COVID-19 and mental health … What is and will be the impact of COVID-19 on mental health? Since the very beginning of the COVID-19 pandemic there has been significant concern about the mental health care and well-being of general public as well as frontline workers. Social media and news have been constantly publishing tips and guides for psychological self-care and multiple websites, hotlines, and resources have been opening and offered throughout Canada and Ontario.

The concern is there and we should not dismiss it. It is, in fact, a great social achievement that finally mental health well being has moved to the top of our social and political priorities. However, in order to prevent this from becoming another social/political cliché that everybody heard of, but nobody knows what it actually means (like, for example, mindfulness), maybe we should carefully examine actual evidence and to guide provision of such service based of what we know.

My personal experience and knowledge suggest that declaring constantly the mental health is important and offering free hotlines and endless tips and “resources” for coping with stress and anxiety might be not enough. Moreover, my concern is that is actually the least that is actually needed.
So, let us see what we actually know about mental health needs and how they might change over time during this pandemic.

Surprisingly, there have been already published couple of dozens of articles since January 2020 about psychological response and needs during after COVID-19. The majority of articles come form China, with several from South Korea and Singapore.

Here are few take away points about COVID-19 and mental health care:

During the peak of pandemic frontline workers largely not interested in psychological support [1]. Although most of them reported and showed signs of irritability and psychological distress, they refused psychological help. What they reported actually needing is place and time for uninterrupted rest and enough protective supplies.

Overall psychological impact on front-line workers 1-2 months after the peak is moderate [2, 3] – up to 16% reported severe or moderate anxiety or mood symptoms. However, the incidence of traumatization was higher – up to 27%. It suggests we should prepare to address it as soon as the pandemic starts to slow down. Chinese researches report that the incidence of anxiety and traumatization in female medical staff was higher than that in male and that the prevalence of anxiety in nurses was higher than that in doctors. Nurses, frontline medical staff and younger medical staff were more likely to have anxiety and depression than physicians, non-frontline medical staff and older medical staff [3]. Practical implication – special consideration should be given to the mental health of female nurses, especially with regard to PTSD symptomatology [2].

Possibly the impact of vicarious traumatization is more pronounced in less trained and prepared medical practitioners [4]. It appears that non-front-line nurses that take care of COVID-19 patients might be more traumatized than front-line nurses. Interestingly, single non-front-line nurses were traumatized less compared to married, divorced, or even widowed nurses.

We should be prepared that psychological impact on those who got infected and recovered from COVID-19 might be significant.  We also should be prepared for the increased need in mental health care utilization following the COVID-19 pandemic. Bo and colleagues [5] compared the prevalence of PTSD in COVID-19 recovered patients with SARS survivors (2003). The prevalence of significant PTSD in more than 700 COVID-19 recovered patients was 96.2%, while in the early recovery phase from SARS in 2003 it was 9.79%. and 25.6% at 30-months post-SARS assessment. Another important point from this research, most of the patients were older, did not feel comfortable with technology and half of them reported negative attitude toward online interventions.

The researchers found that compared with on-site psychological interventions, online self-guided psycho-educational resources could be less effective, especially for those with reading difficulties and physical discomfort brought by COVID-19 and treatment side effects. Important point to take for after pandemic treatment of COVID-19 survivors – it will be important to have in-person psychological support available as oppose to current tendency moving everything to online counselling. At least for older clients.


Impact on general population:

During the initial phase of COVID-19 outbreak in China, more than 50% of the respondents rated their psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety [6]. Female gender, student status, and specific physical symptoms were associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression. Specific up-to-date and accurate health information, especially on the number of recovered individuals, was associated with lower stress levels. Interestingly, wearing masks, regardless of the presence or absence of symptoms, was associated with lower levels of anxiety and depression.

Research suggest the prevalence of post-traumatic symptomatology a month after the COVID-19 epidemic for hardest-hit areas in China was 7% [7]. Again, higher numbers compared to the post-SARS epidemic (3.7% of depression). Importantly, women reported significant higher post-traumatic symptomatology in the domains of re-experiencing, negative alterations in cognition or mood, and hyper-arousal. Participants with better sleep quality or less frequency of early awakenings reported lower post-traumatic symptomatology.

Another study [8] investigated psychological impact in college students. This population has been always considered more vulnerable to anxiety in part because they are in the midst of a major life transition. Although the prevalence of moderate to severe anxiety was not very high (3.6% combined) post the COVID-19 pandemic, it is slightly higher than usual prevalence of anxiety in college population (1.8%-2.9%)[9]. Results also indicated indicated that economic effects, and effects on daily life, as well as delays in academic activities, were positively associated with anxiety symptoms, while social support was negatively correlated with the level of anxiety.

References:


1. Chen, Q., Liang, M., Li, Y., Guo, J., Fei, D., Wang, L., … & Wang, J. (2020). Mental health care for medical staff in China during the COVID-19 outbreak. The Lancet Psychiatry, 7(4), e15-e16.DOI: 10.1016/S2215-0366(20)30078-X
2. Huang, J. Z., Han, M. F., Luo, T. D., Ren, A. K., & Zhou, X. P. (2020). Mental health survey of 230 medical staff in a tertiary infectious disease hospital for COVID-19. Zhonghua lao dong wei sheng zhi ye bing za zhi= Zhonghua laodong weisheng zhiyebing zazhi= Chinese journal of industrial hygiene and occupational diseases, 38, E001-E001.
3. Guo, J., Liao, L., Wang, B., Li, X., Guo, L., Tong, Z., … & Gu, Y. (2020). Psychological Effects of COVID-19 on Hospital Staff: A National Cross-Sectional Survey of China Mainland. Available at SSRN 3550050.
4. Li, Z., Ge, J., Yang, M., Feng, J., Qiao, M., Jiang, R., … & Zhou, Q. (2020). Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control. Brain, behavior, and immunity.
5. Bo, H. X., Li, W., Yang, Y., Wang, Y., Zhang, Q., Cheung, T., … & Xiang, Y. T. (2020). Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China. Psychological Medicine, 1-7.
6. Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International journal of environmental research and public health, 17(5), 1729.
7. Liu, N., Zhang, F., Wei, C., Jia, Y., Shang, Z., Sun, L., … & Liu, W. (2020). Prevalence and predictors of PTSS during COVID-19 Outbreak in China Hardest-hit Areas: Gender differences matter. Psychiatry research, 112921.
8. Cao, W., Fang, Z., Hou, G., Han, M., Xu, X., Dong, J., & Zheng, J. (2020). The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry research, 112934.
9. Eisenberg, D., Gollust, S. E., Golberstein, E., & Hefner, J. L. (2007). Prevalence and correlates of depression, anxiety, and suicidality among university students. American journal of orthopsychiatry, 77(4), 534-542.