Author: Jie Cao
Translator & Editor: Jie Cao, Jing Ma
The coronavirus disease 2019 (COVID-19) pandemic is an unexpected public health emergency that is having profound effects on all aspects of the society, including mental health. Many people have been coping with psychological stress, such as worry, depression, anxiety, etc. In fact, negative emotions are normal – it is a protection mechanism that shields human beings from exposure to dangers. It is of great necessity that we maintain an objective and scientific attitude toward these negative emotions. Restraining or avoiding talking about the stress, on the contrary, increases one’s feeling of uncertainty and panic. In the following sections, we are going to introduce some research about mental health during this COVID-19 pandemic.
Are you anxious during the pandemic?
The Institute of Psychology, Chinese Academy of Sciences, conducted an online survey in February 2020 about Chinese people’s level of anxiety and depression during the COVID-19 epidemic . The results showed that one-third of the respondents presented some levels of depression, among which the youngest group (under 30 years old) scored the highest, followed by the oldest group (50 years and older), the 41-50 years old group and then the 31-40 years old age group. In addition, 22.4% of the survey respondents showed evidence of anxiety; and similarly, young people scored higher than other age groups. In March, American Psychiatry Association also released a national poll about Americans’ mental well-being . It showed that two-thirds of the respondents fear that the pandemic will have a long-lasting impact on the economy; about 60% of them feel the pandemic is having a serious impact on their day-to-day life; nearly half respondents are anxious about the possibility of getting infected by the COVID-19.
Mental health of vulnerable population raises concerns
Although the world-wide pandemic of COVID-19 is affecting everyone’s mental status, a recent paper published on The Lancet Psychiatry pointed out that some vulnerable populations may experience differently in this outbreak . These people are:
- Children, adolescents and families affected by school closures
School is one of the places where children and adolescents seek most help from. During school closures, their misbehavior may not be timely intervened due to lack of guidance. Absence of free/cheap school meals, accommodation issues may cause problems for families with financial difficulties. Furthermore, peer social, as a main pathway to build children and adolescents’ social networks, is changed and disrupted during the lockdowns.
- Older adults
Elders may feel exacerbated loneliness and isolation during home quarantine. In a recent report, one-third of coronavirus deaths in the U.S. are nursing home residents or workers . That is to say, compared to other populations, older people are more likely to experience painful feelings from loss of friends and loved ones, as they are at high risk of dying from the COVID-19 once infected. In addition, many elders, as a high-risk population, not only feel anxious and worried about getting the disease, but also feel guilty for using more social and healthcare resources.
- People with existing mental health problems
The services and support for people with existing mental health issues may be disrupted during the isolation. Symptoms like depression and anxiety may be exacerbated, and those with severe mental illnesses may be particularly affected by relapse.
- Frontline healthcare workers
On April 26, a New York ER doctor who treated coronavirus patients committed suicide . The tragic death sounded alarm about the importance of mental health issues among the frontline healthcare workers. Unlike most people isolated at home, frontline healthcare workers have a higher probability of being exposed to the coronavirus, therefore, they are more worried about contamination and infection. Taking care of a large number of severe cases and witnessing deaths in a short period also lead to psychological trauma among healthcare workers. Overwhelmed with heavy workload and long working hours, they also lack the time and effort to pay attention to their own mental health.
- People on low incomes
Low income population are more likely to face job and financial insecurity as a result of unemployment and economic contraction. They are also poor in accessing the internet technology and health insurance, making it harder for them to obtain information, medical and social support.
- Socially excluded groups, e.g. prisoners, refugees and homeless
Many prisons worldwide have reported COVID-19 outbreaks. With limited space and resources, the fear and anxiety, together with the coronavirus, spread fast among prisoners. Refugees and homeless lack access to reliable information for disease prevention and treatment. The attention and support for these socially excluded groups are often insufficient. Their connections with the society may be further cut off in the pandemic, thus, may cause problems in their sense of security and social belongings.
Social media playing an important role in mental health services
A correspondence paper published on The Lancet Psychiatry shared China’s experience of using social media to provide online mental health services . The paper mentioned varieties of way mental health services, including 72 online surveys distributed via WeChat, online mental health education program published on WeChat, Weibo and TikTok, WeChat-based 24/7 online psychological counselling services provided by mental health professionals in medical institutions, universities, and academic societies, and online psychological self-evaluation and intervention systems. The paper particularly mentioned the use of artificial intelligence (AI) in mental health services. An AI program “Tree Holes Rescue”, developed by Professor Zhisheng Huang at Wuhan Technology University, is able to monitor and analyze messages posted on Weibo, and identify individuals at risk of suicide. The algorithm was tailored to find people in demand of coronavirus-related mental health services two weeks after the lockdown of Wuhan .
Guidelines for vulnerable populations to maintain mental health
The National Health Commission of China issued a guideline in February 2020 for psychological crisis intervention for people affected by COVID-19 . As the coronavirus spread to more countries, the World Health Organization (WHO)  and United States Centers for Disease Control and Prevention (CDC)  issued documents to guide the general population and vulnerable groups through psychological well-being and stress management. We listed selected suggestions for some vulnerable populations:
- Children and adolescents
Increase communication with the child. Help children find positive ways to express feelings such as fear and sadness. Maintain familiar routines in daily life as much as possible, or create new routines.
- Older adults
Keep in regular contact with older adults, pay attention to their physical and mental health and provide support as needed.
Share simple facts, information and guidelines with older people, in a clear, concise, respectful and patient way.
- People with existing mental health problems
Continue with the current treatment. Be aware of new or worsening symptoms. Actively seek professional help when needed.
- Frontline healthcare workers
Feeling under pressure is a likely experience and it is quite normal to be feeling this way in the current situation. Stress and the feelings associated with it are by no means a reflection that you cannot do your job or that you are weak.
Disclose your negative emotions in some appropriate ways, for example, crying in a secret place, doing a few minutes of boxing workout, chatting with closed ones, etc.
In this battle with COVID-19, we should try our best to be mindful of our own and vulnerable populations’ mental health. As we all maintain and improve our psychological well-being, it will become our best immunity against the virus.
- The Institute of Psychiatry analyzed Chinese general population’s emotional health and mental state during COVID-19 epidemic. http://www.psych.ac.cn/xwzx/kyjz/202004/t20200417_5548762.html. Accessed May 1, 2020, in Chinese.
- New Poll: COVID-19 Impacting Mental Well-Being: Americans Feeling Anxious, Especially for Loved Ones; Older Adults are Less Anxious. https://www.psychiatry.org/newsroom/news-releases/new-poll-covid-19-impacting-mental-well-being-americans-feeling-anxious-especially-for-loved-ones-older-adults-are-less-anxious. Accessed May 1, 2020.
- Holmes, Emily A., et al. “Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science.” The Lancet Psychiatry (2020).
- One-Third of All U.S. Coronavirus Deaths Are Nursing Home Residents or Workers. https://www.nytimes.com/interactive/2020/05/09/us/coronavirus-cases-nursing-homes-us.html. Accessed May 9, 2020.
- New York ER doctor who treated coronavirus patients dies by suicide. https://www.theguardian.com/us-news/2020/apr/28/dr-lorna-breen-new-york-er-coronavirus. Accessed May 1, 2020.
- Liu, Shuai, et al. “Online mental health services in China during the COVID-19 outbreak.” The Lancet Psychiatry 7.4 (2020): e17-e18.
- Prevent suicides and comfort the soul http://paper.people.com.cn/zgcsb/html/2020-03/02/content_1974047.htm. Accessed May 1, 2020, in Chinese.
- Mental health should not be overlooked during the epidemic! (including national mental health support hotlines) http://www.gov.cn/fuwu/2020-02/04/content_5474555.htm. Accessed May 1, 2020, in Chinese.
- Mental health and psychosocial considerations during the
COVID-19 outbreak. https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf. Accessed May 1, 2020.
- Stress and Coping. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprepare%2Fmanaging-stress-anxiety.html. Accessed May 1, 2020.
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