The Impact of the COVID-19 Pandemic on Severe Mental Illness

Abstract Many studies have shown the disproportionately high rates of SARS-CoV-2 infection and its medical complications, including death, experienced by individuals with pre-pandemic severe mental illness (SMI). By contrast, very few studies have thus far attempted to rigorously examine the impact of the pandemic, and infection specifically, on brain and behavioral function in this highly vulnerable group. The lack of such studies is a matter of growing public health concern, given evidence that, in the population overall, the pandemic has been associated with potentially long-lasting deteriorations in measures of mental health and cognitive performance. This proposal is to fill major gaps in our knowledgebase, regarding the impact of the COVID pandemic on individuals living with SMI - defined here to include schizophrenia, bipolar disorders, and severe major depressive disorders. We will do so through new studies that leverage existing, longstanding projects that have focused on elucidating causes and trajectories of SMI, in the Paisa population of Colombia. To conduct these studies, we will re-engage and reassess the Paisa-project participants whom we originally investigated pre- pandemic. Specifically, we will measure outcomes of the pandemic and potential predictors of those outcomes, in individuals with pre-existing SMI and controls (Aim 1). Among the outcome and predictor measures that we will obtain are: neurocognitive batteries, symptom scales, assessments of SMI-related dimensional traits (such as anhedonia) and of pandemic experiences, questionnaires on Social Determinants of Health, SARS-CoV-2 serology, and whole exome and whole genome genotypes. We will then (Aim 2) conduct analyses to identify the relationships between specific outcomes and predictors evaluated in Aim 1. Finally (Aim 3), we will use our EHR- linked biobank to evaluate the relationships in a larger, independent case/control sample, identify modifiers of these relationships, and develop models to predict pandemic-related suicide attempts and changes in healthcare utilization in individuals with SMI.