JMIR Publications

ABSTRACT

Background:

The Coronavirus Disease 2019 (COVID-19) results from infection by SARS-CoV-2 virus to produce a range of mild to severe physical, neurologic and mental health symptoms. Indirectly, the COVID-19 pandemic has caused significant emotional distress, triggering emergence of mental health symptoms in persons not previously affected, or exacerbating symptoms in those with existing mental health conditions. Emotional distress and some mental health conditions can lead to violent ideation and disruptive behavior, including aggression, threatening acts, deliberate harm towards other people or animals, and inattention or noncompliance with education or workplace rules. Of the many mental health conditions that can be associated with violent ideation and disruptive behavior, psychosis can evidence greater vulnerability to unpredictable changes and be at greater risk for them. Individuals with psychosis can also be more susceptible to contracting COVID-19.

Objective:

The objective of this study was to investigate if violent ideation and disruptive behavior or symptoms of psychosis were more prevalent in a population with COVID-19, and did not proceed the pandemic.

Methods:

In this preliminary study, we analyzed questionnaire responses from a population sample, received between end of February 2021 and start of March 2021 (one year into the COVID-19 pandemic) about COVID-19 illness, violent ideation and disruptive behavior, and psychosis symptoms. Using Wilcoxon Rank Sum test followed by multiple comparisons correction, we compared the self-reported frequency of these variables for three-time windows, related to the past one month, past one month to one year, and more than a year ago, between distributions of people who answered if they tested positive and/or were diagnosed with COVID-19 by a clinician. We also used multivariable logistic regression (MVLR), with iterative resampling to investigate the relationship between these variables occurring more than one year ago (i.e., before the pandemic) and the likelihood of contracting COVID-19.

Results:

We observed significantly higher frequency of self-reported violent ideation and disruptive behavior, along with psychosis symptoms for all three-time windows of people who tested positive and/or were diagnosed with COVID-19 by a clinician. Using MVLR with iterative resampling, we observed 72%-94% model accuracy for an increased incidence of COVID-19 in participants who reported violent ideation and disruptive behavior, or psychosis symptoms more than one year ago.

Conclusions:

This preliminary study found that people who reported a test and/or clinician diagnosis of COVID-19 also reported higher frequencies of violent ideation and disruptive behavior or psychotic symptoms, across multiple time windows, indicating they were not likely the result of COVID-19. In parallel, participants who reported these behaviors more than one year ago (i.e., before the pandemic) were more likely to be diagnosed with COVID-19, suggesting violent ideation and disruptive behavior along with psychotic symptoms were associated with COVID-19 with about a 70-90% likelihood.