By Elena Schatell MPH (c) MMS (c) and Dr. Heather F. McClintock PhD MSPH MSW
This is the second part of a IH Blog series, Global Mental Health: Burden, Initiatives and Special Topics.
Part II- Special Topics: Mental Health and COVID-19
The past few months have been an overwhelming time of uncertainty, frustration, fear, sadness and grief. At the end of December 2019, the Chinese city of Wuhan reported a cluster of pneumonia-like cases, and just a few days later, Chinese authorities attributed the outbreak to a novel coronavirus. By the end of January 2020, the World Health Organization (WHO) formally declared the coronavirus disease 2019 (COVID-19) outbreak a Public Health Emergency of International Concern. In a media briefing on March 11, 2020, the WHO Director-General characterized the outbreak as a pandemic. Two weeks later, in a statement to the press, WHO Regional Director for Europe decided to focus his speech on an increasing topic of concern, mental health, stating “at WHO, we consider the consequences of COVID-19 on our mental health and psychological well-being to be very important.” With countries and communities around the world in voluntary and legally-ordered quarantine, and the number of COVID-19 cases continuing to rise, the mental health implications of the pandemic are of paramount importance.
Published research on the mental health impact of past global pandemics, such as SARS, MERS, and Ebola, give us insight into the immediate and long-term mental health burden that is to come with the COVID-19 pandemic. A study of the immediate impact of the 2003 SARS outbreak in a teaching hospital found that health care workers felt stigmatized, feared contagion and infecting their friends, family, and co-workers. Another study found that healthcare worker survivors had significantly higher levels of stress, anxiety, depression and posttraumatic symptoms one year after the SARS outbreak, compared to non-health care workers. During the SARS outbreak, suicide spiked among elderly Hong Kong residents and in Toronto, longer durations of quarantine were associated with increased prevalanece of PTSD symptoms. The psychological impact of quarantine is well documented in the literature. A recently published review in the Lancet summarized negative psychological effects and stressors. Psychological effects included post-traumatic stress symptoms, confusion, and anger. Stressors identified were frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma.
There is emerging evidence from China on the mental health impact of the COVID-19 pandemic. An online survey conducted in China during the initial phase of the outbreak found that over half of the respondents rated the psychological impact of the outbreak as moderate-to-severe and about a third reported moderate-to-severe anxiety. A subsequent larger, nationwide survey in China found that 35% of respondents reported psychological distress. The effects of social media exposure on mental health during the COVID-19 outbreak was studied in China. This study found a high prevalence of mental health problems, with over 80% of participants reporting frequent exposure to social media. Higher social media exposure was associated with higher odds of anxiety as well as a combination of depression and anxiety in adjusted models.
Additional concerning data comes from a Chinese study that focused on the mental health of frontline health care workers. There are numerous factors that put this population at risk for poor mental health. These include the overwhelming workload, non-stop increase in confirmed and suspected cases, rapidly changing protocols, widespread media coverage, depletion of personal protective equipment (PPE), separation from family, and fear of infection. Researchers examined nearly 1,300 healthcare workers in China who were directly involved in the diagnosis, treatment and care of COVID-19 patients. They found that frontline healthcare workers were 50.4% more likely to have depressive symptoms, 44.6% more likely to have anxiety symptoms, 60.8% more likely to experience distress, and three times as likely to have insomnia compared to healthcare workers who were not on the frontline.
As this pandemic continues additional research will be conducted to understand the burden and impact of mental health issues among community members and healthcare workers. The current evidence indicates that this pandemic is extolling a tremendous burden on mental health and well-being globally. In response to this growing public health need, a multitude of international, national, and local initiatives will or are being implemented. To learn more about some of these initiatives please stay tuned for our next blog post: Part III: Global Mental Health Initiatives and COVID-19.
About the Authors:
Elena Schatell MPH (c) MMS (c)
Elena Schatell is a current student at Arcadia University enrolled in the Dual Master of Public Health/Master of Medical Science in Physician Assistant Program. She aims to promote public health in underserved communities as a future physician assistant. Her current public health interests include access to mental health services, stigma surrounding mental illness, and the relationship between faith and mental health. She has interned at the National Alliance for Mental Illness (NAMI) national office in Arlington, Virginia, working closely with the Advocacy and Public Policy team on conducting research on service barriers and state mental health policy. During her time at NAMI, she also authored articles for the Advocate magazine and blog.
Dr. Heather F. McClintock PhD MSPH MSW
Dr. McClintock is an IH Section Member and Assistant Professor in the Department of Public Health, College of Health Sciences at Arcadia University. She earned her Master of Science in Public Health from the Department of Global Health and Population at the Harvard School of Public Health. Dr. McClintock received her PhD in Epidemiology from the University of Pennsylvania with a focus on health behavior and promotion. Her research broadly focuses on the prevention, treatment, and management of chronic disease and disability globally. Recent research aims to understand and reduce the burden of intimate partner violence in Sub-Saharan Africa. Prior to completing her doctorate she served as a Program Officer at the United States Committee for Refugees and Immigrants and a Senior Project Manager in the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania. At the University of Pennsylvania she led several research initiatives that involved improving patient compliance and access to quality healthcare services including the Spectrum of Depression in Later Life Study and Integrating Management for Depression and Type 2 Diabetes Mellitus Study.