COVID-19: A 'Marathon, Not a Sprint' for Psychiatry

Megan Brooks

April 30, 2020

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

The tragic death by suicide this week of an emergency department physician who had been caring for COVID-19 patients in New York City underscores the huge psychological impact of the pandemic ― which will linger long after the virus is gone, experts say.

"For frontline responders, the trauma of witnessing so much illness and death will have lasting effects for many," Bruce Schwartz, MD, president of the American Psychiatric Association (APA), said during the opening session of the virtual APA Spring Highlights Meeting 2020, which is replacing the organization's canceled annual meeting.

"We will need the full workforce to cope with the psychiatric effects" of the pandemic, added Schwartz, who is also deputy chairman and professor, Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, New York City.

Joshua Morganstein, MD, chair of the APA's Committee on the Psychiatric Dimensions of Disaster, led an afternoon session at the virtual meeting on "healthcare worker and organizational sustainment during COVID-19."

Dr Joshua Morganstein

The crisis is shaping up to be "a marathon, not a sprint; and self-care will remain a critical and ongoing issue. We are in this together," he said.

Once the pandemic passes, "if history is any predictor, we should expect a significant 'tail' of mental health needs that extend for a considerable period of time," Morganstein added.

Psychological First Aid

It is important to realize that the psychological and behavioral effects of disasters are experienced by "more people, over a greater geography, across a much longer period of time than all other medical effects combined. This is important for disaster resource planning," Morganstein told meeting attendees.

At times of crisis, many people will experience distress reactions and engage in behaviors that put their health at risk. Insomnia, increased alcohol and substance use, and family conflict are common and have a negative impact on functioning, he said.

In addition, pandemics result in unique responses. Protracted fear and uncertainty, elements of isolation, anger, misinformation, and faltering confidence in government/institutions may alter perceptions of risk.

"It's the perception of risk, not the actual risk, that will ultimately determine how people behave," Morganstein said.

"The ability to influence risk perception will alter the degree to which any group, community, or population ultimately chooses to engage in or reject recommended health behaviors," he added.

In times of crisis, it's also helpful to keep in mind and act upon the five essential elements of "psychological first aid," he noted. These are safety, calming, self/community efficacy, social connectedness, and hope/optimism.

Psychological first aid is an evidence-based framework of supporting resilience in individuals, communities, and organizations, Morganstein said.

Individuals have a wide range of needs during times of crisis, and support should be tailored accordingly, he noted. As with many crises, instrumental support needs are significant and may be the primary need for many people. These include the need for food, clothing, rent/mortgage, financial relief, and childcare.

Providing emotional support ― empathy, validation, self-actualization, encouragement, and insight ― will help individuals engage with instrumental supports.

"The reality is that it's often difficult to talk about being sad when you feel hungry or worried you can't pay the rent," said Morganstein.

It's often difficult to talk about being sad when you feel hungry or worried you can't pay the rent. Dr Joshua Morganstein

He also emphasized the importance of appropriate messaging and language during a crisis. These can have a profound impact on community well-being and the willingness of the public to engage in recommended health behaviors.

"As psychiatrists, we understand [that] the words we choose when we discuss this pandemic will have power. Communication is not only a means by which we deliver interventions, but it is, in and of itself, a behavioral health intervention. Good communication can serve to normalize experiences and function as an antidote to distress during times of uncertainty," Morganstein said.

Importantly, "we need to remind people that eventually this will end and the vast majority of people, including those who have difficulties along the way, will ultimately be okay."

The APA has provided a COVID-19 resource page on its website.

Morganstein and Schwartz have reported no relevant financial relationships.

American Psychiatric Association (APA) Spring Highlights Meeting 2020: Presented April 25, 2020.

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