177 COVID-19 and social relationships 6 (F(1,15) = 5.984, p = 0.027). Social support, age, gender, and daytime activities did not significantly contribute to the models. Besides, none of the variables significantly predicted change in family relationships and contact frequency. Our results indicate that higher levels of emotional loneliness predicted more negative changes in general social relationships and romantic relationships. DISCUSSION Worldwide the COVID-19 restrictions have impacted social relationships and increased feelings of loneliness and disconnectedness (Hoffart et al., 2020; Kraaij-Dirkzwager et al., 2021; Ponnet et al., 2020; Vindegaard & Benros, 2020), yet no knowledge regarding the experience of forensic psychiatric outpatients with pre-existing social network-related problems was available. Therefore, this mixed methods prospective cohort study explored the impact of the COVID-19 restrictions on the quality of social relationships of a forensic psychiatric population. First, quantitative data revealed that feelings of dissatisfaction with the quality of social relationships, loneliness and negative social support were evident in forensic outpatients before onset of the COVID-19 restrictions. These findings are in line with our expectations and previous research on social networks in forensic psychiatric populations (Estroff et al., 1994; Murphy, 2000; ter Haar-Pomp et al., 2015). Second, contrary to our expectations, quantitative data revealed that the vast majority of forensic outpatients perceived no changes in social relationships throughout the period of the COVID-19 restrictions. A smaller group experienced negative changes on social relationships. This could be explained by the fact that a substantial part of our sample was socially isolated before COVID-19, which minimized the deterioration in quality of social relationships after the introduction of the restrictions in March 2020. Third, we found that only family relationships slightly deteriorated throughout the COVID-19 period. These findings partially met our expectations, and may suggest that family relationships are more at risk over time during the COVID-19 restrictions. However, whether these deteriorated family relationships lead to interpersonal problems of forensic outpatients, such as elevated aggression between family members or psychological distress of patients and family members, remains unknown.
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