The mental health emergency: the invisible pandemic after COVID-19

The impact that the new virus is having on physical and mental health worldwide has become more than apparent in recent months. With an estimated 17 million people infected and over 667,000 deaths worldwide, these numbers are expected to continue to grow in many countries in the coming months. On the other hand, at the end of March it was estimated that 40% of the world’s population was confined, with the consequent psychological impact of this type of situation on children, adolescents and adults. Therefore, in addition to the consequences that this pandemic is having on public health (Onder, Rezza and Brusaferro, 2020) it is also expected to have a very significant impact on mental health (Fiorillo and Gorwood, 2020; Li, Wang, Xue, Zhao and Zhu, 2020; Torales et al., 2020).

Fiorillo & Gorwood (2020) consider that the negative psychological consequences of the pandemic can be particularly severe in four groups of people: a) Those who have been directly or indirectly in contact with the virus; b) those who are already vulnerable to psychosocial stressors (including people affected by mental health problems); c) health professionals (due to the higher level of exposure); and d) even people who follow the news through numerous media channels.

Containment measures (e.g., quarantine and social distancing, and self-isolation), while necessary to contain the pandemic, have had a negative impact on mental health. In particular, the increase in loneliness, the reduction of social interactions, concern for one’s own health and that of loved ones (particularly the elderly or those who suffer from physical illness), as well as uncertainty about the future, can generate or exacerbate symptoms of intense fear, anxiety, depression, stress, and substance use (Fiorillo and Gorwood, 2020; Li, Wang, Xue, Zhao and Zhu, 2020; Torales and others, 2020). Early detection of these problems, along with proper treatment, can prevent them from prolonging unnecessarily, increasing the risk of more serious mental health disorders, including anxiety disorders such as panic, obsessive-compulsive, stress, and trauma related disorders (Fiorillo and Gorwood, 2020).

The increase in mental health disorders is beginning to be confirmed by some studies conducted in China. In a first study carried out by Wang et al. (2020) after a survey of 1210 people, it was observed that 53.8% assessed the psychological impact of the situation as moderate-severe, 16.5% reported moderate or severe depressive symptoms, 28.8% moderate or severe anxiety symptoms and 8.1% moderate or severe stress levels. In another study, conducted in the city of Wuhan, health professionals reported more mental health problems such as stress, anxiety, depressive symptoms, insomnia, or very intense fears. These mental health problems not only affected medical workers’ attention, understanding, and decision-making, which could affect the fight against COVID-19 but also had a lasting effect on their overall well-being (Kang et al., 2020). Another recent systematic review, which included studies conducted mainly in China, concludes that this pandemic may have a direct impact on anxiety and depression symptoms (16-28%), stress (8%), and major sleep disturbances (Rajkumar, 2020).

Gradually, data and figures from other countries are beginning to arrive. According to a recent WHO report (World Health Organization [WHO], 2020), in Canada, a significant increase in alcohol consumption during the pandemic has been estimated, particularly among people aged 15-49. The same report notes that in the United Kingdom, more young people needed mental health care, and 32% of the sample agreed that the pandemic had worsened their mental health. Another study in Ethiopia in April 2020 reported that the prevalence of depressive symptoms had tripled compared to Ethiopia’s estimates before the epidemic (World Health Organization [WHO], 2020).

In Spain and Italy, two of the countries most affected by COVID-19, a very recent study provides the first data on the emotional impact of quarantine on children and adolescents (Orgilés, Morales, Delvecchio, Mazzeschi, & Espada, 2020). After sending a survey to 1,143 parents of Italian and Spanish children/adolescents from 3 to 18 years old, the results point out that 85.7% of parents perceived changes in their children’s emotional state and behavior during the quarantine. Specifically, the most frequent symptoms were difficulty concentrating (76.6%), boredom (52%), irritability (39%), restlessness (38.8%), nervousness (38%), feelings of loneliness (31.3%), malaise (30.4%) and worry (30.1%).

According to Orgilés et al. (2020), considering the negative psychological impact of quarantine on young Italians and Spaniards, there is an urgent need to reinforce and detect children with emotional and behavioral problems as early as possible in order to improve their emotional well-being and prevent future mental disorders. An immediate priority is the collection of high quality data about the effects of the COVID-19 pandemic on the mental health of the entire population and vulnerable groupsand also about the brain function, cognition and mental health of COVID-19 patients (Holmes et al., 2020).

It seems that the WHO, the United Nations, and the Lancet Commission on Global Health all agree that mental health problems exist along a continuum from mild, time-limited discomfort to serious mental health conditions. The COVID-19 pandemic influences where people are located on this continuum. Many people who previously had few experiences of anxiety and distress may experience an increase in the frequency and intensity of these symptoms. And those who previously had a mental health problem may experience a worsening of their condition and a more significant impairment in different areas of their lives.

From PSICONEXIA, we consider that it could be interesting to classify the psychopathological risk based on our digital tool.. Determining which people have a low, medium, or high risk of suffering a specific psychological problem can be of great help in monitoring the mental health of the general population and the most vulnerable groups, and in turn, optimize the effectiveness of psychological treatments. In other words, having this updated information can be particularly useful in providing immediate attention whenever the person needs it. And more importantly, to be able to target preventive interventions on those people who, even without presenting a high psychopathological risk, do present mild or moderate symptomatology that could worsen in the long term.

As suggested by Fiorillo and Gorwood (2020), early detection of these problems is critical, which, together with appropriate treatment, can prevent them from becoming unnecessarily prolonged, increasing the risk of more serious mental health disorders, including anxiety disorders such as panic, obsessive-compulsive, stress and trauma related disorders.

References

• Li, S., Wang, Y., Xue, J., Zhao, N., & Zhu, T. (2020). The impact of COVID-19 epidemic declaration on psychological consequences: a study on active Weibo users. International journal of environmental research and public health, 17(6), 2032.
• Fiorillo, A., & Gorwood, P. (2020). The consequences of the COVID-19 pandemic on mental health and implications for clinical practice. European Psychiatry, 63(1).
• Onder, G., Rezza, G., & Brusaferro, S. (2020). Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. Jama, 323(18), 1775-1776.
• Holmes, E. A., O’Connor, R. C., Perry, V. H., Tracey, I., Wessely, S., Arseneault, L., … & Ford, T. (2020). Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. The Lancet Psychiatry.
• World Health Organization. (2020, May 14). Substantial investment needed to avert mental health crisis. Retrieved from https://www.who.int/news-room/detail/14-05-2020-substantial-investment-needed-to-avert-mental-health-crisis
• Office for National Statistics, Statistical bulletin: Coronavirus and the latest indicators for the UK economy and society: 14 May 2020.
• Torales, J., O’Higgins, M., Castaldelli-Maia, J. M., & Ventriglio, A. (2020). The outbreak of COVID-19 coronavirus and its impact on global mental health. International Journal of Social Psychiatry, 0020764020915212.
• Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., McIntyre, R. S., … & Ho, C. (2020). A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain, behavior, and immunity.
• Kang, L., Ma, S., Chen, M., Yang, J., Wang, Y., Li, R., … & Hu, S. (2020). Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study. Brain, behavior, and immunity.
• Rajkumar, R. P. (2020). COVID-19 and mental health: A review of the existing literature. Asian journal of psychiatry, 102066.
• Orgilés, M., Morales, A., Delvecchio, E., Mazzeschi, C., & Espada, J. P. (2020). Immediate psychological effects of the COVID-19 quarantine in youth from Italy and Spain. PsyArXiv Preprints.