1 Department of Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
2 Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
3 Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
The current COVID-19 pandemic is likely to affect the physical and mental health and the well-being of people globally. The physicians and nurses on the frontline of patients care will be among the most affected in their psychosocial well-being, being exposed to trauma consequences and burnout syndrome. It is still unknown whether the COVID-19 infection will have direct neuropsychiatric consequences. The impact of the quarantine lockdown on mental health, too, has to be taken into account. The inclusion of mental health as part of national public health response to the COVID-19 pandemic is mandatory in assisting all those in need.
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Mental Health and the COVID-19 Pandemic: A Call for Action
It is well known that COVID-19 affects not only physical health but also mental health and well-being of people globally [1Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020; 395(10227): 912-20. [http://dx.doi.org/10.1016/S0140-6736(20)30460-8] [PMID: 32112714] ]. For its impact on health and well-being and its social and economic consequences, this pandemic can be compared with natural disasters, such as earthquakes or tsunami [2Morganstein JC, Ursano RJ. Ecological disasters and mental health: causes, consequences, and interventions. Front Psychiatry 2020; 11: 1. [http://dx.doi.org/10.3389/fpsyt.2020.00001] [PMID: 32116830] ], or with international massive armed conflicts. Slowly but surely, COVID-19 will become the biggest mental health problem on the international level, and the consequences on the mental health will be enormous.
The authors consider that people with existing mental health problems are among the most vulnerable category, together with the infected and ill patients, their families, and health staff involved in the treatment. In this regard, social media with the sensational headlines and rumors, despite the lack of sources for real information do significantly cause additional harm by creating a sense of threat, discomfort, panic, etc. which increases the risks of occurrence and resurfacing of the mental health disorders [3Shimizu K. 2019-nCoV, fake news, and racism. Lancet 2020; 395(10225): 685-6. [http://dx.doi.org/10.1016/S0140-6736(20)30357-3] [PMID: 32059801] ].
Concurrently, the health workers, who are currently carrying the biggest burden of today, are at the greatest risk of burnout syndrome being exposed. Indeed, they are exposed to high levels of stress due to a large number of working hours without sufficient rest, as well as the lack of adequate personal protective equipment in most of the countries severely affected by COVID-19. Furthermore, doctors and nurses that are on the frontline of coronavirus patients care will likely be among the most affected in their mental health and psychosocial well-being [4Maunder RG, Lancee WJ, Balderson KE, et al. Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak. Emerg Infect Dis 2006; 12(12): 1924-32. [http://dx.doi.org/10.3201/eid1212.060584] [PMID: 17326946] ].
Aside from this, the loss of smell, along with the loss of taste, anosmia and dysgeusia, manifests itself in the early stages of the coronavirus-induced disease or occurs in patients with mild or no symptoms [5Giacomelli A, Pezzati L, Conti F, et al. Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study. Clin Infect Dis 2020. published online March 26.]. This suggests the possible relationship and direct neuropsychiatric consequences of the infection.
There should also be considered the impact of the quarantine lockdown, which was resorted to by many governments as the most effective measure to prevent the spread of the infection in the population. In general, social isolation, loneliness, and social distancing have major effects on people's mental health, resulting in increased stress, anxiety, depression, self-harm, and suicide attempts [6Elovainio M, Hakulinen C, Pulkki-Råback L, et al. Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study. Lancet Public Health 2017; 2(6): e260-6. [http://dx.doi.org/10.1016/S2468-2667(17)30075-0] [PMID: 28626828] ].
The foreseen economic consequences of the quarantine lockdown will also have a likely impact on the mental health and well-being of the population. Financial problems and unemployment will be the main factors in the worsening of the population’s mental health where quarantine directly or indirectly has a foreseeable impact on physical health and well-being. Reduced exposure to the sun and vitamin D, reduced activity and increased sedentary, poor nutrition, less social relationships and longer duration of the quarantine was associated in past studies with poorer mental health, symptoms of the post-traumatic stress, anger and atypical behaviors [7Soames Job RF. Effective and ineffective use of fear in health promotion campaigns. Am J Public Health 1988; 78(2): 163-7. [http://dx.doi.org/10.2105/AJPH.78.2.163] [PMID: 3276236] ]. Besides, people who have been quarantined suboptimal experience assessments of any physical symptoms experienced during this period [8Rubin GJ, Harper S, Williams PD, et al. How to support staff deploying on overseas humanitarian work: a qualitative analysis of responder views about the 2014/15 West African Ebola outbreak. Eur J Psychotraumatol 2016; 7: 30933. [http://dx.doi.org/10.3402/ejpt.v7.30933] [PMID: 27863536] ]. Quarantine probably will be responsible for the worsening of pre-existing mental disorders and the worsening of mental stress in people with non-psychiatric disabilities because of the reduced medical care and support.
Anxiety, stress, and both the spontaneous fear and the fear incited by social media may favor the development of behavioral disorders, such as uncontrolled drinking, eating, smoking, which will bring consequences with long-lasting effect [9Hawryluck L, Gold WL, Robinson S, Pogorski S, Galea S, Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis 2004; 10(7): 1206-12. [http://dx.doi.org/10.3201/eid1007.030703] [PMID: 15324539] ]. Another important thing to note is that people with coronavirus have often been the target of discrimination, stigmatization, and social rejection [10Rubin GJ, Wessely S. The psychological effects of quarantining a city. BMJ 2020; 368: m313. [http://dx.doi.org/10.1136/bmj.m313] [PMID: 31992552] ] where infected people and their families are at risk of facing stigmatization by their local neighborhoods and relatives [11Wester M, Giesecke J. Ebola and healthcare worker stigma. Scand J Public Health 2019; 47(2): 99-104. [http://dx.doi.org/10.1177/1403494817753450] [PMID: 29359634] ]. These factors have a cumulative effect on the increase in the negative emotions that have the potential to give long-term consequences on mental health and well-being.
Various psychiatric hospitals, daycare counseling, and psychotherapy centers, as well as psychological institutions, have developed specialized hotline for counseling and assistance to people in need [12National Health Commission of the People’s Republic of China. Guideline for psychological crisis intervention during 2019-nCoV 2020.]. We believe that the inclusion of mental health as part of national public health systems is a step forward in assisting today when millions of people need it, and tomorrow after the crisis when the consequences for mental health will culminate. The COVID-19 crisis should also be seen as psychological trauma. Trauma experts will play a significant role in this crisis because they potentially have the knowledge to provide support and care for the people nowadays and in the near future [13Gelkopf M, Lapid Pickman L, Carlson EB, Greene T. The dynamic relations among peritraumatic and posttraumatic stress symptoms: An experience sampling study during wartime. J Traum Stress 2019; 32: 119-29.]. With the help of all these facts gathered together, we hope to raise awareness among health policies and health strategists that public mental health is a vital component in further dealing with COVID-19 pandemic and as such, significantly affect the people’s health and psychosocial well-being and functioning.
In conclusion, we recommend the following measures to the list of comprehensive interventions and reduction of COVID-19 impact on the people’s mental well-being globally such: world coordination of the mental health assistance initiatives, increased financing of countries with limited resources, creation of a global consortium on mental health consequences of the COVID-19 pandemic research, as well as the inclusion of the mental health and COVID-19 into the countries’ National Health Strategic Response Plans. Perhaps, the biggest problem that we will face in the near future will be a general decline of available resources for mental health because of the redirection of public resources to the treatment of COVID-19 patients. The effect of this phenomenon will be greater in the countries with already limited resources and therefore, it is necessary to avoid the worst consequences of this redirection of public resources, since, as illustrated, the impact of the COVID-19 pandemic on mental health and well-being will be enormous.
CONFLICT OF INTEREST
The authors declare no conflicts of interest, financial or otherwise.
GoceKalcev (MD) was participating in the writing of this paper, in the framework of the International Ph.D in Innovation Sciences and Technologies at the University of Cagliari, Italy.
Maunder RG, Lancee WJ, Balderson KE, et al. Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak. Emerg Infect Dis 2006; 12(12): 1924-32. [http://dx.doi.org/10.3201/eid1212.060584] [PMID: 17326946]
Giacomelli A, Pezzati L, Conti F, et al. Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study. Clin Infect Dis 2020. published online March 26.
Elovainio M, Hakulinen C, Pulkki-Råback L, et al. Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study. Lancet Public Health 2017; 2(6): e260-6. [http://dx.doi.org/10.1016/S2468-2667(17)30075-0] [PMID: 28626828]
Rubin GJ, Harper S, Williams PD, et al. How to support staff deploying on overseas humanitarian work: a qualitative analysis of responder views about the 2014/15 West African Ebola outbreak. Eur J Psychotraumatol 2016; 7: 30933. [http://dx.doi.org/10.3402/ejpt.v7.30933] [PMID: 27863536]
National Health Commission of the People’s Republic of China. Guideline for psychological crisis intervention during 2019-nCoV 2020.
Gelkopf M, Lapid Pickman L, Carlson EB, Greene T. The dynamic relations among peritraumatic and posttraumatic stress symptoms: An experience sampling study during wartime. J Traum Stress 2019; 32: 119-29.