In a recently published study in naturopathyResearchers examined the direct and indirect mental health impacts of coronavirus disease 2019 (COVID-19) and the COVID-19-induced pandemic.
The indirect impacts of COVID-19 included stressful and disruptive societal changes that negatively impacted the mental well-being of the general population. COVID-19 also triggered many direct effects such as: B. Acute and long-lasting neuropsychiatric sequelae occurring during the primary infection or three to four weeks later, and in some cases lasting 12 weeks or more after the initial infection.
About the study
In the present study, researchers first summarized empirical evidence on how the COVID-19 pandemic affected mental health at the population level by reviewing reports of mental health symptoms and prevalent mental disorders and suicide rates. Next, they described the psychological consequences of COVID-19 (e.g. symptoms of cognitive impairment and fatigue). In addition, they reviewed the neurobiological effects on brain structure and function. Finally, researchers addressed the knowledge gaps and discussed lessons learned to propose the best strategies to manage and mitigate mental health problems in future crises.
The majority of the general population showed remarkable resilience and adaptability, as the researchers observed a slight increase in mental health symptoms in the general population. However, they found alternative explanations for this; For example, community support activities may have eased the mental health burden. Drug overdose or murder likely masked the onset of mental disorders. Due to a lag effect, some social/financial consequences of the COVID-19 pandemic may have surfaced later.
In addition, the studies showed that women consistently reported more mental health problems than men. They faced higher levels of stress due to increased childcare responsibilities, domestic violence, and economic hardship due to career breaks. Adolescents and young adults were also inexplicably affected. Alarmingly, studies in China and Japan showed a significant increase in suicide rates among children and adolescents during school closures. Black, Hispanic, and Asian individuals had higher unmet mental health needs during the COVID-19 pandemic in the United States (US). Likewise, people with multiple comorbidities represented another vulnerable group negatively impacted by the COVID-19 pandemic. Perhaps they felt more stress and fear of infection due to disruptions in regular health services.
A meta-analysis of nearly 206 studies found that the mental well-being of health workers (HCWs) was comparable to that of the general population. However, this analysis did not take into account the different conditions faced by frontline and non-frontline HCWs. Still, HCWs have faced increased workloads during the pandemic, accompanied by fears of contaging themselves and their families. Multiple reports documented a higher incidence of depression and anxiety in HCWs.
Even before the COVID-19 pandemic, most countries had disorganized and understaffed mental health systems. In addition, doctors shortened or postponed appointments and acute inpatient hospital stays in the first 18 months of the pandemic.
The broader neuropsychiatric impact was heterogeneous and depended on the severity of the infection. Several asymptomatic COVID-19 cases had no neuropsychiatric symptoms. However, others had transient, non-severe neuropsychiatric symptoms. For example, a meta-analysis examining patients 12 weeks after confirmed diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) found that 32% experienced fatigue and 22% experienced cognitive impairment. Unfortunately, these studies did not have well-matched controls with other types of respiratory infections or inflammatory diseases.
During a hospitalization related to COVID-19, the most common neuropsychiatric outcome was delirium, occurring in a third of patients and over 50% of patients requiring admission to the intensive care unit (ICU). In another one-year follow-up study using the US Veterans Affairs database, the risk difference for incidents of mental health disorders caused by COVID-19 was 64 per 1,000 people.
A study analyzed electronic health records from the TriNetX network in the United States of 236,379 COVID-19 survivors and found that risks from neurological diagnoses correlated with disease severity and decreased by 78% and 32%, respectively, compared to influenza and other respiratory infections increased, respectively. However, whether post-acute consequences of SARS-COV-2 infection form a unique pattern remains questionable.
Studies have shown that acute neuropsychiatric symptoms in patients with severe COVID-19 correlate with the level of serum inflammatory markers. Neuroimaging deciphered leukoencephalopathy, acute disseminated encephalomyelitis and cytotoxic lesions in the corpus callosum. Studies on autopsy specimens revealed significant neuropathology with evidence of hypoxic damage and neuroinflammation. Post-acute neuroimaging studies in SARS-CoV-2 recovered patients showed numerous changes in brain structure compared to control patients without COVID-19. For example, such patients had a small reduction in gray matter thickness in the cerebral cortex and within the corpus callosum, and reduced overall brain size.
All of these results are consistent with the detection of anosmia, tremors, affect problems, and cognitive impairment problems in COVID-19 patients. However, the neurobiological mechanisms of SARS-CoV-2-mediated neuropsychiatric consequences remain unclear. It is also unclear whether hospitalizations related to COVID-19 due to hypoxia result in brain abnormalities or whether it is a direct effect of SARS-CoV-2 infection.
Learnings and future prospects
First and foremost, mental health is just as important as physical health and requires attention. There should be provisions for early intervention for those most at risk, including those at risk because of low socioeconomic status. Therefore, priority should be given to such interventions for adolescents and young adults, women, those with poor physical health and early childhood trauma, or those with higher exposure to pandemic-related work changes (e.g., HCWs).
Another important finding was that media communication during crises should provide concrete and actionable advice to avoid polarization and increase vigilance. In addition, it should promote resilience and help prevent an increase in mental health problems. Most importantly, longer follow-up periods of how a pandemic is affecting a population’s mental health is critical. There is an urgent need to prepare research and health infrastructures to monitor the long-term mental health implications of the COVID-19 pandemic and future crises. Overall, collaborative and interdisciplinary efforts with well-controlled prospective studies using standardized instruments will be crucial.