Surviving the 2021 heat dome with schizophrenia: A qualitative, interview-based unpacking of risks and vulnerabilities

Abstract

This study explores the multifaceted challenges experienced by individuals with schizophrenia during extreme heat, highlighting the interplay between individual factors, social dynamics, and environmental influences. Despite making up only 1% of the Canadian population, individuals diagnosed with schizophrenia comprised 16% (n = 97) of the deaths during the 2021 heat dome in Western Canada. However, to date, there exists scant qualitative research that explore the direct experiences and the intricacies of intersecting factors faced by individuals with schizophrenia during extreme heat events. This study aims to explore experiences of heat by those living with schizophrenia, including social, behavioural and physiological vulnerability factors that may exacerbate heat-related risks. Between October 2023 and February 2024, semi-structured interviews were conducted with 35 people with a clinical diagnosis of schizophrenia from in-patient and community settings. Participants had experienced the 2021 Heat Dome, or other extreme heat events, in a community setting within British Columbia, Canada. A descriptive form of thematic analysis that prioritizes participants' experiences was used to identify and explore patterns in the interview transcripts. Participants' narratives underscore how some symptoms of schizophrenia - such as paranoia and delusional thinking - may hinder participants' ability to seek relief from the heat and interpret bodily sensations accurately. Social isolation, compounded by societal stigma, acts as a significant barrier to accessing support networks and public resources for coping with extreme temperatures. Additionally, participants described feeling deterred from seeking medical care or public resources due to past negative experiences and social stigma. Findings illustrate various factors that contribute to the disproportionate impact of extreme heat on individuals diagnosed with schizophrenia, encapsulating both schizophrenia-specific biomedical factors as well as social vulnerability associated with their diagnosis. These findings can inform the development of a multidimensional approach that transcends individual responsibility and addresses the systemic and structural determinants of health.

Keywords: Climate change; Extreme heat; Health inequities; Ill-housed persons; Mental disorders; Social determinants of health; Social isolation; Substance use.