key: cord-1043551-0msmo9w6
authors: Maguire, Paul A.; Reay, Rebecca E.; Looi, Jeffrey C.L.
title: H1N109 pandemic research in people with schizophrenia providing insights into COVID-19 clinical care
date: 2021-09-01
journal: Schizophr Res
DOI: 10.1016/j.schres.2021.08.029
sha: d6f985f640ef8643239ad773ed398d6a0402fc94
doc_id: 1043551
cord_uid: 0msmo9w6

nan

We conducted research on the H1N109 (swine) influenza pandemic in people with schizophrenia, and provide an overview to inform the clinical care of people with schizophrenia during the COVID-19 pandemic.

Two key components of an effective response plan to a pandemic (Australian Government 2019) are: (1) communication of the best available health information to the public, and (2) minimization of community spread of the virus. People with schizophrenia are a vulnerable group during a pandemic, due to their increased medical comorbidity (especially CHD, COPD and diabetes mellitus type 2) and barriers to accessing health care. Therefore, our research investigated: (1) how people with schizophrenia obtain information on health matters; (2) how they perceive the risks associated with the viral pandemic;

(3) what they are prepared to do about those risks; and (4) perceived obstacles to adopting protective measures.

A cross-sectional study comparing the questionnaire responses of 71 people with schizophrenia to 238 people in the general population was conducted in Canberra, Australia in 2009 during the early phase of the swine influenza pandemic (Maguire, 2014; Maguire et al., 2011) . Patients with schizophrenia from both inpatient and community health centre settings were invited to participate through flyers and information brochures. People without schizophrenia attending thirteen general practices were similarly recruited into the study. The study received institutional ethical approval. The questionnaire was designed based on key concepts in risk perception and health behaviours literature (Maguire, 2014) .

The most commonly used sources for obtaining health information for people with schizophrenia were: doctor (59.2%); family and friends (53.5%); television (52.1%) followed by followed by radio (37.1%), Internet (35.2%), magazines (25.4%) and newspapers (19.7%). Regression analysis revealed that, compared the general population, people with schizophrenia were less likely to obtain health information from their doctor (adjusted odds ratio [AOR] = 0.27) and the Internet (AOR = 0.43). They were also less likely to trust their doctor as a source of information on health matters (AOR = 0.22). A substantive amount of the information obtained from a given source was explained by variance in the level of trust in that source (e.g. for family and friends, R 2 = 0.3 for people with schizophrenia, and 0.5 for the general population).

There were no statistically significant differences between people with schizophrenia and the general population in terms of influenza risk perception (Maguire et al., 2019) . Positive predictors of perceived risk to self, in the absence of adopting protective measures, for both groups, included perceived likelihood and perceived seriousness of contracting J o u r n a l P r e -p r o o f swine influenza, and affective forecast of fear (self-prediction of feeling afraid) in the event of contracting the pandemic virus.

Regarding protective measures, the majority of participants with schizophrenia reported that they would be willing to increase hand washing (88.6%), be vaccinated (74.2%), self-isolate (73.2%), and wear a face mask (54.9%), if advised to by government authorities (Maguire et al., 2018) . However, they were less willing (AOR = 0.41) to self-isolate compared with the general population. In addition, 71.8% of people with schizophrenia were concerned about "catching "flu" from vaccination. Predictors of willingness to adopt protective actions for the schizophrenia group included selfefficacy (vaccination, face mask, self-isolation), perceived likelihood of contracting swine flu (vaccination), educational status (face mask) and perceived overall risk from swine flu (face mask). In addition, for people with schizophrenia, affective forecast of fear was a predictor for all protective measures except for social isolation, being a particularly strong predictor of willingness to increase handwashing (AORs: vaccination = 2.3; facemask = 3.1; handwashing = 15.2). In contrast, affective forecast of fear was only a weak predictor for wearing a facemask ( AOR -1.5) in the general population.

Key perceived barriers to adopting protective measures for people with schizophrenia included: vaccinationconcerns about side effects, cost, transport to a clinic; self-isolationloneliness, accessing food and groceries, boredom; facemaskappearance/stigma, discomfort, difficulty breathing; and increased handwashing -access to washing facilities (e.g. basin), skin irritation and time.

Based on our findings, people with schizophrenia require a more assertive approach compared with the general population during the COVID-19 pandemic, including:

(1) Exploration and education regarding any misconceptions about contracting influenza or COVID-19 from a vaccine, by treating doctors (GP and psychiatrists), in addition to public messaging via television.

(2) Facilitation of self-efficacy to increase uptake of protective measures e.g., reduce vaccine hesitancy, through modelling of vaccination by doctors, family and friends.

(3) Modify education based upon understanding of fear motivation to increase uptake of protective measures (especially hand washing).

(4) Provision of funding and transport for vaccination, or administration of the vaccine through outreach or home visits. 

Australian Health Management Plan for Pandemic Influenza (AHMPPI)

Pandemic Influenza: Risk Perception and Protective Behaviours in People with Schizophrenia

A sense of dread: affect and risk perception in people with schizophrenia during an influenza pandemic

Nothing to sneeze at -uptake of protective measures against an influenza pandemic by people with schizophrenia: willingness and perceived barriers

Neither the internist nor the Internet: Use of and trust in health information sources by people with schizophrenia