DISCUSSION
Our results are in line with previous chart-reviews showing a general decrease in use of mental health services during the pandemic. Our study was not limited to chart review, however, and to the best of our knowledge, it is the first to assess mental health services use of psychiatric outpatients during the pandemic, using a clinician-administered interview. Contrary to our expectations, we found that the SCZ group reported the lowest need for help during the pandemic. Interestingly, though ANX/OCD and MDD patients reported a higher need for help compared to the SCZ group, fewer of them used services. The need for contact in the BPD group was also higher than that in the SCZ group, but the BPD group did not differ from the SCZ group in terms of actual use of services. Taken together, these findings suggest that patients with a severe mental disorder, such as schizophrenia or bipolar disorder, seem not to be at a disadvantage in terms of worsening of symptoms, getting appointments or contacting the clinic during the pandemic. It is interesting that patients with severe mental disorders report lower disruption during the pandemic, a finding also reported by other studies (Gupta et al., 2022, Pinkham et al., 2020). Especially the SCZ group reported much lower need for contact and lower PGI scores, suggesting less worsening of clinical status.
Why is everything so favorable for the SCZ group? Is it because they have low insight and cannot judge their status in a realistic way? Or do we have a biased sample? Or did they not need so much help after all? Our design cannot answer these questions, though it is possible that our mental health care system is more suited to the needs of SCZ or BPD patients and not to those of the MDD and the ANX/OCD patients. SCZ and BPD patients had much longer duration of illness than the others, so they were likely more stable in their medications and symptoms. It is also possible that patients with severe mental disorders may be more resilient to some effects (i.e., isolation) of the pandemic (Pinkham et al., 2020).
Though the sample size was small to conduct multivariate analyses within each diagnostic group, preliminary analyses suggest that living outside of Ankara and having been previously hospitalized are important predictors of use of services in the MDD group, whereas having an accessible psychiatrist/psychologist is the sole predictor of services use among the ANX/OCD group only (analyses not reported). Our findings, if consolidated by future research, may help us reshape our services to better fit the needs of all types of diagnostic groups during pandemics. The current structure of our service provision may be sufficient to serve people with severe mental disorders, but we may be neglecting the large group of anxiety/depression spectrum patients. Combined with the fact that the ANX/OCD and the MDD groups had higher scores on COVID-19 anxiety, a finding also reported by Seo et al. (2021), managing COVID-19-related fears among these groups may be the first step to improve help-seeking during the pandemic.