Schizophrenia and COVID-19: A bibliometric analysis of trends and themes

Abstract

Dear Editor, Patients with schizophrenia are more likely to become infected and have poorer results when exposed to COVID-19, especially if they have psychiatric comorbidities (Gadelha et al., 2020). Fear of the illness, stress, and weariness linked with compulsory seclusion make them more vulnerable to increased psychotic illnesses and recurrence (Palomar-Ciria et al., 2020). Studies suggest that healthcare providers and relatives should pay extra attention and assistance to persons with schizophrenia to prevent COVID-19 infection and detect pulmonary and psychotic symptoms as soon as feasible (Barlati et al., 2021). A study conducted by (Nemani et al., 2021) indicated that adults with a diagnosis of schizophrenia spectrum disorder had a higher mortality rate, while mood and anxiety disorders did not raise the risk of dying. These findings imply that patients with COVID-19 may be at risk for dying from schizophrenia spectrum diseases. Bibliometric analysis is an effective technique for understanding the fragmented literature in specific research areas (Shekhar, 2021). The study performed a bibliometric analysis (using Biblioshiny, an R-based software) to visualize the trends and themes related to Schizophrenia research amidst COVID-19. To fetch the data from the Scopus database, the researcher used the search theme “Schizophrenia” AND “COVID-19” OR “Coronavirus”. The search key retrieved 566 documents (326 research articles, three conference reviews, 103 letters to editors, 26 editorials, 22 notes, 85 reviews, and one short survey). Descriptive techniques, thematic mapping, collaborative, co-citation, and co-concurrence networks, word clouds, and so on were used to interpret the data. The study reported documents published between 2020 and 2022 (mid-April). Average years of publication, average citations per paper, and average citations per year per paper were reported as 1.11, 7.67, and 3.05 respectively. The study also reported 21,951 references, 4577 keywords plus, and 983 keywords used by authors. Two thousand eight hundred nineteen authors contributed to COVID-19 and Schizophrenia research. Of which 48 contributed as single-authored papers and the rest multiauthored. Author search appearances were reported as 3220, papers per author as 0.201, and authors per paper as 4.98. The co-authors per paper and collaboration index were found to be 5.69 and 5.4, respectively. The annual scientific production in 2020 was 158 papers, followed by 314 in 2021 and 94 in 2022 (mid-April). The top journals publishing the theme of the study were Schizophrenia Research (22 articles) followed, Psychiatry Research (21 articles), Asian Journal of Psychiatry (19 articles), Frontiers in Psychiatry (15 articles), International Journal of Environmental Research and Public Health (12 articles) and European Archives of Psychiatry and Clinical Neuroscience (10 articles). Schizophrenia Research had the top global citations (324) followed by World Psychiatry (284), Psychiatry Research (278), Asian Journal of Psychiatry (204), and Schizophrenia Bulletin (195). As per Bradford's law (Ray and Sen, 2012), 16 journals fell in zone 1 (highly productive). Schizophrenia Research topped the spot. The remaining journals fell in zone 2 (moderately productive) and zone 3 (low productive). Schizophrenia Research topped the place in local h index (8), m index (2.66), and g index (18) as well. The top authors were Li Y (7 documents), Boyer L (6), Fond G (6), Li W (5), and Llorca P M (5). Braithwaite J was the top local cited author, followed by Gavris C (45) and Liu Z (36). The study supported Lotka's law (Martín Sobrino et al., 2009). Two thousand five hundred fifty-two authors contributed at least one paper to the theme of the study, 173 authors contributed two articles, and 65 authors contributed three papers. Verkhratsky A, reported maximum citations (287) followed by Steardo J (244) and Volkow N D (209). Harward Medical School was the highest contributor to COVID-19 and schizophrenia research with 28 articles, followed by Tehran University of Medical Sciences (23), King's College London (16), University of Toronto (15), and University of Otago (12). The USA led in multi-country publications with 13 documents, followed by China (11) and the UK (8). The USA was also leading in single-country publications (76) followed by the UK (22) and Spain (20). The USA was the most cited country (789 citations) followed by India (325) and Spain (307). Work by Wang et al. (2021) was the top globally cited document with 209 citations. It was followed by Steardo et al. (2020) with 163 citations, Kozloff et al. (2020) with 139 citations, Brown et al. (2020) with 137 citations, and Chatterjee et al. (2020) with 130 citations. Word cloud analysis indicated schizophrenia (614 occurrences), human (501), and coronavirus disease 2019 (418) as the top-cited words. Co concurrence network stated the formation of three clusters. The first cluster focused on schizophrenia and related disorders. The second cluster focused on humans' clinical studies, and the third cluster pointed to the pandemic and associated diseases. Thematic maps indicated the formation of basic themes (schizophrenia and related mental health/disorders, bipolar disorders, anxiety, mental illness, depression, etc.) which clustered around psychopathology, motor themes clustered around related conditions and consequences (comorbidity, immunity, and COVID-19 lockdown related psychological studies), niche themes pointed to psychological methods to address the disorders (psychotherapy for psychotic disorders, mood disorders) and emerging themes (electroconvulsive theory, COVID & suicide counseling, universal health coverage etc.) pointed towards holistic health services. Co-citation network analysis reported the formation of two clusters. Journals like Lancet Psychiatry, Lancet, Plos One, Jama fell together in one cluster and closely cited one another. The second cluster included the Schizophrenia Bulletin, Psychiatry Research, World Psychiatry, and Schizophrenia Research in the second cluster. Regarding collaboration, the USA was closely collaborating with Italy, France, Korea, India, etc. The UK, Canada, Australia, Denmark, Ireland, etc., were the second group. It was worth noting that the annual growth rate of papers steadily increased from 2020 to 2022. While the collaboration between countries was found to be pretty satisfactory, the partnership was skewed towards American, European, and Asian countries. Hardly any partnership has been located with African and other lower-income countries. Future research must include African countries and lower-income countries to understand the mental illness patterns in developing countries. The results of the co-concurrent network analysis may help the researchers to focus on future research explicitly directed to the three clusters mentioned in the study. Researchers may shift their focus from basic themes to niche and emerging themes. There aren't many studies on psychotherapy, infections related to the brain, latent diseases, psychotic and mood disorders, electroconvulsive therapies, etc. Hence the number of studies related to COVID-19 and Schizophrenia needs to continuously grow owing to the importance of COVID-19 and mental health issues. Future studies may also focus on effective psychosis, psychotic symptoms, at-risk mental stages, schizophrenia, COVID-related mortality, etc. The research was not without any limitations. The papers were scrutinized from the Scopus database alone. Future research may focus on other databases like Web of Science, Google Scholar, etc. A comprehensive study that merges many databases may give a broader clarity of the trend and themes. Bibliometric analysis on the search theme of schizophrenia and COVID-19 exhibited concern about the mental health of schizophrenia patients. However, the analysis helps in setting the direction of research across clustered themes (emerging and niche themes) as identified in the paper for the larger benefit of the stakeholders. Improvements in international collaboration across various authors, organizations, and nations are still necessary for research on schizophrenia and COVID-19 and its impact on mental health. The effects of the virus infection, the safety and potential interactions of antipsychotic medicines, and COVID-19 treatment options should all be the subject of more thorough research. It is thus concluded that future research on pandemics should prioritise studying mental health problems, with a special focus on schizophrenia populations' mental health in particular. Declaration of competing interest There is no conflict of interest for this paper.