COVID-19 Health Crisis Experiences Interview Guide

1. Abstract

The COVID-19 Health Crisis Experiences Interview Guide is a qualitative psychometric and clinical research instrument developed by French psychiatric researchers Hammadi Ben Rejeb, Clémence Isaac, and Dominique Januel (2023) at the Établissement Public de Santé Ville-Évrard. Formulated during the unprecedented onset of the global pandemic between March and June 2020, this semi-structured assessment tool was specifically designed to capture the subjective lived experiences, psychological distress, coping mechanisms, and institutional perceptions of hospitalized psychiatric inpatients confronting the double burden of severe mental illness and pandemic-related disruptions. Comprising eight open-ended, thematic prompt items, the interview protocol systematically queries critical domains such as acute reactions to viral diagnosis, familial transmission dynamics, inpatient and residential quarantine protocols, disruptions to daily routines, protective health behaviors, institutional psychiatric care quality, contamination phobia, and perceptions surrounding gradual lockdown lifting.

Methodologically grounded in phenomenological and clinical psychology frameworks, the instrument was evaluated among hospitalized psychiatric inpatients stratified into confirmed positive cases (COVID-19+) and non-infected controls (COVID-19−) housed in designated psychiatric isolation wards. Administration of the protocol typically requires approximately 30 minutes, producing rich narrative data amenable to inductive thematic analysis, descriptive psychopathology mapping, and consensual qualitative research paradigms. While traditional quantitative psychometric metrics—such as Cronbach’s alpha, exploratory factor analysis, or structural equation modeling—are methodologically non-applicable due to its open-ended qualitative design, the guide demonstrates robust content and ecological validity. It provides exceptional clinical utility for mental health practitioners, health psychologists, and psychiatric hospital administrators seeking to comprehend the nuanced vulnerabilities and adaptive capacities of institutionalized populations during public health emergencies.

2. Keywords

COVID-19, Health Crisis Experiences, Hospitalized Patients, Mental Disorders, Psychiatric Inpatients, Semi-Structured Interview, Qualitative Psychometrics, Infection Control in Psychiatry, Psychological Adaptation, Confinement Impact

3. Authors

The COVID-19 Health Crisis Experiences Interview Guide was conceived, designed, and clinically deployed by a dedicated team of clinical researchers affiliated with public mental health institutions and academic universities in France:

• Hammadi Ben Rejeb, MD: Psychiatrist and Clinical Practitioner, Pôle 93G03, Unité d’Hospitalisation Temps Plein (Full-Time Inpatient Unit), Établissement Public de Santé (EPS) Ville-Évrard, Neuilly-sur-Marne, France.
• Clémence Isaac, PhD: Clinical Research Coordinator and Methodologist, Unité de Recherche Clinique (Clinical Research Unit), EPS Ville-Évrard, Neuilly-sur-Marne, France. ORCID: 0000-0002-9229-0249.
• Dominique Januel, MD, PhD: Professor of Psychiatry and Head of Department, Université Sorbonne Paris Nord; Chief of Service, Pôle 93G03, Unité de Recherche Clinique, EPS Ville-Évrard, 202 avenue Jean-Jaurès, 93330 Neuilly-sur-Marne, France. Primary Corresponding Author: [email protected].

4. Purpose

The primary purpose of the COVID-19 Health Crisis Experiences Interview Guide is to provide a standardized, clinically sensitive qualitative measurement framework to systematically investigate how institutionalized individuals with severe mental illness (mental disorders, including schizophrenia, bipolar disorder, and major depressive disorder) experienced the onset of the SARS-CoV-2 pandemic. During early 2020, public health containment measures enforced unprecedented social restrictions worldwide. In psychiatric inpatient settings, these measures translated into strict ward lockdowns, prohibition of family visitations, suspension of therapeutic group activities, confinement to individual bedrooms, and the rapid reconfiguration of units into specialized COVID-19 treatment wards.

Historically, individuals diagnosed with psychiatric disorders experience elevated rates of somatic comorbidities, reduced health literacy, socioeconomic marginalization, and systemic institutional vulnerability. The emergence of COVID-19 substantially heightened these vulnerabilities, introducing acute physiological threats alongside severe cognitive and emotional stressors. Traditional self-report quantitative scales frequently fail to capture the nuanced subjective realities of this population, particularly when cognitive deficits, delusional ideation, or severe affective flattening preclude the meaningful interpretation of Likert-type scales. Consequently, Ben Rejeb and colleagues engineered this semi-structured guide to afford patients an expressive, flexible, yet standardized communicative space to articulate their subjective experiences.

In clinical practice, the tool serves as a diagnostic adjunct and psychotherapeutic entry point. It assists clinicians in discerning whether emerging psychiatric exacerbations—such as acute paranoia, treatment non-adherence, or depressive withdrawal—stem from baseline psychopathology or constitute reactive responses to institutional pandemic protocols. In academic research, the instrument addresses a pronounced void in the global health crisis literature by providing empirical phenomenological data from a historically underrepresented and silenced demographic. By contrasting the lived experiences of virally infected patients with those of uninfected psychiatric controls, the guide clarifies the direct psychosomatic repercussions of contracting a novel, life-threatening viral pathogen versus the secondary psychological toll exerted by prolonged confinement, social isolation, and institutional reorganization.

5. Psychological Construct

The central psychological construct operationalized by the interview guide is the multidimensional subjective lived experience of a public health catastrophe within a closed institutional setting. Rather than treating pandemic stress as a monolithic affective state, the instrument delineates this overarching construct into several distinct clinical dimensions:

Acute Viral Diagnostic Shock and Somatopsychic Integration

This dimension evaluates the cognitive appraisal and emotional reaction triggered by confirmation of a life-threatening viral infection. In patients with preexisting mental health conditions, receiving a COVID-19 diagnosis often induced catastrophic existential anxiety, fears of death, somatic hypervigilance, or intense hypochondriacal delusions. The guide assesses the degree to which an individual successfully integrated the physical realities of viral infection into their psychic awareness without precipitating severe decompensation or dissociative reactions.

Familial Relational Dynamics and Vicarious Pandemic Anxiety

Investigating the intersection of social connection and acute health threats, this dimension probes whether the patient had close relatives who contracted SARS-CoV-2 and evaluates the resulting relational stress. Hospitalized inpatients were physically severed from their family units due to infection prevention protocols. Learning of a relative’s infection while locked within an inpatient facility fostered intense feelings of guilt, vicarious helplessness, and severe attachment distress.

Confinement Adaptation and Spatial Restriction

This component captures the psychological burden of spatial confinement across three micro-environments: the psychiatric ward bedroom, the familial residence prior to admission, or the professional workplace. It examines subjective feelings of imprisonment, claustrophobic distress, sensory deprivation, and the erosion of therapeutic milieu dynamics resulting from quarantine protocols.

Disruption of Functional Routines and Temporal Structuring

Severe mental illnesses frequently necessitate rigid behavioral routines, occupational therapy, and structured daily rhythms for symptom stabilization. This dimension explores how the cancellation of hospital programming, alterations in dining arrangements, and structural disruptions in daily life compromised the patient’s capacity for personal organization, behavioral self-regulation, and vocational functioning.

Salutogenic Coping and Positive Resilience Factors

Grounded in positive psychology and salutogenesis, this dimension identifies the internal coping mechanisms, interpersonal interactions, or environmental resources that actively fostered psychological well-being. It investigates spontaneous coping strategies, ranging from reading, artistic expression, and telecommunication with relatives, to supportive therapeutic interactions with nursing personnel.

Institutional Trust and Perception of Inpatient Healthcare Quality

This domain examines the patient’s appraisal of systemic psychiatric care, safety protocols, and therapeutic rapport under extreme crisis conditions. It assesses whether patients felt medically safeguarded or administratively abandoned, measuring institutional alliance and perceived clinical empathy amidst mask-wearing and protective physical barriers.

Contamination Phobia and Perceived Viral Vulnerability

Focusing on fear conditioning and anxiety symptomatology, this dimension probes the patient’s subjective dread of viral transmission both within the hospital environment and in the external community. It helps clinicians differentiate rational health caution from obsessive-compulsive cleaning rituals, agoraphobic avoidance, or persecutory beliefs regarding biological contamination.

Post-Confinement Anxiety and De-escalation Adaptation

The final dimension evaluates the prospective psychological adaptation required when transitioning from strict quarantine to partial reopening. It captures the paradox of confinement—wherein the locked ward served simultaneously as a restrictive prison and a safe sanctuary—and assesses the emergence of the “cave syndrome” (anxiety regarding the resumption of social and physical contact outside protected institutional spaces).

6. Theoretical Framework

The COVID-19 Health Crisis Experiences Interview Guide is anchored in three convergent psychological and psychiatric paradigms: Richard Lazarus and Susan Folkman’s Transactional Model of Stress and Coping, Aaron Antonovsky’s Salutogenic Theory, and Karl Jaspers’ phenomenological psychopathology.

The Transactional Model of Stress and Coping

Lazarus and Folkman (1984) conceptualized stress not as an objective external event, but as a dynamic transaction between an individual and their environment, mediated by cognitive appraisal processes. In primary appraisal, an individual evaluates an environmental event as irrelevant, benign-positive, or stressful (involving harm/loss, threat, or challenge). In secondary appraisal, the individual evaluates their available coping resources to mitigate that threat.

In the context of the interview guide, the emergence of SARS-CoV-2 and mandatory hospital confinement represents an acute environmental stressor of catastrophic magnitude. Psychiatric patients, whose cognitive appraisal mechanisms may be altered by mood disorders or psychotic illness, process the primary threat of viral infection through unique cognitive filters. The interview items prompt respondents to articulate their cognitive evaluations (e.g., assessing personal contamination risk) and their available behavioral and cognitive coping strategies (problem-focused versus emotion-focused coping), elucidating how cognitive appraisal governs affective stability during severe crises.

Salutogenesis and the Sense of Coherence

Rather than exclusively focusing on pathogenic deterioration, the theoretical architecture of the guide integrates Antonovsky’s (1979) salutogenic model, which examines the origins of psychological and physiological health. A central tenet of this framework is the Sense of Coherence (SOC), comprising comprehensibility (the belief that internal and external environments are structured and predictable), manageability (the perception that resources are available to meet environmental demands), and meaningfulness (the belief that demands are worthy of investment and engagement).

Item 5 explicitly queries positive influences on well-being and health during confinement. This orientation enables researchers to determine whether institutionalized patients maintained a viable sense of coherence despite disorienting environmental changes. It reframes psychiatric patients from passive, vulnerable victims into active human agents capable of mobilizing internal resistance resources and finding adaptive meaning within confined settings.

Phenomenological Psychopathology

Originating from the works of Karl Jaspers and Ludwig Binswanger, phenomenological psychopathology emphasizes the rigorous descriptive study of subjective conscious experiences, suspending preconceived diagnostic categories to understand how a patient experiences time, space, the body, and interpersonal relations (intersubjectivity). The interview guide directly operationalizes this philosophical framework. By avoiding restrictive closed-ended survey structures, it permits hospitalized psychiatric inpatients to articulate their altered perceptions of somatic vulnerability (the physical body as a potential host for viral illness), institutional space (the transformation of therapeutic spaces into containment zones), and social reality.

7. Validity

Because the COVID-19 Health Crisis Experiences Interview Guide was conceived and executed as an open-ended qualitative assessment instrument, its measurement properties are evaluated using established qualitative validation criteria—namely credibility, transferability, dependability, and confirmability (Lincoln & Guba, 1985)—alongside traditional psychometric concepts of content and ecological validity.

Content Validity

The content validity of the interview protocol was established through rigorous clinical consensus among senior psychiatrists, clinical psychologists, and psychiatric nurse researchers at EPS Ville-Évrard. The primary developers drew upon direct frontline psychiatric observations during the rapid escalation of the first pandemic wave in March 2020. Items were iteratively constructed to ensure comprehensive coverage of the physical, psychological, social, and systemic dimensions of inpatient pandemic life. By addressing both the direct somatic reality of infection (Item 1) and broader psychosocial repercussions (Items 3, 4, 7, and 8), the guide exhibits exceptional content coverage without redundant semantic overlap.

Ecological and Face Validity

The instrument possesses exemplary ecological validity, as it was administered in real-time within the actual crisis environment under investigation. Conducted within a specialized COVID-19 psychiatric inpatient unit during the acute phase of national lockdown, the guide captured real-time cognitive and affective reactions rather than retrospective reconstructions prone to recall decay. Patients readily accepted the face validity of the questions, recognizing them as authentic inquiries into their ongoing struggles and treatment realities.

Empirical Insights from Comparative Subgroups

The initial validation study by Ben Rejeb, Isaac, and Januel (2023) investigated twelve hospitalized psychiatric inpatients, divided into two distinct cohorts: six patients who tested positive for SARS-CoV-2 (COVID-19+) and six non-infected psychiatric controls (COVID-19−). Qualitative comparative analysis revealed nuanced convergent and divergent themes:

• Diagnostic Shock and Resignation: COVID-19+ patients frequently expressed an initial phase of acute shock followed by fatalistic resignation or stoic acceptance, whereas COVID-19− patients expressed persistent, anticipatory contamination anxiety.
• Institutional Reassurance vs. Alienation: Both cohorts uniformly validated the critical role of nursing staff in alleviating isolation, yet COVID-19+ patients reported deeper appreciation for somatic medical monitoring within the psychiatric setting.
• Confinement Paradox: While confinement exacerbated feelings of boredom and lethargy, it simultaneously provided a psychological refuge against external contamination anxiety.

Quantitative predictive, convergent, and discriminant validity coefficients (e.g., Pearson correlations against standard depression or generalized anxiety inventories) have not been established, representing an area for future mixed-methods validation studies.

8. Reliability

In qualitative psychometrics and semi-structured clinical interviewing, reliability is understood through procedural consistency, administration fidelity, and inter-rater interpretive dependability, rather than mathematical internal consistency metrics such as Cronbach’s alpha or McDonald’s omega.

Administration Fidelity and Standardization

The reliability of the interview guide is reinforced through its standardized administration protocol. Each interview was conducted by trained clinical researchers adhering strictly to the eight-item sequence, with uniform probing techniques to clarify ambiguous participant responses. The average completion time was consistently maintained at approximately 30 minutes (ranging between 20 and 45 minutes depending on patient cognitive processing speed and clinical verbosity), demonstrating stable temporal pacing across varying diagnostic profiles.

Interpretive Dependability and Consensual Coding

To establish interpretive reliability during data analysis, Ben Rejeb, Isaac, and Januel utilized consensual qualitative analysis strategies. Audio-recorded interviews were transcribed verbatim and subjected to dual independent coding. Emergent themes, subthemes, and conceptual categories were reviewed collectively by the investigative team until complete coding consensus was achieved, thereby minimizing single-researcher subjective bias. While traditional test-retest reliability was neither feasible nor methodologically appropriate—given that pandemic conditions and psychological adaptation fluctuated dynamically day by day—the structural stability of the narrative responses across both infected and non-infected subgroups confirms the robust dependability of the instrument’s thematic elicitation.

9. Factor Analysis

Traditional Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) require large sample sizes (typically N > 200) and continuous or ordinal rating data. Because the COVID-19 Health Crisis Experiences Interview Guide comprises eight open-ended qualitative prompts administered to clinical inpatient samples (N = 12 in the initial validation cohort), quantitative factor analysis was neither performed nor conceptually indicated.

Qualitative Thematic Structure

In lieu of statistical latent factor models, thematic analysis revealed an underlying conceptual architecture comprising three broad qualitative domains:

• Factor/Domain I: Somatic and Existential Threat Appraisal (Items 1, 2, and 7)
  Encompasses the cognitive and emotional processing of direct viral threats, including personal infection confirmation, familial contamination anxiety, and general fear of contagion within and outside the hospital.
• Factor/Domain II: Spatial and Structural Confinement Repercussions (Items 3, 4, and 8)
  Encompasses the operational and psychological consequences of spatial restriction, routine disruption, loss of autonomy, and prospective apprehension regarding quarantine de-escalation.
• Factor/Domain III: Systemic and Internal Resilience Mechanisms (Items 5 and 6)
  Encompasses positive psychological resources, internal coping strategies, and the subjective evaluation of institutional healthcare support.

Future quantitative adaptations of this instrument could convert these eight thematic prompts into Likert-scale indicators to empirically test this hypothesized three-factor measurement model via CFA.

10. Instrument / Measurement Tool

Below is the structured technical specification of the COVID-19 Health Crisis Experiences Interview Guide:

• Test Type: Semi-Structured Clinical Interview Guide / Qualitative Psychometric Protocol
• Format: Open-ended qualitative prompt questions administered verbally in an individual face-to-face clinical setting
• Item Count: 8 core thematic items (with conditional branching for viral status)
• Administration Modality: Clinician-administered; individual interview; audio-recorded and transcribed verbatim
• Estimated Completion Time: Approximately 30 minutes (range: 20–45 minutes)
• Language Available: Original version in French; translational adaptations into English for research dissemination
• Target Population: Adult psychiatric inpatients (aged 18 years and older) across diagnostic categories, including SARS-CoV-2 positive and negative individuals
• Scoring Rules: Non-numerical scoring; evaluation relies on qualitative thematic analysis, content analysis, or framework analysis using consensual coding paradigms to identify dominant psychological themes

11. Permissions & Fee and Test Year

• Test Year: Developed in 2020 during the initial COVID-19 pandemic wave; officially published in peer-reviewed literature in 2023.
• Copyright & Permissions: The interview guide is copyrighted by the authors (Ben Rejeb, Isaac, & Januel) and the publishing journal (Elsevier / Annales Médico-Psychologiques).
• Permissible Use: The instrument may be utilized free of charge for non-commercial academic research, institutional teaching, and clinical evaluation, provided appropriate formal citation is accorded to the original authors.
• Commercial Exploitation: Commercial deployment, inclusion in proprietary digital health software, or unauthorized distribution for profit is prohibited without explicit prior written authorization from the authors and publisher.
• Contact for Permissions: Requests regarding broader institutional adaptation or clinical translation should be addressed to Prof. Dominique Januel, Unité de Recherche Clinique, EPS Ville-Évrard, via email at [email protected].

12. References

• Antonovsky, A. (1979). Health, stress, and coping. Jossey-Bass.
• Ben Rejeb, H., Isaac, C., & Januel, D. (2023). Regards croisés de patients psychiatriques COVID positifs ou négatifs sur leur vécu de la crise sanitaire au sein d’une unité COVID lors de la première vague [Cross-views of positive or negative COVID psychiatric patients on their experience of the health crisis in a COVID unit during the first wave]. Annales Médico-Psychologiques, revue psychiatrique, 181(7), 635–640. https://doi.org/10.1016/j.amp.2022.01.005
• Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer Publishing Company.
• Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. SAGE Publications.

13. Items of the Scale