Skip to main content
NCBI home page
Elsevier - PMC COVID-19 Collection logoLink to Elsevier - PMC COVID-19 Collection
. 2021 Sep 14;237:148–152. doi: 10.1016/j.schres.2021.09.003

COVID-19 dimensions and psychotic experiences among US college students: Findings from the Healthy Mind Study 2020

Hans Oh a,⁎, Jessica Goehring a, Ravi Rajkumar b, Megan Besecker a, Sasha Zhou c, Jordan E DeVylder d
PMCID: PMC8438539  PMID: 34534946

Abstract

Background

The COVID-19 pandemic has caused tremendous changes in daily living, which may be related to mental health problems, including psychotic experiences, though research has only begun to assess these associations.

Methods

We analyzed data from the Healthy Minds Survey (Fall Semester Cohort 2020), which is a non-probability sample of students attending one of 36 universities in the United States, who completed an online survey during the COVID-19 pandemic (September–December 2020). We used multivariable logistic regression to examine the associations between several COVID-19 dimensions (anxiety, discrimination, financial distress, infection, illness of loved one, death of loved one, caregiving) and 12-month psychotic experiences, adjusting for age, gender, race/ethnicity, and international student status.

Results

Each individual COVID-19 dimension was significantly associated with greater odds of having 12-month psychotic experiences, with the exception of being a caregiver. When accounting for all COVID-19 dimensions simultaneously in the same model, only COVID-19 related anxiety, financial distress, and infection were associated with psychotic experiences.

Conclusion

COVID-19 dimensions were linked to psychotic experiences among university students, which may also apply to the larger population. This can potentially inform assessment and treatment during the pandemic.

Keywords: COVID-19, Coronavirus, Psychotic experiences, Pandemic

1. Introduction

As of March 2021, the COVID-19 pandemic resulted in a total of over 28,500,000 infections in the United States, with a death toll of over half a million (Centers for Disease Control and Prevention, 2021). The pandemic dramatically altered the country's way of life, which may be linked to elevated levels of mental health problems in the population (Rajkumar, 2020; Luo et al., 2020; Xiong et al., 2020; Hossain et al., 2020; Vindegaard and Benros, 2020). Between 2019 and 2021, the overall prevalence of depression and anxiety symptoms increased in the country (Panchal et al., 2020), along with other mental health problems, substance use, and suicidal thoughts and behaviors (Rosenberg et al., 2021; Khubchandani et al., 2020; Ammerman et al., 2021). COVID-19 infection may have had direct health effects that include cognitive problems and psychiatric symptoms during and even after recovery from the virus (Whiteside et al., 2021). However, those who were not infected may still have suffered mental health problems from encountering several COVID-19 related stressors, including job loss and financial distress (Bureau of Labor Statistics, 2020; Panchal et al., 2020), the rise in racist and xenophobic discrimination (Dhanani and Franz, 2020), isolation due to lockdowns and social distancing (Rosenberg et al., 2021), and worrying about loved ones being infected (Deng et al., 2020; Gallagher et al., 2020).

Several clinical reports and preliminary epidemiological research showed that COVID-19 infection has been associated with psychotic symptoms (Lanier et al., 2020; Huarcaya-Victoria et al., 2020; Rentero et al., 2020; Oh et al., 2021). The pandemic has also appeared to have given rise to unusual beliefs regarding the origins of COVID-19, sometimes referred to as “conspiracy theories,” which have been identified as a potential coping mechanism (Fountoulakis et al., 2020). It has been hypothesized that such beliefs may lie on the psychosis continuum, and may be rooted in similar errors in cognitive processes (Freeman, 2007; Sanchez and Dunning, 2020). However, there have been few large-scale studies to examine the wide range of COVID-19 dimensions and their effects on psychotic experiences. As such, in this study we examined the associations between several COVID-19 dimensions and their associations with 12-month psychotic experiences among university students in the United States.

2. Methods

2.1. Sample

We analyzed data from the Fall semester cohort of the 2020 Healthy Minds Study (HMS), a cross-sectional, web-based survey examining mental health and related factors in undergraduate and graduate student populations. The survey was administered at 36 universities between September through December of 2020. At each university, a random sample of 8000 students was invited by e-mail to participate, except at smaller universities (<8000 students) where all students were invited to participate. The response rate was 14%, which is typical of online surveys of university populations. The HMS was approved by the Institutional Review Boards at all participating campuses.

2.2. Measures

2.2.1. COVID-19 dimensions (independent variables)

We examined seven COVID-19 dimensions.

Anxiety was measured using nine items that asked: “Over the past two weeks, on average, how much have you been concerned with the following?” The nine items are listed in Table S1. Respondents could answer: Not concerned at all, slightly concerned, moderately concerned, very concerned, and extremely concerned. The nine items were summed into a scale between 10 and 50 (alpha = 0.92).

Racial/ethnic discrimination was measured using the binary item (yes/no): “As a result of the COVID-19 pandemic, have you experienced any discriminatory or hostile behavior due to your race/ethnicity (or what someone thought was your race/ethnicity)?”

Financial distress was measured using the item: “How has your financial situation been affected by the COVID-19 pandemic?” Respondents would answer: a lot less stressful, somewhat less stressful, no significant change, somewhat more stressful, a lot more stressful.

Infection was measured using the item: “Have you had COVID-19 (the novel coronavirus -disease)?” Responses included: yes (confirmed by a test); probably (e.g., a healthcare provider told me that I likely had COVID-19); maybe (e.g., I have had symptoms consistent with COVID-19, but it was not confirmed by a test); and no (no symptoms or other reason to think I have had it). The responses ‘yes’, ‘probably’, and ‘maybe’ were combined to form a binary variable indicating likely COVID-19 infection.

Illness of loved one was assessed using the single binary item (yes/no): “Has a loved one, close family member, or friend experienced significant illness as a result of COVID-19?”

Death of loved one was assessed using the single binary item (yes/no): “Have you grieved the loss of a loved one, close family member, or friend due to COVID-19?”

Caregiver was measured using the single binary item (yes/no): “Have you been a caregiver to someone who experienced illness as a result of COVID-19?”

2.2.2. Psychotic experiences

Psychotic experiences were measured using an abbreviated version of the World Health Organization Composite International Diagnostic Interview Psychosis Screen, which has been used in large global epidemiology studies (McGrath et al., 2016). Respondents were asked if they had ever experienced the following at any point in life: (1) A feeling something strange and unexplainable was going on that other people would find hard to believe; (2) A feeling that people were too interested in you or that there was a plot to harm you?; (3) A feeling that your thoughts were being directly interfered or controlled by another person, or your mind was being taken over by strange forces?; and (4) An experience of seeing visions or hearing voices that others could not see or hear when you were not half asleep, dreaming, or under the influence of alcohol or drugs? Endorsing any of these experiences constituted lifetime psychotic experience. Respondents were then asked a single item (yes/no) about whether these experiences occurred over the past 12 months.

2.2.3. Sociodemographic covariates

Respondents self-reported sociodemographic characteristics, including gender (man, woman, and non-binary), race/ethnicity (white, Black, Asian Pacific Islander, Hispanic, multi-racial), age (continuous), and international student status (yes/no).

2.3. Analysis

Out of 36 colleges, 28 colleges administered the COVID-19 module (N = 15,995). We used complete case analysis to address missing data. We used multivariable logistic regression analyses to test for associations between COVID-19 dimensions and 12-month psychotic experiences, adjusting for age, gender identity, race/ethnicity, and international student status. First, we examined each of the nine COVID-19 dimensions in separate fully adjusted models, and then simultaneously adjusted for all nine COVID-19 dimensions in the same model. We applied sample probability weights to adjust for non-response using the administrative data on full student populations with respect to gender, race/ethnicity, academic level, and GPA. We clustered standard errors by university, and presented results as odds ratios with 95% confidence intervals.

3. Results

Descriptive characteristics are presented in Table 1 . In these data, approximately 14-15% of the sample reported having a psychotic experience over the past year. We calculated means and proportions of COVID-19 dimensions among those with and without psychotic experiences. Overall, the means and proportions of COVID-19 factors were higher among those with psychotic experiences, however, not always to a statistically significant degree. Bivariate logistic regression models are available in the Supplemental Materials (Table S2).

Table 1.

Descriptive statistics.

Variables No psychotic experiences
(n = 13,720)		 Psychotic experiences
(n = 2215)		 Total (N = 15,935) P-value
COVID-19 dimensions
Anxiety (10-50) 31.90 (30.84 - 32.97) 34.07 (32.92 - 35.23) 32.22 (31.22 - 33.22) 0.07
Racial/ethnic discrimination <0.01
 No 12,830 (94.96%) 2001 (92.26%) 14,831 (94.57%)
 Yes 730 (5.04%) 185 (7.74%) 915 (5.43%)
Financial stress (0-4) 2.82 (2.77-2.87) 3.01 (2.96-3.06) 2.85 (2.80-2.89) 0.01
Infection <0.01
 No 10,852 (78.81%) 1633 (72.98%) 12,485 (77.97%)
 Yes 2868 (21.19%) 582 (27.02%) 3450 (22.03%)
Illness of loved one <0.01
 No 9518 (67.86%) 1397 (61.89%) 10,915 (67.00%)
 Yes 4231 (32.14%) 817 (38.11%) 5048 (33.00%)
Death of a loved one 0.01
 No 12,707 (91.45%) 2002 (88.13%) 14,709 (90.97%)
 Yes 1021 (8.55%) 211 (11.87%) 1232 (9.03%)
Caregiver 0.25
 No 12,914 (93.50%) 2067 (92.23%) 14,981 (93.31%)
 Yes 823 (6.50%) 146 (7.77%) 969 (6.69%)



Sociodemographic characteristics
Age 24.51 (23.53 - 25.49) 23.21 (22.26 - 24.16) 24.32 (23.37 - 25.27) 0.07
Race/ethnicity <0.01
 White 16,617 (63.83%) 2618 (62.76%) 19,235 (63.68%)
 Asian Pacific Islander 3226 (8.05%) 416 (7.71%) 3642 (8.00%)
 Black 1582 (7.90%) 286 (5.82%) 1868 (7.60%)
 Latinx 2034 (9.17%) 341 (8.40%) 2375 (9.06%)
 Multiracial 2386 (9.52%) 529 (13.54%) 2915 (10.11%)
 Other 363 (1.02%) 60 (1.13%) 423 (1.04%)
 Missing/unknown 103 (0.50%) 21 (0.63%) 124 (0.52%)
Gender <0.01
 Man 7473 (41.42%) 1306 (44.55%) 8779 (41.88%)
 Woman 18,271 (56.49%) 2717 (49.53%) 20,988 (55.47%)
 Non-binary 520 (1.93%) 234 (5.66%) 754 (2.47%)
 Missing/unknown 47 (0.16%) 14 (0.26%) 61 (0.18%)
Are you an international student? 0.50
 No 24,699 (96.02%) 4052 (96.43%) 28,751 (96.08%)
 Yes 1605 (3.98%) 218 (3.57%) 1823 (3.92%)
Open in a new tab

P-values by t-test for continuous variables and Chi2 test for binary/categorical variables.

Each individual COVID-19 dimension was associated with greater odds of having 12-month psychotic experiences. However, not all COVID-19 dimensions (e.g., being a caregiver) reached a conventional level of statistical significance. When accounting for all COVID-19 dimensions in the same model, only anxiety, financial distress, and infection were significantly associated with psychotic experiences. See Table 2 .

Table 2.

Multivariable logistic regression models depicting associations between COVID-19 dimensions and 12-month psychotic experiences.

Separate models with predictors individually associated with outcome
 All predictors adjusted for in same model
aOR p-Value N aOR p-Value N
Anxiety (10-50) 1.02 [1.01, 1.04] 0.000 14,725 1.02 [1.01, 1.03] 0.004 14,646
Racial/ethnic discrimination 1.70 [1.16, 2.51] 0.009 15,741 1.45 [0.91, 2.31] 0.118
Financial distress (0-4) 1.31 [1.22, 1.41] 0.000 30,531 1.18 [1.05, 1.34] 0.010
Infection 1.36 [1.13, 1.64] 0.002 15,930 1.35 [1.08, 1.69] 0.011
Illness of loved one 1.34 [1.18, 1.53] 0.000 15,958 1.10 [1.01, 1.21] 0.037
Death of a loved one 1.59 [1.24, 2.03] 0.001 15,936 1.31 [1.00, 1.71] 0.049
Caregiver 1.29 [0.94, 1.77] 0.117 15,945 1.17 [0.78, 1.75] 0.448
Open in a new tab

Adjusted for age, gender, race/ethnicity, and international student status.

Healthy Minds Study, September–December 2020.

4. Discussion

Our findings showed that COVID-19 dimensions were related to 12-month psychotic experiences in a large non-probability sample of college students in the United States during the pandemic, though the strength and significance of the associations varied. In separate models, all the COVID-19 dimensions were significantly associated with psychotic experiences, except for being a caregiver for someone who became ill due to COVID-19. While caretaker burden is a significant source of stress in other contexts (Adelman et al., 2014), it did not appear to increase odds of reporting psychotic experiences at a conventional level of statistical significance in these data, possibly because caregiving may even increase social contact with others. The COVID-19 anxiety scale captured several distressing aspects of the pandemic (e.g., fear of contracting the virus, feelings of isolation), which were associated with greater odds of psychotic experiences, corroborating early clinical reports (Huarcaya-Victoria et al., 2020; Rentero et al., 2020). These anxieties may have also reflected greater social isolation, which has been known to increase risk for psychotic experiences (e.g., Lim and Gleeson, 2014; Dodell-Feder et al., 2020). Discrimination has been strongly linked to psychotic experiences in prior studies (Bardol et al., 2020; Pearce et al., 2019), and our findings align with the social defeat model, where experiences of exclusion from the social majority group can result in an elevated risk of psychosis in vulnerable individuals (Selten and Cantor-Graae, 2005; Selten et al., 2013). Financial distress due to COVID-19 comports with the literature that suggests socioeconomic status and social disadvantage are related to psychosis (Oh et al., 2021; Morgan et al., 2009); however, the entire sample consisted of college students, which represents a particular social strata of educated individuals. That being said, there is considerable heterogeneity within the college population, and experiencing financial stress while being a student may signify more precarious life circumstances and vulnerability to mental health problems. COVID-19 infection was associated with psychotic experiences, and it is possible that the virus may cause a profound inflammatory response that results in hallucinations or delusions. Having loved ones contract the virus or die from it can be major life stressors that are linked to psychotic experiences, which also comports with prior studies (Castelnovo et al., 2015).

The COVID-19 pandemic constituted a major stressful life event that proliferated stress and may have been linked to both the onset and re-emergence of psychosis (Martland et al., 2020). While the exact pathways are unclear, it is possible that COVID-19 operates through psychological mechanisms such as dissociation, emotional dysregulation, negative mood states, and increased vigilance (Alameda et al., 2020). The biological correlates may possibly include altered neuroimmune signaling (Fillman et al., 2014), increased activity in monoamine circuits mediating arousal (Ross and Van Bockstaele, 2021), dysregulation of dopaminergic circuits connecting the midbrain to cortical and limbic regions (Sonnenschein et al., 2020) and genetic variants affecting neuropeptide and neuroendocrine reactivity to stress (Cristóbal-Narváez et al., 2017). COVID-19 infection may itself be associated with a risk of psychosis (Oh et al., 2021), but the analysis of this association is confounded by several factors (Watson et al., 2020). However, the multitude of stressors related to the pandemic and its attendant control measures—particularly social-evaluative stressors that lead to social defeat—have been linked to psychosis risk via the mechanisms listed above, as well as through dysregulation of the hypothalamic-pituitary-adrenal axis (Carol et al., 2021; Murray et al., 2020). This may be reflected in our associations of discrimination, financial stress (which may cause a respondent to lose social status), and COVID-19 anxiety (which may cause an individual to withdraw socially during the pandemic), but not for caregiving (which is a stressful experience that increases engagement with other people while imparting feelings of self-worth).

4.1. Limitations

Our study is among the first large-scale studies to examine COVID-19 factors and psychotic experiences among college students in the US; however, there were several limitations. First, data were cross-sectional and did not allow for us to ascertain the temporal order of events or make causal inferences, though it is unclear how psychotic experiences would directly cause these COVID-19 dimensions. With that said, it is possible that individuals with paranoid ideation may be more likely to experience COVID-19 anxiety or perceive COVID-19 related racial discrimination. Second, the data were self-reported, and may have been vulnerable to recall and social desirability biases (e.g., reluctance to disclose the occurrence of psychotic experience or COVID-19 infection). Third, this study was only conducted among college students, most of whom were in the peak age range for psychosis risk; however, more research is needed to determine whether these findings are generalizable to the larger population. Our findings may also contradict findings from other countries (Bortolon et al., 2021), and should be properly contextualized. Fourth, the response rate was 14%, which raises concerns about sampling bias and generalizability of findings, though this response rate is comparable to surveys of this nature, and survey weights were used to adjust for non-response.

4.2. Conclusion

This study shows that the effects of the COVID-19 pandemic created conditions that are linked to the occurrence of psychotic experiences during roughly the same time period of the pandemic. While the sample in this study consisted of college students, they are generally within the age range when psychotic experiences often first occur (McGrath et al., 2016). Our findings may inform preventive interventions during the pandemic, given that psychotic experiences are linked to a wide range of mental and physical health problems and may be indicative of underlying (psycho)pathology (Oh et al., 2021). To reduce risk for psychosis and other mental health problems, it may be critical to formulate broad efforts to address the range of stressors related to COVID-19 (e.g., financial stress, loneliness, grief/bereavement), potentially through telehealth.

Contributors

Dr. Hans Oh was the primary author and performed all statistical analyses. Ms. Jessica Goehring ran statistical models and provided editorial assistance. Dr. Ravi Rajkumar provided conceptual support and contributed to the writing of the manuscript. Ms. Megan Besecker provided statistical consultation. Dr. Jordan DeVylder provided conceptual assistance and contributed to the writing of the manuscript.

Role of funding source

None.

Declaration of competing interest

None.

Acknowledgments

None.

Footnotes

Appendix A

Supplementary data to this article can be found online at https://doi.org/10.1016/j.schres.2021.09.003.

Appendix A. Supplementary data

Supplementary tables

mmc1.docx (20.2KB, docx)

References

  1. Adelman R.D., Tmanova L.L., Delgado D., Dion S., Lachs M.S. Caregiver burden: a clinical review. JAMA. 2014;311(10):1052–1060. doi: 10.1001/jama.2014.304. [DOI] [PubMed] [Google Scholar]
  2. Alameda L., Rodriguez V., Carr E., Aas M., Trotta G., Marino P., Vorontsova N., Herane-Vives A., Gadelrab R., Spinazzola E. A systematic review on mediators between adversity and psychosis: potential targets for treatment. Psychol. Med. 2020;50(12):1966–1976. doi: 10.1017/S0033291720002421. [DOI] [PubMed] [Google Scholar]
  3. Ammerman B.A., Burke T.A., Jacobucci R., McClure K. Preliminary investigation of the association between COVID-19 and suicidal thoughts and behaviors in the US. J. Psychiatr. Res. 2021;134:32–38. doi: 10.1016/j.jpsychires.2020.12.037. [DOI] [PubMed] [Google Scholar]
  4. Bardol O., Grot S., Oh H., Poulet E., Zeroug-Vial H., Brunelin J., Leaune E. Perceived ethnic discrimination as a risk factor for psychotic symptoms: a systematic review and meta-analysis. Psychol. Med. 2020;50(7):1077–1089. doi: 10.1017/S003329172000094X. [DOI] [PubMed] [Google Scholar]
  5. Bortolon C., Capdevielle D., Dubreucq J., Raffard S. Persecutory ideation and anomalous perceptual experiences in the context of the COVID-19 outbreak in France: what’s left one month later? J. Psychiatr. Res. 2021;134:215–222. doi: 10.1016/j.jpsychires.2020.12.042. [DOI] [PubMed] [Google Scholar]
  6. Bureau of Labor Statistics . The Economic Daily; 2020. Unemployment Rate Rises to Record High 14.7 Percent in April 2020. [Google Scholar]
  7. Carol E.E., Spencer R.L., Mittal V.A. Acute physiological and psychological stress response in youth at clinical high-risk for psychosis. Front. Psychiatry. 2021;12 doi: 10.3389/fpsyt.2021.641762. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Castelnovo A., Cavallotti S., Gambini O., D’Agostino A. Post-bereavement hallucinatory experiences: a critical overview of population and clinical studies. J. Affect. Disord. 2015;186:266–274. doi: 10.1016/j.jad.2015.07.032. [DOI] [PubMed] [Google Scholar]
  9. Centers for Disease Control and Prevention . 2021. COVID Data Tracker. [Google Scholar]
  10. Cristóbal-Narváez P., Sheinbaum T., Myin-Germeys I., Kwapil T.R., de Castro-Catala M., Domínguez-Martínez T., Racioppi A., Monsonet M., Hinojosa-Marqués L., van Winkel R. The role of stress-regulation genes in moderating the association of stress and daily-life psychotic experiences. Acta Psychiatr. Scand. 2017;136(4):389–399. doi: 10.1111/acps.12789. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Deng J., Zhou F., Hou W., Silver Z., Wong C.Y., Chang O., Huang E., Zuo Q.K. The prevalence of depression, anxiety, and sleep disturbances in COVID-19 patients: a meta-analysis. Ann. N. Y. Acad. Sci. 2020;1486(1):90–111. doi: 10.1111/nyas.14506. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Dhanani L.Y., Franz B. Unexpected public health consequences of the COVID-19 pandemic: a national survey examining anti-Asian attitudes in the USA. Int. J. Public Health. 2020;65(6):747–754. doi: 10.1007/s00038-020-01440-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Dodell-Feder D., Shovestul B., Woodyatt J., Popov V., Germine L. Social anhedonia, social networks, and psychotic-like experiences: a test of social deafferentation. Psychiatry Res. 2020;284 doi: 10.1016/j.psychres.2019.112682. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Fillman S.G., Sinclair D., Fung S.J., Webster M.J., Weickert C.S. Markers of inflammation and stress distinguish subsets of individuals with schizophrenia and bipolar disorder. Transl. Psychiatry. 2014;4(2) doi: 10.1038/tp.2014.8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. 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. Self-reported changes in anxiety, depression and suicidality during the COVID-19 lockdown in Greece. J. Affect. Disord. 2020;279:624–629. doi: 10.1016/j.jad.2020.10.061. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Freeman D. Suspicious minds: the psychology of persecutory delusions. Clin. Psychol. Rev. 2007;27(4):425–457. doi: 10.1016/j.cpr.2006.10.004. [DOI] [PubMed] [Google Scholar]
  17. Gallagher M.W., Zvolensky M.J., Long L.J., Rogers A.H., Garey L. The impact of covid-19 experiences and associated stress on anxiety, depression, and functional impairment in American adults. Cogn. Ther. Res. 2020;44(6):1043–1051. doi: 10.1007/s10608-020-10143-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Hossain M.M., Tasnim S., Sultana A., Faizah F., Mazumder H., Zou L., McKyer E.L.J., Ahmed H.U., Ma P. Epidemiology of mental health problems in COVID-19: a review. F1000Research. 2020;9(636):1–16. doi: 10.12688/f1000research.24457.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Huarcaya-Victoria J., Herrera D., Castillo C. Psychosis in a patient with anxiety related to COVID-19: a case report. Psychiatry Res. 2020;289 doi: 10.1016/j.psychres.2020.113052. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Khubchandani J., Sharma S., Webb F.J., Wiblishauser M.J., Bowman S.L. Post-lockdown depression and anxiety in the USA during the COVID-19 pandemic. J. Public Health. 2020;1–8 doi: 10.1093/pubmed/fdaa250. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Lanier C.G., Lewis S.A., Patel P.D., Ahmed A.M., Lewis P.O. An unusual case of COVID-19 presenting as acute psychosis. J. Pharm. Pract. 2020;1–4 doi: 10.1177/0897190020977721. [DOI] [PubMed] [Google Scholar]
  22. Lim M.H., Gleeson J.F. Social connectedness across the psychosis spectrum: current issues and future directions for interventions in loneliness. Front. Psychiatry. 2014;5:154. doi: 10.3389/fpsyt.2014.00154. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Luo M., Guo L., Yu M., Wang H. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public–a systematic review and meta-analysis. Psychiatry Res. 2020;291 doi: 10.1016/j.psychres.2020.113190. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Martland N., Martland R., Cullen A.E., Bhattacharyya S. Are adult stressful life events associated with psychotic relapse? A systematic review of 23 studies. Psychol. Med. 2020;50(14):2302–2316. doi: 10.1017/S0033291720003554. [DOI] [PubMed] [Google Scholar]
  25. McGrath J.J., Saha S., Al-Hamzawi A.O., Alonso J., Andrade L., Borges G., Bromet E.J., Oakley Browne M., Bruffaerts R., Caldas de Almeida J.M. Age of onset and lifetime projected risk of psychotic experiences: cross-national data from the world mental health survey. Schizophr. Bull. 2016;42(4):933–941. doi: 10.1093/schbul/sbw011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Morgan C., Fisher H., Hutchinson G., Kirkbride J., Craig T.K., Morgan K., Dazzan P., Boydell J., Doody G.A., Jones P.B. Ethnicity, social disadvantage and psychotic-like experiences in a healthy population based sample. Acta Psychiatr. Scand. 2009;119(3):226–235. doi: 10.1111/j.1600-0447.2008.01301.x. [DOI] [PubMed] [Google Scholar]
  27. Murray R.M., Mondelli V., Stilo S.A., Trotta A., Sideli L., Ajnakina O., Ferraro L., Vassos E., Iyegbe C., Schoeler T. The influence of risk factors on the onset and outcome of psychosis: what we learned from the GAP study. Schizophr. Res. 2020;225:63–68. doi: 10.1016/j.schres.2020.01.011. [DOI] [PubMed] [Google Scholar]
  28. Oh Hans, Nagendra Arundati, Besecker Megan, Smith Lee, Koyanagi Ai, Wang Julia Shu-huah. Economic strain, parental education and psychotic experiences among college students in the United States: Findings from the Healthy Minds Study 2020. Early Intervention in Psychiatry. 2021 doi: 10.1111/eip.13221. [DOI] [PubMed] [Google Scholar]
  29. Oh H., Schiffman J., Marsh J., Zhou S., Koyanagi A., DeVylder J. Biological Psychiatry Global Open Science. 2021. COVID-19 infection and psychotic experiences: findings from the Healthy Minds Study 2020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Oh H., DeVylder J.E., Koyanagi A. Psychotic experiences as a health indicator: a provisional framework. Int. J. Soc. Psychiatry. 2021:1–9. doi: 10.1177/0020764021992809. [DOI] [PubMed] [Google Scholar]
  31. Panchal N., Kamal R., Orgera K., Cox C., Garfield R., Hamel L., Chidambaram P. Kaiser Family Foundation; 2020. The Implications of COVID-19 for Mental Health and Substance Use. [Google Scholar]
  32. Pearce J., Rafiq S., Simpson J., Varese F. Perceived discrimination and psychosis: a systematic review of the literature. Soc. Psychiatry Psychiatr. Epidemiol. 2019;54(9):1023–1044. doi: 10.1007/s00127-019-01729-3. [DOI] [PubMed] [Google Scholar]
  33. Rajkumar R.P. COVID-19 and mental health: a review of the existing literature. Asian J. Psychiatr. 2020;52 doi: 10.1016/j.ajp.2020.102066. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Rentero D., Juanes A., Losada C.P., Álvarez S., Parra A., Santana V., Martí I., Urricelqui J. New-onset psychosis in COVID-19 pandemic: a case series in Madrid. Psychiatry Res. 2020;290 doi: 10.1016/j.psychres.2020.113097. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Rosenberg M., Luetke M., Hensel D., Kianersi S., Fu T.-C., Herbenick D. Depression and loneliness during April 2020 COVID-19 restrictions in the United States, and their associations with frequency of social and sexual connections. Soc. Psychiatry Psychiatr. Epidemiol. 2021;1–12 doi: 10.1007/s00127-020-02002-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Ross J.A., Van Bockstaele E.J. The locus coeruleus-norepinephrine system in stress and arousal: unraveling historical, current, and future perspectives. Front. Psychiatry. 2021;11 doi: 10.3389/fpsyt.2020.601519. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Sanchez C., Dunning D. Jumping to conclusions: implications for reasoning errors, false belief, knowledge corruption, and impeded learning. J. Pers. Soc. Psychol. 2020;120(3) doi: 10.1037/pspp0000375. [DOI] [PubMed] [Google Scholar]
  38. Selten J.-P., Cantor-Graae E. Social defeat: risk factor for schizophrenia? Br. J. Psychiatry. 2005;187(2):101–102. doi: 10.1192/bjp.187.2.101. [DOI] [PubMed] [Google Scholar]
  39. Selten J.-P., Van Der Ven E., Rutten B.P., Cantor-Graae E. The social defeat hypothesis of schizophrenia: an update. Schizophr. Bull. 2013;39(6):1180–1186. doi: 10.1093/schbul/sbt134. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Sonnenschein S.F., Gomes F.V., Grace A.A. Dysregulation of midbrain dopamine system and the pathophysiology of schizophrenia. Front. Psychiatry. 2020;11:613. doi: 10.3389/fpsyt.2020.00613. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Vindegaard N., Benros M.E. COVID-19 pandemic and mental health consequences: systematic review of the current evidence. Brain Behav. Immun. 2020;89:531–542. doi: 10.1016/j.bbi.2020.05.048. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Watson C.J., Thomas R.H., Solomon T., Michael B.D., Nicholson T.R., Pollak T.A. COVID-19 and psychosis risk: real or delusional concern? Neurosci. Lett. 2020;741 doi: 10.1016/j.neulet.2020.135491. [DOI] [PubMed] [Google Scholar]
  43. Whiteside D.M., Oleynick V., Holker E., Waldron E.J., Porter J., Kasprzak M. Neurocognitive deficits in severe COVID-19 infection: case series and proposed model. Clin. Neuropsychol. 2021;1–20 doi: 10.1080/13854046.2021.1874056. [DOI] [PubMed] [Google Scholar]
  44. Xiong J., Lipsitz O., Nasri F., Lui L.M., Gill H., Phan L., Chen-Li D., Iacobucci M., Ho R., Majeed A. Impact of COVID-19 pandemic on mental health in the general population: a systematic review. J. Affect. Disord. 2020;277:55–64. doi: 10.1016/j.jad.2020.08.001. [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary tables

mmc1.docx (20.2KB, docx)

Articles from Schizophrenia Research are provided here courtesy of Elsevier

RESOURCES