Coronavirus: Scientists warn of global psychological crisis, call for real-time mental health monitoring
The COVID-19 pandemic is significantly impacting all aspects of society, including psychological health, and scientists have now called for real-time monitoring of mental health issues across the general population, in vulnerable groups, as well as among healthcare professionals.
A group of 24 experts from the UK and the US, spanning across multiple disciplines, have warned that the direct and indirect psychological and social effects of the COVID-19 pandemic are pervasive and could affect mental health now and in the future.
The researchers have called for “moment to moment” monitoring of anxiety, depression, self-harm, suicide, as well as other mental health issues globally. They say this needs to be on a massive scale, and “must be coordinated, targeted and comprehensive” to give scientists an evidence-based picture of what is really going on in societies worldwide. They explain that knowing what is happening in real-time will allow medical experts to respond by designing more user-friendly and effective ways to promote good mental health while people are in their homes.
The experts also recommend a rapid roll-out of evidence-based programs and treatments, which can be accessed by computer, mobile phone or other remote ways, to treat mental health conditions and increase resilience to keep people mentally healthy.
“Whether using established or new cohorts, priority should be given to methods that can ascertain COVID-19 status, symptoms, and behaviors in as close to real-time as possible, providing a dynamic picture of change in illness status, social circumstances, and behaviors. Questions regarding COVID-19 and mental health symptoms and social stressors can readily be disseminated through smartphones,” say researchers in a “position paper” published in The Lancet Psychiatry.
According to the experts, research funders and researchers must deploy resources to understand the psychological, social, and neuroscientific effects of the COVID-19 pandemic. “Mobilization now will allow us to apply the learnings gained to any future periods of increased infection and lockdown, which will be particularly important for front-line workers and vulnerable groups, and to future pandemics,” says the team.
The report says that the severe acute respiratory syndrome (SARS) epidemic in 2003 was associated with a 30% increase in suicide in those aged 65 years and older. Around 50% of recovered patients remained anxious, and 29% of healthcare workers experienced probable emotional distress, it says. Patients who survived severe and life-threatening illnesses were at risk of post-traumatic stress disorder and depression.
The experts explain that many of the anticipated consequences of quarantine and associated social and physical distancing measures are themselves key risk factors for mental health issues. These include suicide and self-harm, alcohol and substance misuse, gambling, domestic and child abuse, and psychosocial risks, such as social disconnection, entrapment, cyberbullying, financial stress, bereavement, loss, unemployment, homelessness, and relationship breakdown.
A major adverse consequence of the COVID-19 pandemic is likely to be increased social isolation and loneliness, which are strongly associated with anxiety, depression, self-harm, and suicide attempts across the lifespan, say experts in their report. Accordingly, tracking loneliness and intervening early are important priorities, they suggest.
The immediate research priorities are to monitor and report rates of anxiety, depression, self-harm, suicide, and other mental health issues both to understand mechanisms and crucially to inform interventions. “This should be adopted across the general population and vulnerable groups, including front-line workers,” the findings state.
Working from home, loss of employment and social and physical distancing have abruptly interrupted many social opportunities important to physical and psychological health, say experts. “It is important to research the mental health dimension of online life and investigate how changes in engagement with gaming and online platforms might inform interventions aimed at improving mental health. We must rapidly learn from successful existing strategies to maintain and build social resources and resilience and promote good mental health in specific populations moving forward,” says the team.
The researchers also surveyed the public and “people with lived experience of mental ill-health.” They found that there were widespread concerns about the effect of social isolation or social distancing on wellbeing; increased anxiety, depression, stress, and other negative feelings. People were also concerned about the practical implications of the pandemic response, including financial difficulties. The prospect of becoming physically unwell with COVID-19 ranked lower than these issues related to the social and psychological response to the pandemic, says the report.
The researchers, however, emphasize that there cannot be a “one size fits all” approach to keeping people mentally healthy. Any new approaches will need to be tailored to particular groups of people, such as front line medical and social care staff.
Adverse impact on brain functions
The researchers caution that SARS-CoV-2, the virus that causes the new coronavirus, might infect the brain or trigger immune responses that have additional adverse effects on brain function and mental health in patients with COVID-19.
The researchers say “almost nothing is known with certainty about the effect of SARS-CoV-2 infection on the human nervous system.” But as other coronaviruses have been shown to pass into the central nervous system, the experts recommend research to monitor and understand whether COVID-19 also has effects on the brain and nervous system.
“Neurological symptoms of COVID-19 infection are common, diverse, and often severe. In a retrospective study of 214 patients in Wuhan, China 36% had CNS (central nervous system) symptoms or disorders and the subgroup of 88 patients with severe respiratory disease had significantly increased frequency of CNS problems (45%). The problems reported include dizziness, headache, loss of smell, loss of taste, muscle pain and weakness, impaired consciousness, and cerebrovascular complications,” says the study.
It adds, “SARS-CoV-2 infection of the brain could be a contributor to the core medical syndrome of respiratory distress and failure in patients with COVID-19. In the longer term, SARS-CoV-2 may have persistent direct neurotoxic effects and immune-mediated neurotoxic effects on the brain.”
Accordingly, the research team has called for setting up a new database to monitor any psychological or brain effects of COVID-19 and for research to look at the way the virus could enter the nervous system. “Following the progression of clinical symptoms over time will be key to understanding and predicting the effects of infection on the central nervous system,” say experts.
In a separate study, researchers from the University of California San Diego School of Medicine have also suggested that in the aftermath of the novel coronavirus pandemic, a host of neuropsychiatric challenges may remain — or emerge — for those recovering from COVID-19 infections.
The study, published in the journal Brain, Behavior, and Immunity, warns that past pandemics have demonstrated that diverse types of neuropsychiatric symptoms, such as mood changes, psychosis, and neuromuscular dysfunction may accompany acute viral infection, or may follow infection by weeks, months, or longer in recovered patients. The authors recommend that the medical community should begin monitoring for symptoms of “neuropsychiatric conditions and the neuroimmune status of persons” exposed to the COVID-19 virus.