Lower income associated with increased psychotic symptoms, severity in pandemic

Individuals with the lowest incomes were found to have more psychotic symptoms and experienced a greater degree of distress from these symptoms after the onset of the COVID-19 pandemic, according to a study published in Psychiatry Research.

“Considering the potential of psychosis to be disruptive, it would be important to assess if the current pandemic increased the level of psychotic experiences in the general population,” Alexandre Andrade Loch, MD, BPhil, PhD, professor of psychiatry at the University of São Paulo in Brazil, and colleagues wrote. “Furthermore, given the economic impact of the pandemic, it would also be imperative to evaluate if the pandemic differentially affected these psychotic experiences according to socioeconomic status — allowing for targeted mental health initiatives.

“Our study aims to evaluate the expression of psychosis in the general population and compare it to a previous sample recruited before the pandemic, and to evaluate if there is any differential effect of socioeconomic status on psychotic experiences,” they added.

The researchers conducted the cohort study in São Paulo, Brazil, and surveyed 1,950 participants aged 18 to 30 years in 2016 and 1,804 individuals aged 18 to 30 years in 2020. They used the Prodromal Questionnaire (PQ) to assess psychotic symptoms within the study population. The survey conducted in 2020 utilized the PQ-16 and included three additional questions asking if participants had ever sought any professional help because of mental health issues, if they had already been prescribed any psychiatric medication and if they were currently under psychiatric treatment. For each PQ-16 item, distress was measured on a scale of zero to three, from no distress to great distress respectively.

Mean PQ scores were found to have significantly increased between 2016 and 2020 (P < .001). When analyzed by socioeconomic status, all classes, with the exception of those considered high-income, showed a statistically significant increase in their PQ score measured after the onset of the pandemic (P < .001). Within-year analysis also showed that lower-income individuals had higher PQ scores than higher-income individuals in both 2016 and 2020.

The study found that 89% of individuals above the proposed cutoff point of the PQ were not undergoing psychiatric treatment. When compared with those below the PQ threshold, these individuals also showed a significantly higher mean level of distress related to their psychotic experiences (1.566 vs. 0.932; P < .001).

Lower age significantly correlated with a higher PQ score, as did lower income. Other significant predictors included level of education and the year the survey was conducted.

“Our study brings important findings, which should inform public policy makers to target the less socioeconomically favored individuals for mental health initiatives — especially because in our results individuals with more symptoms are more distressed and mostly not under treatment,” the researchers wrote.