Since schizophrenia was called the “disease of civilization” at the dawn of the 20th century, there has been controversy over its incidence and prevalence in low- and middle-income countries (1). Schizophrenia, as a highly disabling and under-recognized psychiatric disorder, puts a heavy economic burden on different societies. Inadequate health care services are often provided to patients with the disease and their families (2). Some schizophrenia researchers point to the need for reexamination in results for better prognosis of the disease in low- and middle-income countries due to methodological limitations in related studies, lack of evidence for the positive effects of some socio-cultural factors on the prognosis of the disease, and rapid socioeconomic changes in these countries in recent years that impaired the traditional family care system for people with schizophrenia (3).
With the global spread of COVID-19, serious concerns have been raised about the possible increase in the prevalence of the disease in the coming decades for a variety of reasons (4). This point highlights the need to pay more attention to this severe mental health disorder and the need to increase vigilance for the symptoms of psychosis among people with COVID-19 (5).
Another important issue is forecasting the greater impact of this pandemic on the health and economic conditions of this group of patients. In particular, global health systems during the COVID-19 pandemic, especially in low- and middle-income countries, had many shortcomings in the management of mental health problems (6). Also, the restrictions created and their effects on the social network may exacerbate negative symptoms of this group of patients (7). Due to the potential effects of the COVID-19 pandemic on different age groups in this area and serious restrictions on access to reliable and reachable information resources, translational and intervention research is needed to improve quality of life of patients and systematically prepare conditions for better care (8). Also, some researchers have emphasized the need to pay attention to studies with different results in different countries in order to have more access to scientific breakthroughs based on the current condition of the pandemic (9).
However, the question then arises is how to take such measures in low- and middle-income countries due to the problems in their economic and cultural infrastructure. Even if policymakers are aware of the ongoing challenges and cost-effective and appropriate research measures or if they are enthusiastic to promote health in these countries (10), it is not clear whether such ambitions can be fulfilled at an optimally effective level.
In fact, in this pandemic, two short-term and long-term challenges are encountered by patients with schizophrenia. In the short term, there is restricting access to community care and medical services (11), in conjunction with the increased risk of infection and worse outcomes (12). But in the long run, it seems that uncertain circumstances will likely raise the need for more comprehensive research in schizophrenia (8).
One of the most important concerns in this area is the availability of financial and human resources to conduct such researches, which has always been accompanied by serious limitations in low- and middle-income countries. Therefore, even for basic mental health care, there are serious limitations in various fields (13). On the other hand, the question arises as to whether, in the context of a disease such as schizophrenia which is affected by various social, cultural and biological aspects, the results of research obtained in one country or in the region with a specific socio-cultural context, are applicable to other countries. In this regard, there are even important differences in opinions regarding the assessment of the prevalence of this disease in these two different economic and cultural conditions (14). Also, culture seems to have a definite and different effect on course and outcome of schizophrenia among high-income and low- and middle-income countries (15).
However, in recent years, some appropriate measures have been taken in low-and middle-income countries to take care of patients with schizophrenia and other psychotic disorders. For example, taking several interventions in the first episode of psychosis and related diagnostic and therapeutic measures in low- and middle-income countries, in addition to reviewing relevant research being conducted in high-income countries, are the benefits of studies performed in low-and middle-income countries (13,16). However, there seems to be a difficult path ahead.
Undoubtedly, the continuation of research in the field of schizophrenia, especially considering the new conditions of COVID-19 pandemic, is of great importance in various epidemiological, biological, cultural, and social aspects. It seems that health policymakers, especially in the field of mental health, should pay special attention to this issue along with pursuing other matters related to pandemic control. Informing governments and decision-makers at the national level about this issue is another task of schizophrenia researchers. The role and position of relevant international institutions is also of great importance in supporting applicable research projects in low-and middle-income countries. Bridging serious knowledge gaps in the field of schizophrenia, in the current COVID-19 situation, especially in low-and middle-income countries, requires the redoubled efforts of schizophrenic politicians and researchers.
Conflict of Interest
There is no conflict of interest.
COVID-19, Developing countries, Research, Schizophrenia