Psychiatric disorders, and especially severe mental illness, are associated with an increased risk of severe acute respiratory syndrome coronavirus 2 infection and COVID-19-related morbidity and mortality. People with severe mental illness should therefore be prioritised in vaccine allocation strategies. Here, we discuss the risk for worse COVID-19 outcomes in this vulnerable group, the effect of severe mental illness and psychotropic medications on vaccination response, the attitudes of people with severe mental illness towards vaccination, and, the potential barriers to, and possible solutions for, an efficient vaccination programme in this population.

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In: Transplantation (in press, to be published 2011)To refer to or to cite this work, please use the citation to the published version: Dor, F.; Massey, E.; Frunza, M.; Johnson, R.; Lennerling, A.; Lovén, C.; Mamode, N.; Pascalev, A.; Sterckx, S.; Van

This article synthesizes and compares environmental governance theories. For each theory we outline its main tenets, claims, origin, and supporting literature. We then group the theories into focused versus combinatory frameworks for comparison. The analysis resonates with many types of ecosystems; however, to make it more tangible, we focus on coastal systems. First, we characterize coastal governance challenges and then later link salient research questions arising from these challenges to the theories that may be useful in answering them. Our discussion emphasizes the usefulness of having a diverse theoretical toolbox, and we argue that if governance analysts are more broadly informed about the theories available, they may more easily engage in open-minded interdisciplinary collaboration. The eight theories examined are the following: polycentricity, network governance, multilevel governance, collective action, governmentality (power / knowledge), adaptive governance, interactive governance theory (IGT), and evolutionary governance theory (EGT). Polycentricity and network governance both help examine the links or connections in governance processes. Polycentricity emphasizes structural configurations at a broader level, and network governance highlights agency and information flow within and between individuals or organizations. Collective action theory is helpful for examining community level governance, and helps analyze variables hindering or enabling self-organization and shared resource outcomes. In contrast, multilevel governance helps understand governance integration processes between localities, regions, and states across administrative, policy, or legal dimensions. Governmentality is helpful for understanding the role of discourse, power, knowledge, and narratives in governance, such as who creates them and who becomes governed by them with what effect. Adaptive governance helps analyze the links between context, change, and resilience. IGT helps examine the interdependencies between the systems being governed and the governing systems. EGT is helpful for unpacking how coevolutionary processes shape governance and the options for change.

Background: Increasing clinical evidence suggests that people with severe mental illness (SMI), including schizophrenia spectrum disorders, bipolar disorder (BD), and major depressive disorder (MDD), are at higher risk of dying from COVID-19. Several systematic reviews examining the association between psychiatric disorders and COVID-19-related mortality have recently been published. Although these reviews have been conducted thoroughly, certain methodological limitations may hinder the accuracy of their research findings.Methods: A systematic literature search, using the PubMed, Embase, Web of Science, and Scopus databases (from inception to July 23, 2021), was conducted for observational studies assessing the risk of death associated with COVID-19 infection in adult patients with pre-existing schizophrenia spectrum disorders, BD, or MDD. Methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS).Results: Of 1,446 records screened, 13 articles investigating the rates of death in patients with pre-existing SMI were included in this systematic review. Quality assessment scores of the included studies ranged from moderate to high. Most results seem to indicate that patients with SMI, particularly patients with schizophrenia spectrum disorders, are at significantly higher risk of COVID-19-related mortality, as compared to patients without SMI. However, the extent of the variation in COVID-19-related mortality rates between studies including people with schizophrenia spectrum disorders was large because of a low level of precision of the estimated mortality outcome(s) in certain studies. Most studies on MDD and BD did not include specific information on the mood state or disease severity of patients. Due to a lack of data, it remains unknown to what extent patients with BD are at increased risk of COVID-19-related mortality. A variety of factors are likely to contribute to the increased mortality risk of COVID-19 in these patients. These include male sex, older age, somatic comorbidities (particularly cardiovascular diseases), as well as disease-specific characteristics.Conclusion: Methodological limitations hamper the accuracy of COVID-19-related mortality estimates for the main categories of SMIs. Nevertheless, evidence suggests that SMI is associated with excess COVID-19 mortality. Policy makers therefore must consider these vulnerable individuals as a high-risk group that should be given particular attention. This means that targeted interventions to maximize vaccination uptake among these patients are required to address the higher burden of COVID-19 infection in this already disadvantaged group.