From the time the new Coronavirus pandemic broke out in Israel in early March 2020 and until the time the third wave ended in February 2021, there was a 19% decrease in the number of reported new persons with schizophrenia, according to a new University of Haifa study.
The study was published in the journal European Psychiatry (Biopsychosocial exposure to the COVID-19 pandemic and the relative risk of schizophrenia: Interrupted time-series analysis of a nationally representative sample). The team included research student Yael Travis-Lumer of the Technion-Israel Institute of Technology’s Faculty of Industrial Engineering and Management; Prof. Levine from the University of Haifa’s Department of Community Mental Health; Prof. Arad Kodesh of Meuhedet Health Services and the University of Haifa’s Department of Community Mental Health; Prof. Yair Goldberg of the Technion-Israel Institute of Technology’s Faculty of Industrial Engineering and Management; and Prof. Sophia Frangou and Prof. Abraham Reichenberg of the Mount Sinai Health System in New York.
“Researchers have suggested there’s a high probability that a substantial part of this decrease is linked to the underdiagnosis of schizophrenia during the COVID-19 pandemic which potentially resulted in people not receiving the care they so needed,” said Prof. Stephen Levine of the University of Haifa who led the research.
Schizophrenia is a chronic mental disorder that disrupts functioning and is characterized by symptoms of psychosis, such as delusions and hallucinations. According to the researchers, the COVID-19 pandemic widespread closures, social isolation, and loneliness may have been the risk factors for a rise in psychosis symptoms, and therefore it was expected that there would be an increase in schizophrenia patients during this period.
“We expected that there would be a rise in the number of new presentations of schizophrenia during the pandemic, but surprisingly, this trend did not materialize,” Prof. Levine continued. “There are three possible main reasons for this: it’s possible that the pandemic caused the family atmosphere to be closer and more positive, which led to fewer outbreaks of schizophrenia. However, the other reasons suggest that there may not have been a decrease, but rather that the condition went by underreported – a decline in the supply of health services and the shift to online digital medical interviewing made it challenging to obtain accurate diagnoses.”
The team sought to scrutinize the relationship between exposure to the COVID-19 pandemic and the risk of incident schizophrenia. They collected data between January 2013 and February 2021 on 736,356 persons ages 15 to 64 years.
The study results showed that during the pandemic period, covering three closures, there was a 19% decrease in the incidence of schizophrenia. In comparison, between 2017 and 2018 (before the onset of the pandemic), 570 patients were diagnosed, compared to 530 during the pandemic. “In practice, if we statistically account for the number of Israelis insured in HMOs each year and the expected time trend of schizophrenia, we observe a gap between before and during COVID-19 that translates into a 19% statistically significant decrease in the incidence of schizophrenia during the pandemic. Based on forecast scenarios, the study demonstrated that within 10 months, if there are no more severe limitations on the population due to the pandemic, the rate of schizophrenia will rise.
The researchers wanted to test whether periods of extreme stress and the COVID-19 pandemic differentially influenced the rate of schizophrenia. They compared the rate of schizophrenia diagnosis during the pandemic to the diagnosis rate of schizophrenia outbreaks during Operation Protective Edge (the Israeli military operation launched by Israel in July 2014 against the Hamas-ruled Gaza Strip. The war involved massive missile firing against Israeli civilians). In contrast to the marked decrease observed during the pandemic, during the 2014 war, there was no change in the rate of schizophrenia, so the period of stress did not increase the outbreaks, but neither did it reduce them. According to the researchers, the results underscore the fact that different periods of extreme stress affect the incidence of schizophrenia outbreaks differently. Also, this strengthens the later findings because comparing two traumatic events is a conservative comparison.
Overall, the researchers said three main reasons could explain the decline in schizophrenia during as opposed to before the pandemic. The first reason is positive: the very fact that we were at home for a long time, with family members close to us, caused a more cohesive and positive atmosphere that contributed to fewer new schizophrenia cases.
The other two reasons, however, are negative. These suggest that people may have experienced an outbreak of schizophrenia, but were not diagnosed and so, in all likelihood, not treated. The second reason may be that because of pressure on the medical staff or the fear of people leaving home during the pandemic, fewer medical services were available. The third reason is that in the context of underdiagnosis, a large proportion of physician-patient interactions has shifted to online digital media platforms. These platforms may make the process of schizophrenia diagnosis difficult.