key: cord-0777889-coce64hh authors: Yasuma, Naonori; Yamaguchi, Sosei; Ogawa, Makoto; Shiozawa, Takuma; Abe, Makiko; Igarashi, Momoka; Kawaguchi, Takayuki; Sato, Sayaka; Nishi, Daisuke; Kawakami, Norito; Fujii, Chiyo title: Care difficulties and burden during COVID‐19 pandemic lockdowns among caregivers of people with schizophrenia: A cross‐sectional study date: 2021-03-25 journal: Neuropsychopharmacol Rep DOI: 10.1002/npr2.12171 sha: 6de53319d5f0517e476c887a11473fa83ede4a95 doc_id: 777889 cord_uid: coce64hh AIMS: The purpose of this study was to retrospectively investigate care difficulties experienced by caregivers of people with schizophrenia during COVID‐19 pandemic lockdowns in Japan (April 7‐May 25, 2020) and examine associations between these care difficulties during lockdowns and daily caregiver burden. METHODS: Data were collected from 132 participants of the LINE Schizophrenia Family Association using an online survey. RESULTS: Caregivers were mostly concerned about who would care for people with schizophrenia if caregivers become infected with COVID‐19. A significant association was found between higher daily caregiver burden and more difficult care experiences during COVID‐19 pandemic lockdowns (B = 0.58, 95% confidence interval, 0.40‐0.75, P < .01, adjusted R‐squared = .34). CONCLUSIONS: Further studies and supports for caregivers of people with schizophrenia are needed. The COVID-19 outbreak has created many public mental health concerns in the general population. 1 The COVID-19 pandemic and associated lockdowns also appear to have negatively impacted the lives of vulnerable populations, including people with schizophrenia and their caregivers. Despite urgent research needs, 2, 3, 4 only a few studies have focused on people with schizophrenia. For example, people with schizophrenia have experienced higher stress, anxiety, depression, and paranoia compared to general population. 4 However, no studies have examined the social impact of the COVID-19 pandemic on caregivers of people with schizophrenia, a topic requiring urgent attention 5 because they may have a variety of burdens such as physical, mental, or financial problems during the COVID-19 pandemic. 5 The purpose of this study is to retrospectively investigate care difficulties experienced by caregivers of people with schizophrenia during COVID-19 pandemic lockdowns in Japan (April 7 -May 25, 2020) and examine associations between care difficulties during lockdowns and daily caregiver burden. An online cross-sectional survey was conducted during August 1-31, 2020. Participants were recruited from the LINE Family Association of Schizophrenia, which had 238 registered members as of August 1, 2020. The association offers a platform for information exchange and peer support for caregivers of people with schizophrenia using the "LINE" online software. Eligibility criteria were as follows: (a) caregiver of people with schizophrenia and (b) age over 20 years. For example, a caregiver can be someone who cares for a family member with schizophrenia and look after his or her daily living needs. Respondents were invited to participate on a voluntary basis. Participants gave fully informed consent through the internet. The study protocol was approved by the Research Ethics Committee of the National Center of Neurology and Psychiatry (No. A2020-036). Table 2) . These items were based on a five-point Likert scale: (1) strongly disagree, (2) disagree, (3) neither agree nor disagree, (4) agree, and (5) strongly agree. Participants responded to the 10 items by recalling care difficulties during COVID-19 pandemic lockdowns. The validity of this measurement has not been fully evaluated. J-ZBI_8 was used to measure caregiver burden 6 (Appendix 2). It consists of eight items scored on a five-point Likert scale from 0 (never) to 4 (nearly always). The total score ranges from 0 to 32, with higher scores indicating higher burden. J-ZBI_8 has high test-retest reproducibility and internal consistency. Concurrent validity and construct validity have also been confirmed. 6 Caregiver burden was assessed during the study period of August 1-31, 2020. We first calculated descriptive statistics for the items about care difficulties. Next, multiple linear regression was used to examine the relationship between daily caregiver burden and the total number of care experiences during COVID-19 pandemic lockdowns. In this model, we adjusted for age, gender, education, household income, and care time since previous studies have pointed out that these variables are potential confounders. 7 Statistical significance was set at the 5% level. All analyses were conducted using SPSS, Windows version 26. A total of 132 participants completed the online self-reported questionnaire. Participant characteristics are presented in Table 1 . Participants were mostly middle-aged mothers with a care duration of less than 5 years. This is the first study to describe care difficulties experienced by caregivers of people with schizophrenia during COVID-19 pandemic lockdowns in Japan and its association with daily caregiver burden. We identified several caregivers' worries during COVID-19 pandemic lockdowns in Japan. We found an association between higher daily caregiver burden and more difficult experiences while caring for family members with schizophrenia. Further studies and supports for caregivers are needed. None. NY wrote the first draft of the manuscript, and other authors critically revised the manuscript. All authors approved the final manuscript. The study was approved by the Research Ethics Committee of the National Center of Neurology and Psychiatry (No. A2020-036). Informed consent was obtained from all subjects. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy and ethical restrictions. We did not explain to the participants about the public access to the data in the informed consent process. When we receive a reasonable request, the data will be made available after approval by the ethics committee of the Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population. The lancet Psychiatry The COVID-19 Global Pandemic: implications for people with schizophrenia and related disorders The impact of COVID-19 on individuals living with serious mental illness Psychological distress in patients with serious mental illness during the COVID-19 outbreak and one-month mass quarantine in Italy Caregivers of people with severe mental illness in the COVID-19 pandemic The short version of the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI8): its reliability and validity Predictors of burden among lower socioeconomic status caregivers of persons with chronic mental illness Caregiver burden and coping strategies for patients with schizophrenia: comparison between Japan and Korea Caring for the family caregivers of persons with mental illness Burden of care in caregivers of patients with alcohol use disorder and schizophrenia and its association with anxiety, depression and quality of life Caregiver burden: a clinical review