COVID-19: Experts Hasten to Head Off Mental Health Crisis

Liam Davenport

April 20, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The COVID-19 pandemic is already affecting mental health at a population level, with increased anxiety, feelings of isolation, and concerns about access to mental healthcare.

The two UK surveys were conducted to inform research priorities for mental health research and in an effort to head off a mental health crisis.

The UK charity MQ conducted a "stakeholder" survey of 2198 individuals who had a lived experience of mental illness, while Ipsos MORI conducted a poll of 1099 members of the public.

The online surveys were conducted in late March, the same week the UK's nationwide lockdown measures were announced. Respondents were asked about their biggest mental health and well-being concerns and coping strategies as they relate to the COVID-19 pandemic.

Results showed that across the two surveys, respondents' primary concern was anxiety, which was cited in 750 responses. Reported symptoms included overthinking, crying, nausea, heart palpitations, sleep disturbance, and a sense of guilt about not knowing how to help others.

In addition, respondents were worried about social isolation, becoming mentally unwell, lack of access to mental health services, and the impact of the pandemic on personal relationships.

The findings were used by a panel of experts to inform a position paper published online April 15 in the Lancet Psychiatry. The paper outlines a proposed government response to curb the long-term "profound" and "pervasive" impact of the pandemic on mental health.

"Unprecedented Response" Needed

"Governments must find evidence-based ways to boost the resilience of our societies and ... to treat those with mental ill health remotely to come out of this pandemic in good mental health," co-author of the paper Emily A. Holmes, PhD, Department of Psychology, Uppsala University, Uppsala, Sweden, said in a release.

"Front-line medical staff and vulnerable groups such as the elderly and those with serious mental health conditions must be prioritized for rapid mental health support," she added.

The position paper authors call for "moment-to-moment" monitoring of anxiety, depression, self-harm, and suicide, as well as using digital technology and rapid deployment of evidence-based programs and treatments.

Patients will need to be accessible via computer, cell phone, and other remote technologies in order to receive treatment during physical isolation.

However, they note there is no "one size fits all" approach, and novel approaches custom-tailored to particular populations, including front-line healthcare workers, are necessary.

"To make a real difference we will need to harness the tools of our digital age, finding smart new ways to measure the mental health of individuals remotely, finding creative ways to boost resilience, and finding ways to treat people in their homes. This effort must be considered central to our global response to the pandemic," coauthor Ed Bullmore, PhD, department of psychiatry, University of Cambridge, England, said in a statement.

Bullmore added that it will take "unprecedented research response if we are to limit the negative consequences of this pandemic on the mental health of our society now and in the future."

Most Vulnerable Will Bear the Brunt

During a webinar held to discuss the paper, Matthew Hotopf, PhD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, England, cautioned that society's most vulnerable citizens will bear the brunt of the pandemic's mental health consequences.

"These individuals often have unstable housing, unstable work, and are disadvantaged in terms of their physical health and their mental health," with a "very significant gap" in life expectancy vs the rest of the population, he said. The COVID-19 pandemic will widen the gap between "the haves and the have nots," he said.

"People with established and significant mental disorders are one version of the 'have nots' but actually it applies to a lot of people," said Hotopf, noting that his experience of lockdown is "very different" from that of someone "living in overcrowded, unstable accommodation, with kids running around and maybe a partner who has problems with anger control."

The authors of the position paper note that the COVID-19 pandemic highlights several important research priorities that need to be addressed in the coming weeks and months. These include:

  • Understanding the effect of COVID-19 on risk of anxiety, depression, and other outcomes, such as self-harm and suicide

  • Understanding how to create physical and social supports to ensure mental health in a climate of physical distancing

  • Determining the mental health consequences of social isolation for vulnerable groups, and how can these be mitigated under pandemic conditions

  • Understanding the mental health impact of media reporting of COVID-19 in traditional and social media

  • Determining the best methods for promoting successful adherence to behavioral advice about COVID-19 while enabling mental well-being and minimizing distress

Another area highlighted by the experts is the potential for neuropsychiatric sequelae in individuals infected with COVID-19. They called for "experimental medicine studies to validate clinical biomarkers and repurpose new treatments for the potentially neurotoxic effects of the virus."

The authors/investigators have disclosed no relevant financial relationships.

Lancet Psych. Published online April 15, 2020. Full text

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