Responding to the Heat and Planning for the Future: An Interview-Based Inquiry of People with Schizophrenia Who Experienced the 2021 Heat Dome in Canada
Abstract
:1. Introduction
Conceptual Framework
2. Materials and Methods
2.1. Ethics
2.2. Participant Selection and Recruitment
2.3. Interviews
2.4. Data Analysis
3. Results
3.1. General Participant Characteristics
3.2. Theme I: Personal Reflections on the Impact of Extreme Heat
3.2.1. Physical Impacts of Heat
“Kind of maybe even a bit disoriented a little bit to some degree, like not heatstroke, but like out of sorts a little bit from it.”(A12: 42; Male; Housed; Non-Prescribed Substance Use: Cough Syrup, Vapes, Dill, Cocaine, Acid)
“At one point in the heat dome, like I, I thought I was gonna die. Um, like, I went and had to go, but I couldn’t sleep in the living room. And I was on my home hospital bed, and it was just so hot. And it just, it felt like my soul was just gonna fall out of my body. I don’t know how else to say it.”(C02: age not specified; Female; Housed; Non-Prescribed Substance Use: N/A)
“You ever been outside where it’s so hot and you feel dizzy? You just don’t feel like right? It’s not even like, any problem or anything like, you, know, it’s not your fault. It’s the outside’s fault, and you can’t stop being dizzy, and you just don’t feel like you’re even in reality anymore. That’s kind of what it was like.”(A10: 31; Male; Housed; Non-Prescribed Substance Use: Cannabis, Alcohol, Cocaine)
“I remember the air conditioning couldn’t keep up with the heat. And I remember we decided to go for a walk when it was like 41 degrees outside. And I remember being able to not really breathe very easily. And I felt really hot and very exhausted.”(A12: 42; Male; Housed; Non-Prescribed Substance Use: Cough Syrup, Vapes, Dill, Cocaine, Acid)
“It was just hot, so sweaty and all my clothes were stuck to me, so I couldn’t really move around freely.”(A06: 25; Male; Housed; Non-Prescribed Substance Use: Cocaine, Cannabis, Alcohol;)
“Oh, yeah. I sweat more…it’s like, at the beginning of, a slight sensation of stress in the body because of sweating more and feeling that moisture on your skin that’s really hot feeling. And then it. Yeah, it also makes me more anxious, more and more anxiety, too. So, like that, that can contribute to like my mental stability, too. Right.”(C03: 23; Male; Housed; Non-Prescribed Substance Use: N/A; Prescribed Medication: N/A)
“I remember this one time during the summer I was at the hospital, and I was so drained I’m so high out of my mind, and heat exhaustion was suggested.”(A14: 33; Male; Unhoused; Non-Prescribed Substance Use: Heroin, Cocaine, Crystal Meth)
3.2.2. Impacts on Cognitive Capacity, Emotional and Mental Stability
“Yes, yes, yes. And like this, it has been verified by many studies already that sleep does have an effect...less quality sleep equals more chance of psycho-psychotic events happening in any mentally disturbed person. Actually, even in normal people, even normal people, if they get sleep deprived, if they get sleep deprived as like, they might even like have somehow like long enough to get like almost psychotic symptoms, like hallucinations and stuff right, but, this is more for the people who are mentally ill like who are already mentally ill or and then we need medication. Right.”(C03: 23; Male; Housed; Non-Prescribed Substance Use: N/A)
“Anxious. Anxious. I feel really anxious when I’m hot. I can’t breathe. I can’t. Well, of course, I can breathe, but I feel like I can’t breathe. And I kind of feel very anxious and irritated. I’m worried. Um, like, negative feelings. And some people say, Oh, my God [heat] is the best thing ever. It’s finally hot and warm. It’s like, no, not for me.”(C05: 57; Female; Housed; Non-Prescribed Substance Use: N/A)
3.2.3. Worsening of Symptoms Associated with Schizophrenia
“I think with schizophrenia, and with like, the paranoia that can come with it. I think if you’re concerned about something and it’s not going away, then that kind of ruminates, and you can get more worried about it. And if you have any other health concerns on top that would add to that and exacerbate it. And I think yeah, there’s many things you can worry about.”(C08: 40; Male; Housed; Non-Prescribed Substance Use: N/A)
“I know it does, but not been able to like, quantify or qualify exactly…When I’ve been hot and overhyped, over dehydrated, and I’m unwell, or I’m not eating well, I noticed the experience the psychosis, definitely amidst the schizophrenia symptoms do appear.”(C04: 45; Male; Housed; Non-Prescribed Substance Use: Methamphetamines)
“It would just like, the sweating and the malnutrition of it, and not having water. And I guess it just, seized my brain. You know, like, no water with the brain, you know.”(A01: age not specified; Male; Unhoused; Non-Prescribed Substance Use: Heroin, Cocaine, Speed)
“It wasn’t the setting of the activities that it was—it wasn’t like what we did that was the problem. It’s like the stress that stress-induced like heat inducing, or the heat caused me to get stressed out basically and then like lose my mind—and get out of touch with reality and start hearing, you know, the Gods in my head again…there were Gods in my head or like divine or entities trying to command me to do the good thing…but no, no, no, it’s just psychosis in my mind. Just psychosis, right? Voices and sometimes visions…It just increases the chance for those [with] schizoaffective, you know, makes it unlike normal people where they wouldn’t be hallucinating. Makes me more prone to these hallucinations. Because of my disorder, you know, because, especially during a heatwave, right, especially when the heat causes me stress, right.”(C03: 23; Male; Housed; Non-Prescribed Substance Use: N/A)
“But yeah, I noticed my schizoaffective [disorder] is more, I hear more voices when I stay in the heat and don’t seek shade and don’t drink water. But I notice it more when it’s really hot out…It’s true that heat does affect schizoaffective disorder. We hear more voices. And it seems to bring it out a little bit more…puts you in kinda like a trance…you just kind of get stuck in the loop with the voices because you get so hot, you’re just too hot. But if you’re not in the blaring sun, that’s why I’m saying seek shade, because it’s when the sun is shining right on you, then you hear the voices. If you seek shade, then I think you’re fine. If you’re just hot, it’s fine, but if you got sun blaring at you, then you start to hear the voices. I think that has a lot to do with it.”(A09: 29; Female; Housed; Non-Prescribed Substance Use: Methamphetamine, Ketamine, Acid, NAS, Mushrooms)
“And when I was outside in the heat, I’d be too tired to have my schizophrenia go off. But when I was back inside, it would be going crazy as soon as the heat went away.”(A13: 24; Male; Housed; Non-Prescribed Substance Use: Methamphetamine, Cigarettes, Fentanyl, Benzos; Prescribed Medication: N/A)
3.2.4. Impacts on Everyday Life
“And a few times got really lightheaded at work. Like I would get down to look in the drawers for a cosmetic or a cream or something and stand back up, I’m five nine and a half, I’d stand back up, and I feel dizzy and have to clutch onto one of the rails at work, but so I don’t know if that was dehydration or the stuff in the air.”(C06: 60; Female; Housed; Non-Prescribed Substance Use: Alcohol)
“I couldn’t cook. I remember that. I could not cook. Because if you turned the elements on or the stove on at all, it’s way too hot. We had to order Domino’s like every day.”(A10: 31; Male; Housed; Non-Prescribed Substance Use: Cannabis, Alcohol, Cocaine)
“And I was like, forgetting how to even though I’ve written tons of essays, I was like, forgetting how to... [write]. And it was, and I didn’t do everything properly….but I forgot how to construct an essay and, um, I guess, there was just a lot of fog, and I’m just, I’m not back to where I am not back to the ability I had before the heat dome.”(C02: age not specified; Female; Housed; Non-Prescribed Substance Use: N/A)
3.3. Theme II: Lack of Information
“I couldn’t really figure out what was what, there was no manual [on the air conditioner] or nothing.”(A10: 31; Male; Housed; Non-Prescribed Substance Use: Cannabis, Alcohol, Cocaine)
“It’s hard for me to imagine what I need to be cooler.”(C02: age not specified; Female; Housed; Non-Prescribed Substance Use: N/A)
“I’m kind of confused about why I didn’t see anything any warning there. I was just really upset that the College didn’t provide information on our news feed.”(C02: age not specified; Female; Housed; Non-Prescribed Substance Use: N/A)
“I didn’t. I braved it most of the time, like about 90% of the time, and I do basically anything anybody asked me to do. So there wasn’t really activities I was avoiding. But it wasn’t like, it wasn’t like, I was not happy to do it. I’m not gonna lie.”(A10: 31; Male; Housed; Non-Prescribed Substance Use: Cannabis, Alcohol, Cocaine)
3.4. Theme III: Cooling Strategies Employed to Mitigate the Heat
3.4.1. Individual-Level Cooling Strategies
“My husband would put me in the shower and run cold water over me. And so that was he would have done that three times a day.”(Participant C02: age not specified; female; housed; Non-Prescribed Substance Use: None)
“And I ended up surviving just with theone powered fan that I have. But I also learned about new tricks. Like you can sleep with your cold socks or wet socks, and that will help regulate your body... It’s like, you know, like wet clothes or damp clothes. kind of help regulate your body.”(Participant C04: 45; male; housed; Non-Prescribed Substance Use: meth)
“I do remember having to go and have a cold shower and, in my apartment lay down on the floor. Because the heat rises, right?... I was able to manage it by getting down closer to the floor and regulating it with fans.”(Participant C06: 60; female; housed; Non-Prescribed Substance Use: alcohol)
3.4.2. Building-Level Cooling Strategies
“Yeah, actually, I do remember; what we did was we would leave the windows open at night and shut them in the day, including the balcony door; we’d have that open at night and shut it in a day. My only concern with that was like if it was a security risk, but we just felt like the risk was outweighed by the benefit of having a cooler house.”(Participant C08: 40; male; housed; Non-Prescribed Substance Use: None)
3.4.3. Cooling Strategies Used in Alternative Living Environments
“I just tried to find a shady tree or something. I lived in the, in the parks underneath trees and stuff. So you know, I would just stay in the shade.”(Participant A02: age not specified; female; housed; Non-Prescribed Substance Use: Heroin, crytal meth, fentanyl)
“I ate cold foods. And sometimes I’d grab ice and put it on my head if I needed it. But otherwise, I just used drugs, and the heat just kind of didn’t seem as bad if I was high.”(Participant C04: 45; male; housed; Non-Prescribed Substance Use: meth)
3.5. Theme IV: Participant Perspectives and Suggestions for Future Heat Protection
4. Discussion
4.1. The Presentation and Expression of Heat Stress by People with Schizophrenia
4.2. Implications of Co-Occurring Heat Stress and Schizophrenia Symptoms
4.3. Navigating the Intersection of Substance Use, Schizophrenia and Heat Stress
4.4. Implications of Information Gaps on the Heat Event and Cooling Strategies
4.5. Addressing Discrimination and Stigma in Health Care for People with Schizophrenia and Its Implications for Heat Protection
4.6. Participant-Driven Suggestions for Future Heat Protection
- Access to Resources: Ensuring availability of light-weight summer clothing and cooling materials, such as window film, to help manage heat exposure.
- Education and Training: Providing targeted education on heat-related illnesses and effective cooling strategies and improving training for healthcare providers on recognizing and addressing heat stress in people with schizophrenia.
- Community Support: Enhancing access to green spaces, shaded areas, and community cooling centers. Establishing services for at-home check-ins during heat events can also provide crucial support.
- Inclusive Policy Development: Actively involving individuals with schizophrenia in the planning and design of heat protection programs to ensure their needs are adequately addressed and to build trust in the system.
4.7. Limitations and Future Research Directions
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Environment and Climate Change Canada Criteria for Public Weather Alerts. Available online: https://www.canada.ca/en/environment-climate-change/services/types-weather-forecasts-use/public/criteria-alerts.html (accessed on 26 July 2024).
- BC Coroners Service. Extreme Heat and Human Mortality: A Review of Heat-Related Deaths in B.C. in Summer 2021; British Columbia Coroners Service: Burnaby, BC, Canada, 2022.
- Henderson, S.B.; McLean, K.E.; Lee, M.J.; Kosatsky, T. Analysis of Community Deaths during the Catastrophic 2021 Heat Dome: Early Evidence to Inform the Public Health Response during Subsequent Events in Greater Vancouver, Canada. Environ. Epidemiol. 2022, 6, e189. [Google Scholar] [CrossRef] [PubMed]
- Lamothe, F.; Vague de Chaleur—Été 2018 à Montréal. Enquête Épidémiologique/Coordination—Véronique Duclos [...], Montréal, Direction Régionale de Santé Publique Du CIUSSS Du Centre-Sud-de-l’Île-de-Montréal, 2019, 1 Ressource En Ligne (33 Pages), Collections de BAnQ. Available online: https://banq.pretnumerique.ca/ (accessed on 1 March 2024).
- Canadian Mental Health Association. Schizophrenia. Available online: https://cmha.bc.ca/documents/schizophrenia-3/#:~:text=Schizophrenia%20affects%20about%201%25%20of,40%2C000%20people%20in%20British%20Columbia (accessed on 24 April 2024).
- Sung, T.-I.; Chen, M.-J.; Lin, C.-Y.; Lung, S.-C.; Su, H.-J. Relationship between Mean Daily Ambient Temperature Range and Hospital Admissions for Schizophrenia: Results from a National Cohort of Psychiatric Inpatients. Sci. Total Environ. 2011, 410–411, 41–46. [Google Scholar] [CrossRef]
- Christodoulou, N.; Laaidi, K.; Fifre, G.; Lejoyeux, M.; Ambar Akkaoui, M.; Geoffroy, P.A. Heatwaves and Mental Disorders: A Study on National Emergency and Weather Services Data. Eur. J. Psychiatry 2024, 38, 100249. [Google Scholar] [CrossRef]
- Crank, P.J.; Hondula, D.M.; Sailor, D.J. Mental Health and Air Temperature: Attributable Risk Analysis for Schizophrenia Hospital Admissions in Arid Urban Climates. Sci. Total Environ. 2023, 862, 160599. [Google Scholar] [CrossRef]
- Levinson, D.F. Neuroleptic-Induced Extrapyramidal Symptoms With Fever: Heterogeneity of the “Neuroleptic Malignant Syndrome”. Arch. Gen. Psychiatry 1986, 43, 839. [Google Scholar] [CrossRef]
- Heh, C. Neuroleptic-Induced Hypothermia Associated with Amelioration of Psychosis in Schizophrenia. Neuropsychopharmacology 1988, 1, 149–156. [Google Scholar] [CrossRef] [PubMed]
- Hermesh, H.; Shiloh, R.; Epstein, Y.; Manaim, H.; Weizman, A.; Munitz, H. Heat Intolerance in Patients with Chronic Schizophrenia Maintained with Antipsychotic Drugs. Am. J. Psychiatry 2000, 157, 1327–1329. [Google Scholar] [CrossRef] [PubMed]
- Cape, G.; Antebi, D.; Standen, P.; Glazebrook, C. Schizophrenia: The Views of a Sample of Psychiatrists. J. Ment. Health 1994, 3, 105–113. [Google Scholar] [CrossRef]
- Maier, U.; Aigner, J.M.; Klein, H.E. [Hypothermia caused by neuroleptics. 2 case reports and review of the literature]. Nervenarzt 1994, 65, 488–491. [Google Scholar]
- Perlstein, W.M.; Dixit, N.K.; Carter, C.S.; Noll, D.C.; Cohen, J.D. Prefrontal Cortex Dysfunction Mediates Deficits in Working Memory and Prepotent Responding in Schizophrenia. Biol. Psychiatry 2003, 53, 25–38. [Google Scholar] [CrossRef]
- Schwaninger, M.; Weisbrod, M.; Schwab, S.; Schröder, M.; Hacke, W. Hypothermia Induced by Atypical Neuroleptics. Clin. Neuropharmacol. 1998, 21, 344–346. [Google Scholar]
- Shiloh, R.; Weizman, A.; Epstein, Y.; Rosenberg, S.-L.; Valevski, A.; Dorfman-Etrog, P.; Wiezer, N.; Katz, N.; Munitz, H.; Hermesh, H. Abnormal Thermoregulation in Drug-Free Male Schizophrenia Patients. Eur. Neuropsychopharmacol. 2001, 11, 285–288. [Google Scholar] [CrossRef]
- Chong, T.W.H.; Castle, D.J. Layer upon Layer: Thermoregulation in Schizophrenia. Schizophr. Res. 2004, 69, 149–157. [Google Scholar] [CrossRef]
- Dilsaver, S.C.; Alessi, N.E. Antipsychotic Withdrawal Symptoms: Phenomenology and Pathophysiology. Acta Psychiatr. Scand. 1988, 77, 241–246. [Google Scholar] [CrossRef]
- Van Tol, Z.; Vanos, J.K.; Middel, A.; Ferguson, K.M. Concurrent Heat and Air Pollution Exposures among People Experiencing Homelessness. Environ. Health Perspect. 2024, 132, 015003. [Google Scholar] [CrossRef]
- Wright, P. The Intersection of Stigma and Inequity: The Impact of Structural Violence on People with Lived and Living Experience of Substance Use and Homelessness in the Emergency Department. Master’s Thesis, University of British Columbia, Vancouver, BC, Canada, 2020. [Google Scholar]
- Ebi, K.; Capon, A.; Berry, P.; Broderick, C.; de Dear, R.; Havenith, G.; Honda, Y.; Kovats, R.; Ma, W.; Malik, A.; et al. Hot Weather and Heat Extremes: Health Risks. Lancet 2021, 398, 698–708. [Google Scholar] [CrossRef]
- Ku, B.S.; Compton, M.T.; Walker, E.F.; Druss, B.G. Social Fragmentation and Schizophrenia: A Systematic Review. J. Clin. Psychiatry 2021, 83, 38587. [Google Scholar] [CrossRef]
- Saraceno, B.; Levav, I.; Kohn, R. The Public Mental Health Significance of Research on Socio-Economic Factors in Schizophrenia and Major Depression. World Psychiatry 2005, 4, 181–185. [Google Scholar]
- Mezzina, R.; Gopikumar, V.; Jenkins, J.; Saraceno, B.; Sashidharan, S.P. Social Vulnerability and Mental Health Inequalities in the “Syndemic”: Call for Action. Front. Psychiatry 2022, 13, 894370. [Google Scholar] [CrossRef]
- Allardyce, J.; Boydell, J. Environment and Schizophrenia: Review: The Wider Social Environment and Schizophrenia. Schizophr. Bull. 2006, 32, 592–598. [Google Scholar] [CrossRef]
- Yumagulova, L.; Okamoto, T.; Crawford, E.; Klein, K. Lived Experience of Extreme Heat in B.C.: Final Report to the Climate Action Secretariat; SHIFT, URSUS Resilient Strategies Inc.: Slocan, BC, Canada, 2022. [Google Scholar]
- Hansen, A.; Nitschke, M.; Saniotis, A.; Benson, J.; Tan, Y.; Smyth, V.; Wilson, L.; Han, G.-S.; Mwanri, L.; Bi, P. Extreme Heat and Cultural and Linguistic Minorities in Australia: Perceptions of Stakeholders. BMC Public Health 2014, 14, 550. [Google Scholar] [CrossRef]
- Sampson, N.R.; Gronlund, C.J.; Buxton, M.A.; Catalano, L.; White-Newsome, J.L.; Conlon, K.C.; O’Neill, M.S.; McCormick, S.; Parker, E.A. Staying Cool in a Changing Climate: Reaching Vulnerable Populations during Heat Events. Glob. Environ. Chang. 2013, 23, 475–484. [Google Scholar] [CrossRef]
- Abrahamson, V.; Wolf, J.; Lorenzoni, I.; Fenn, B.; Kovats, S.; Wilkinson, P.; Adger, W.N.; Raine, R. Perceptions of Heatwave Risks to Health: Interview-Based Study of Older People in London and Norwich, UK. J. Public Health 2008, 31, 119–126. [Google Scholar] [CrossRef]
- Bittner, M.-I.; Stößel, U. Perceptions of Heatwave Risks to Health: Results of an Qualitative Interview Study with Older People and Their Carers in Freiburg, Germany. Psycho-Soc. Med. 2012, 9, Doc05. [Google Scholar] [CrossRef]
- Cooper, N.; Stevenson, C.; Hale, G. Integrating Perspectives on Health; Open University Press: Buckingham, UK, 1996. [Google Scholar]
- Engel, G.L. The Need for a New Medical Model: A Challenge for Biomedicine. Psychodyn. Psychiatry 2012, 40, 377–396. [Google Scholar] [CrossRef] [PubMed]
- Germov, J.; Hornosty, J. Imagining Health Problems as Social Issues. In Second Opinion: An Introduction to Health Sociology; Oxford University Press: Don Mills, ON, Canada, 2017; pp. 2–25. [Google Scholar]
- Braun, V.; Clarke, V. Thematic Analysis: A Practical Guide; Sage: Thousand Oaks, CA, USA, 2022. [Google Scholar]
- Braun, V.; Clarke, V. Reflecting on Reflexive Thematic Analysis. Qual. Res. Sport Exerc. Health 2019, 11, 589–597. [Google Scholar] [CrossRef]
- Boyatzis, R. Transforming Qualitative Information: Thematic Analysis and Code Development; Sage: Thousand Oaks, CA, USA, 1998. [Google Scholar]
- Guba, E.; Lincoln, Y. Competing Paradigms in Qualitative Research. In Handbook of Qualitative Research; Sage Publications: Thousand Oaks, CA, USA, 1993; p. 224. [Google Scholar]
- Morse, J.M. Critical Analysis of Strategies for Determining Rigor in Qualitative Inquiry. Qual. Health Res. 2015, 25, 1212–1222. [Google Scholar] [CrossRef] [PubMed]
- Nowell, L.S.; Norris, J.M.; White, D.E.; Moules, N.J. Thematic Analysis: Striving to Meet the Trustworthiness Criteria. Int. J. Qual. Methods 2017, 16, 160940691773384. [Google Scholar] [CrossRef]
- Chou, F.H.-C.; Tsai, K.-Y.; Su, C.-Y.; Lee, C.-C. The Incidence and Relative Risk Factors for Developing Cancer among Patients with Schizophrenia: A Nine-Year Follow-up Study. Schizophr. Res. 2011, 129, 97–103. [Google Scholar] [CrossRef]
- Brown, S.; Inskip, H.; Barraclough, B. Causes of the Excess Mortality of Schizophrenia. Br. J. Psychiatry 2000, 177, 212–217. [Google Scholar] [CrossRef] [PubMed]
- Wible, C.G. Schizophrenia as a Disorder of Social Communication. Schizophr. Res. Treat. 2012, 2012, 920485. [Google Scholar] [CrossRef]
- Brüne, M.; Abdel-Hamid, M.; Sonntag, C.; Lehmkämper, C.; Langdon, R. Linking Social Cognition with Social Interaction: Non-Verbal Expressivity, Social Competence and “Mentalising” in Patients with Schizophrenia Spectrum Disorders. Behav. Brain Funct. 2009, 5, 6. [Google Scholar] [CrossRef]
- Andreasen, N.C.; Calarge, C.A.; O’Leary, D.S. Theory of Mind and Schizophrenia: A Positron Emission Tomography Study of Medication-Free Patients. Schizophr. Bull. 2008, 34, 708–719. [Google Scholar] [CrossRef] [PubMed]
- Javitt, D.C. When Doors of Perception Close: Bottom-up Models of Disrupted Cognition in Schizophrenia. Annu. Rev. Clin. Psychol. 2009, 5, 249–275. [Google Scholar] [CrossRef]
- Pelley, L. How Extreme Heat Impacts the Human Body—And Why It Eventually Kills You. CBC News, 27 July 2023. [Google Scholar]
- Wehring, H.J.; Carpenter, W.T. Violence and Schizophrenia. Schizophr. Bull. 2011, 37, 877–878. [Google Scholar] [CrossRef] [PubMed]
- Kenny, G.; Wilson, T.; Flouris, A.; Fujii, N. Heat Exhaustion. In Handbook of Clinical Neurology; Elsevier: Amsterdam, The Netherlands, 2018; Volume 157, pp. 505–529. ISBN 978-0-444-64074-1. [Google Scholar]
- Polgar, S.; McGartland, M.; Hales, T. Cigarette Smoking and Schizophrenia: A Public Health Issue. Aust. J. Prim. Health 1996, 2, 21. [Google Scholar] [CrossRef]
- Health Canada. Heat Alert and Response Systems to Protect Health: Best Practices Guidebook; Health Canada: Ottawa, ON, Canada, 2012.
- Gray, R.; Brewin, E.; Noak, J.; Wyke-Joseph, J.; Sonik, B. A Review of the Literature on HIV Infection and Schizophrenia: Implications for Research, Policy and Clinical Practice. J. Psychiatr. Ment. Health Nurs. 2002, 9, 405–409. [Google Scholar] [CrossRef]
- Wey, M.C.; Loh, S.; Doss, J.G.; Abu Bakar, A.K.; Kisely, S. The Oral Health of People with Chronic Schizophrenia: A Neglected Public Health Burden. Aust. N. Z. J. Psychiatry 2016, 50, 685–694. [Google Scholar] [CrossRef]
- Burchell, A.; Fernbacher, S.; Lewis, R.; Neil, A. “Dental as Anything” Inner South Community Health Service Dental Outreach to People with a Mental Illness. Aust. J. Prim. Health 2006, 12, 75. [Google Scholar] [CrossRef]
- Chou, F.H.; Tsai, K.; Wu, H.; Shen, S. Cancer in Patients with Schizophrenia: W Hat Is the next Step? Psychiatry Clin. Neurosci. 2016, 70, 473–488. [Google Scholar] [CrossRef] [PubMed]
- Hinshaw, S.P.; Stier, A. Stigma as Related to Mental Disorders. Annu. Rev. Clin. Psychol. 2008, 4, 367–393. [Google Scholar] [CrossRef] [PubMed]
- Irwin, K.E.; Henderson, D.C.; Knight, H.P.; Pirl, W.F. Cancer Care for Individuals with Schizophrenia. Cancer 2014, 120, 323–334. [Google Scholar] [CrossRef] [PubMed]
- Hanzawa, S.; Nosaki, A.; Yatabe, K.; Nagai, Y.; Tanaka, G.; Nakane, H.; Nakane, Y. Study of Understanding the Internalized Stigma of Schizophrenia in Psychiatric Nurses in Japan. Psychiatry Clin. Neurosci. 2012, 66, 113–120. [Google Scholar] [CrossRef]
- Aggleton, P. Behavior Change Communication Strategies. AIDS Educ. Prev. Off. Publ. Int. Soc. AIDS Educ. 1997, 9, 111–123. [Google Scholar]
- Stoller, E.J.; Rutherford, G.W. Evaluation of AIDS Prevention and Control Programs. Aids 1989, 3, S289–S296. [Google Scholar] [CrossRef]
Themes | Personal Reflections on the Impact of Extreme Heat | Lack of Information | Cooling Strategies | Proposed Strategies for the Future | |||||||
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Concepts | Physical Impacts of Heat | Impacts on Cognition and Mental Stability | Worsening of Schizophrenia Symptoms | Impacts on Everyday Life | Lack of Information and Awareness | Individual-Level Cooling Strategies | Building-Level Cooling Strategies | Cooling Strategies Used in Alternative Living Environments | Individual Behaviour Oriented Mitigations and Adaptations | Structural and Societal Mitigations and Adaptations | Built Environment Oriented Mitigations and Adaptations |
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Yoon, L.; Tetzlaff, E.J.; Wong, C.; Chiu, T.; Hiscox, L.; Mew, S.; Choquette, D.; Kenny, G.P.; Schütz, C.G. Responding to the Heat and Planning for the Future: An Interview-Based Inquiry of People with Schizophrenia Who Experienced the 2021 Heat Dome in Canada. Int. J. Environ. Res. Public Health 2024, 21, 1108. https://doi.org/10.3390/ijerph21081108
Yoon L, Tetzlaff EJ, Wong C, Chiu T, Hiscox L, Mew S, Choquette D, Kenny GP, Schütz CG. Responding to the Heat and Planning for the Future: An Interview-Based Inquiry of People with Schizophrenia Who Experienced the 2021 Heat Dome in Canada. International Journal of Environmental Research and Public Health. 2024; 21(8):1108. https://doi.org/10.3390/ijerph21081108
Chicago/Turabian StyleYoon, Liv, Emily J. Tetzlaff, Carson Wong, Tiffany Chiu, Lucy Hiscox, Samantha Mew, Dominique Choquette, Glen P. Kenny, and Christian G. Schütz. 2024. "Responding to the Heat and Planning for the Future: An Interview-Based Inquiry of People with Schizophrenia Who Experienced the 2021 Heat Dome in Canada" International Journal of Environmental Research and Public Health 21, no. 8: 1108. https://doi.org/10.3390/ijerph21081108