)
    Employed4 (13.8%)
    Not employed6 (20.7%)
    Disability pension15 (51.7%)
    Retired4 (13.8%)
Cohabitation status (N, %)
    Living alone5 (17.2%)
    Parents/siblings14 (48.3%)
    Partner/children2 (6.9%)
    Roommates8 (27.6%)
ICD-10 Diagnosis (N, %)
    F20–F29 (Schizophrenia, schizotypal and delusional disorders)19 (65.5%)
    F30–F39 (Affective disorders)2 (6.9%)
    F80–F89 (Pervasive and specific developmental disorders)2 (6.9%)
    Multiple diagnosis 4 (13.8%)
    Other2 (6.9%)
Housing (N, %)
    Community22 (75.9%)
    Psychiatric Rehabilitation Residence7 (24.1%)
Attendance before second semester 2019
    Yes23 (79.3%)
    No6 (20.7%)
Table 2. HoNOS results expressed in percentages in the second semester of 2019.
Table 2. HoNOS results expressed in percentages in the second semester of 2019.
HoNOS ItemsMinor to no ProblemsMild ProblemsModerate to Severe Problems
    Aggression/overactivity89.610.4-
    Self-harm100.0--
    Substance abuse96.63.4-
    Cognitive impairment62.020.717.3
    Physical impairment82.810.46.8
    Hallucinations/delusions75.917.26.9
    Depressed mood93.23.43.4
    Relationships34.544.820.7
    Daily living31.048.320.7
    Living conditions82.110.36.8
    Occupation/activities31.048.320.7
HoNOS subscales
    Behavior89.67.03.4
    Impairment55.320.724.0
    Symptom27.617.255.2
    Social6.910.382.8
Other mental/behavioral problemsPrevalence of problems
    Obsessive/compulsive24.1
    Anxiety 17.2
    Mental strain/tension 13.8
    Phobic 3.4
    Sleep6.9
    None34.5
Table 3. Differences in HoNOS and GAF scores before, during and after the pandemic and their significance level according to Friedman Test.
Table 3. Differences in HoNOS and GAF scores before, during and after the pandemic and their significance level according to Friedman Test.
HoNOS ItemsMean RankFriedman Test
201920202021X2p
    Aggression/overactivity1.932.032.031.0430.658
    Self-harm---
    Substance abuse1.971.952.092.9230.407
    Cognitive impairment2.071.971.970.5710.790
    Physical impairment1.971.982.050.6360.818
    Hallucinations/delusions1.911.952.142.4500.360
    Depressed mood2.102.001.903.0000.277
    Other mental/behavioral problems1.932.091.980.6770.727
    Relationships2.171.901.933.2340.204
    Daily living2.101.882.021.3440.526
    Living conditions1.951.972.091.6520.503
    Occupation/activities1.971.932.101.3330.542
HoNOS subscales
    Behavior1.901.982.122.688
    Impairment1.982.022.000.040
    Symptom1.972.032.000.107
    Social2.091.762.163.595
GAF score1.772.212.023.4130.181
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Ninou, A.; Peritogiannis, V.; Tzimogianni, S.M.; Fotopoulou, V.; Bakola, M.; Jelastopulu, E. Clinical Outcome in Persons with Severe Mental Disorders Attending a Mental Health Day Center during the COVID-19 Pandemic. J. Clin. Med. 2024, 13, 1241. https://doi.org/10.3390/jcm13051241

AMA Style

Ninou A, Peritogiannis V, Tzimogianni SM, Fotopoulou V, Bakola M, Jelastopulu E. Clinical Outcome in Persons with Severe Mental Disorders Attending a Mental Health Day Center during the COVID-19 Pandemic. Journal of Clinical Medicine. 2024; 13(5):1241. https://doi.org/10.3390/jcm13051241

Chicago/Turabian Style

Ninou, Angeliki, Vaios Peritogiannis, Sophia Maria Tzimogianni, Vassiliki Fotopoulou, Maria Bakola, and Eleni Jelastopulu. 2024. "Clinical Outcome in Persons with Severe Mental Disorders Attending a Mental Health Day Center during the COVID-19 Pandemic" Journal of Clinical Medicine 13, no. 5: 1241. https://doi.org/10.3390/jcm13051241

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop