Mental Health Concerns Arise Amid COVID-19 Epidemic

Experts studying the spread of novel coronavirus disease (COVID-19) are increasingly concerned about the psychological ramifications of the epidemic, particularly for older adults and medical staff working on the ground. The issue has been raised in several correspondence pieces published in Lancet Psychiatry.

Preceding the outbreak of COVID-19 in Wuhan, China, the Chinese government had developed guidelines to improve mental health and psychological crisis interventions related to public health emergencies.¹ However, as Duan and Zhu note, these procedures have several shortcomings, including a lack of coordination between medical departments engaging in psychological interventions and decoupling of efforts by community and mental health services.

Epidemics take a significant toll on the general populace. However, healthcare workers are especially vulnerable to stress and sleep trouble. In the Second Xiangya Hospital, Central South University, Changsha, China, staff attempted to alleviate pressures on caregivers through psychological intervention medical teams, an assistance hotline, and other interventions such as group activities.² However, as Chen et al observed, “medical staff were reluctant to participate in the group or individual psychology interventions provided,” with some nurses denying challenges despite signs of irritability and distress.²

To meet the needs of frontline healthcare workers, the intervention was adjusted by offering a place for rest and time alone and facilitating leisure activities to reduce stress. In addition, the hospital guaranteed food and other necessities.

In 2 correspondences published in Lancet Psychiatry, experts drew attention to patient populations that may need tailored interventions: older adults and international migrant workers.^3,4 Given China’s large aging population and their susceptibility to COVID-19, older adults with psychiatric conditions may be experiencing further distress. Moreover, they may not have access to care as a result of mass quarantine restrictions and public transport closure.³

Similarly, international migrant workers, who already experience serious barriers to healthcare in their countries of residence, may be neglected by public health campaigns and the medical response to COVID-19. As Liem et al noted, migrant workers “have a high burden of common mental disorders (eg, depression) and a lower quality of life than local populations.”⁴ They observed that migrant workers may be at increased risk given lack of access to official and accurate information and that “infections among these individuals could also lead to community infection, eventually affecting the entire population’s health.”⁴

Both correspondences remarked on the value of online mental health services, although older adults may be less likely to use them.^3,4 In a correspondence, Liu et al highlighted the role of WeChat-based psychological counseling services, including therapies for depression, anxiety, and insomnia, as well as artificial intelligence programs such as Tree Holes Rescue, which monitors suicide risk by analyzing messages on Weibo.⁵ They wrote, “online mental health services being used for the COVID-19 epidemic are facilitating the development of Chinese public emergency interventions, and eventually could improve [their] quality and effectiveness.”⁵

Overall, the COVID-19 epidemic has underscored potential gaps in mental health services during emergencies, while also testing the resilience of healthcare workers and medical systems. In light of the rise in psychological problems during this epidemic, including anxiety, depression, and stress,⁵ public health advocates and government officials can learn from previous shortcomings to develop better responses. In fact, mental health challenges may be rooted in problems preceding the epidemic. As Duan and Zhu noted, “Interventions should be based on a comprehensive assessment of risk factors leading to psychological issues, including poor mental health before a crisis, bereavement, injury to self or family members, life-threatening circumstances, panic, separation from family and low household income.”¹

References

1. Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic [published online February 18, 2020]. Lancet Psychiatry. doi: 10.1016/ S2215-0366(20)30073-0

2. Chen Q, Liang M, Li Y, et al. Mental health care for medical staff in China during the COVID-19 outbreak [published online February 18, 2020]. Lancet Psychiatry. doi:10. 1016/S2215-0366(20)30078-X

3. Yang Y, Li W, Zhang Q, Zhang L, Cheung T, Xiang YT. Mental health services for older adults in China during the COVID-19 outbreak [published online February 18, 2020]. Lancet Psychiatry. doi: 10.1016/ S2215-0366(20)30079-1

4. Liem A, Wang C, Wariyanti Y, Latkin CA, Hall BJ. The neglected health of international migrant workers in the COVID-19 epidemic [published February 18, 2020]. Lancet Psychiatry. doi: 10.1016/ S2215-0366(20)30076-6

5. Liu S, Yang L, Zhang C, et al. Online mental health services in China during the COVID-19 outbreak [published online February 18, 2020]. Lancet Psychiatry. doi: 10.1016/ S2215-0366(20)30077-8