COVID-19: psychosocial impact and mental health in Latin America

COVID-19: impactos na saúde mental e psicossociais na América Latina

COVID-19: impacto psicosocial y salud mental en América Latina

Miguel Gallegos Andrés J. Consoli Ilka Franco Ferrari Mauricio Cervigni Viviane de Castro Peçanha Pablo Martino Tomás Caycho-Rodríguez Anastasia Razumovskiy About the authors

Abstract

The COVID-19 pandemic has not only had health, economic, and political impacts, but also significant psychosocial and mental health consequences worldwide. In this article, different documentation and studies on mental health were analyzed, with the aim of identifying the various problems detected during the pandemic. Methodologically, a narrative and integrative review of the scientific literature was carried out. In Latin America, the most recent studies have documented and made patent effects on the various vulnerized populations such as migrants, women, children, the elderly, people living with significant disabilities, people experiencing marked housing and food insecurity, and temporary workers laboring in what has been referred to as the informal economy. In light of this, it is proposed that addressing these issues should involve the coordination of transnational policies and the definition of an agenda of critical priorities to focus and address. For this to come about, it is important that the empirical evidence generated by regional epidemiological studies contribute to the design of public policies on mental health of the Latin American population, so that they reduce the negative effects as well as prevent the future consequences of a pandemic that is not yet over.

Keywords:
Covid-19; Latin America; mental health; psychosocial; revision

Resumo

A pandemia da COVID-19 no mundo tem impactado a área da saúde, os setores da economia e da política e também tem gerado consequências psicossociais, repercutindo de forma significativa no campo da saúde mental. Este estudo de revisão sistemática analisou diversos documentos e pesquisas abordando saúde mental e COVID-19, bem como problematicas geradas durante a pandemia. A metodologia de pesquisa envolveu revisão narrativa e integrativa da literatura científica. Na América Latina, os estudos mais recentes apresentam os inúmeros efeitos da COVID-19 em populações vulneráveis: imigrantes, mulheres, crianças, idosos, pessoas em situação de rua, trabalhadores informais, etc. Diante desse panorama, propõe-se que a abordagem dessas questões inclua a coordenação de políticas transnacionais e a definição de uma agenda de prioridades críticas a serem consideradas. Os resultados empíricos de estudos epidemiológicos realizados em âmbito regional contribuíram para o desenho de políticas públicas em saúde mental da população latino-americana com o objetivo de reduzir os efeitos negativos e prevenir riscos futuros de uma pandemia que ainda não terminou.

Palavras-chave:
COVID-19; América Latina; saúde mental; psicossocial; revisão

Resumen

La pandemia por el COVID-19 no sólo ha generado diversos impactos en materia de salud, economía y política, sino también importantes consecuencias psicosociales y de salud mental en el mundo. En este trabajo, se analizaron diferentes documentaciones y estudios sobre salud mental, con el objetivo de recuperar las diversas problemáticas detectadas durante la pandemia. Metodológicamente se realizó una revisión narrativa e integrativa de la literatura científica. En América Latina los estudios más recientes comienzan a visualizar diferentes afectaciones sobre las diversas poblaciones vulneralizadas: migrantes, mujeres, niños, los ancianos, personas quienes viven con una discapacidad significativa, personas en situación de calle, trabajadores informales, etc. Frente a este panorama, se plantea que el abordaje de estas cuestiones deberá contar con la coordinación de políticas trasnacionales y la definición de una agenda de prioridades críticas a focalizar y atender. Para esto resulta importante que la evidencia empírica generada por los estudios epidemiológicos regionales contribuya al diseño de las políticas públicas sobre salud mental de la población latinoamericana, de modo que las mismas logren reducir los efectos negativos como también puedan prevenir las consecuencias futuras de una pandemia que todavía no ha finalizado.

Palabras clave:
COVID-19; América Latina; salud mental; psicosocial; revisión

Introduction

Since the health emergency generated by the worldwide pandemic associated with COVID-19, the impact has been felt not only on the economy, employment, politics and governments, but also through the different psychosocial and mental health consequences experienced by the population (GALLEGOS et al., 2020GALLEGOS, Miguel et al. Cómo afrontar la pandemia del Coronavirus (COVID-19) en las Américas: recomendaciones y líneas de acción sobre salud mental. Revista Interamericana de Psicología/Interamerican Journal of Psychology, v. 54, n. 1, p. e1304, Apr. 30, 2020. https://doi.org/10.30849/ripijp.v54i1.1304
https://doi.org/10.30849/ripijp.v54i1.13...
; MORENO et al., 2020MORENO, Carmen et al. How mental health care should change as a consequence of the COVID-19 pandemic. The Lancet Psychiatry, v. 7, n. 9, p. 813-824, July 16, 2020. https://doi.org/10.1016/S2215-0366(20)30307-2
https://doi.org/10.1016/S2215-0366(20)30...
; PULIDO-MARTÍNEZ; BURBANO-VALENTE, 2020PULIDO-MARTÍNEZ, Hernán Camilo; BURBANO-VALENTE, Johanna. La crítica de la psicología, trabajo y la pandemia de Covid-19. Fractal: Revista de Psicologia, Niterói, v. 32, n. 3, p. 318-327, 2020. https://doi.org/10.22409/1984-0292/v32i3/45576
https://doi.org/10.22409/1984-0292/v32i3...
; RODRÍGUEZ-BAILÓN, 2020RODRÍGUEZ-BAILÓN, Rosa. Inequality viewed through the mirror of COVID-19 (La desigualdad ante el espejo del COVID-19). International Journal of Social Psychology, v. 35, n. 3, p. 647-655, Aug. 27, 2020. https://doi.org/10.1080/02134748.2020.1796298
https://doi.org/10.1080/02134748.2020.17...
).

In the health field, the World Health Organization has not only become the target of many criticisms, but has also shown several contradictions in its approach to the pandemic. Nonetheless, such inconsistencies do not justify withdrawing support at this moment (HORTON, 2020aHORTON, Richard. Offline: Why President Trump is wrong about WHO. The Lancet, v. 395, n. 10233, p. 1330, Apr. 25, 2020a. https://doi.org/10.1016/S0140-6736(20)30969-7
https://doi.org/10.1016/S0140-6736(20)30...
). At the country level, it has been seen that very few national health systems were prepared to face a pandemic like the current one. Although health authorities and scientists around the world are working to find immediate solutions, the victims of COVID-19 continue to rise, and it seems that now is the turn of Latin America in terms of increasing the number of infections and deaths (ORGANIZACIÓN PANAMERICANA DE LA SALUD, 2021ORGANIZACIÓN PANAMERICANA DE LA SALUD. Alerta epidemiológica: COVID-19 incremento de las hospitalizaciones y de las defunciones en pacientes menores de 60 años. Washington, D.C.: OPS/OMS, 2021. Available at: Available at: https://www.paho.org/es/documentos/alerta-epidemiologica-covid-19-incremento-hospitalizaciones-defunciones-pacientes . Accessed on: Mar. 20, 2021.
https://www.paho.org/es/documentos/alert...
).

Against this backdrop, the measures implemented by governments to stop the spread of contagion and avoid a major crisis, measures that have included confinement, restrictions on people’s mobility, national border closures, social distancing, wearing face masks, among others, have had important unintended consequences. Specifically, the measures have accentuated preexisting conditions, deepened psychosocial problems, and caused severe side effects on the mental health of the population.

Stress, fear, and worry are normal responses to situations that generate uncertainty or confront us with abrupt changes, such as the health crisis caused by COVID-19. However, the COVID-19 pandemic has triggered alarming levels of psychological and emotional symptoms of distress in the general population worldwide. A review of different studies identified that fear of COVID-19 is strongly related to states of anxiety, traumatic stress, and anguish, as well as moderate levels of stress and depression (ŞIMŞIR et al., 2021ŞIMŞIR, Zeynep et al. The relationship between fear of COVID-19 and mental health problems: A meta-analysis. Death Studies, p. 1-9, Feb. 27, 2021. https://doi.org/10.1080/07481187.2021.1889097
https://doi.org/10.1080/07481187.2021.18...
).

A recent study carried out in seven Latin American countries (Argentina, Colombia, Ecuador, El Salvador, Mexico, Paraguay, and Uruguay), in which 4881 individuals participated, found that 31.4% of the total participants did not present symptoms of generalized anxiety, 43% presented mild anxiety, 17.2% moderate anxiety, and 8.3% severe anxiety. Regarding depressive symptoms, 41.3% presented minimal symptoms associated with depression, 31.2% mild depression, 15.2% moderate depression, 7.6% moderately severe depression, and 3.9% severe depression. The fear of COVID-19 significantly and positively predicted both anxiety and depression, having a greater impact on anxiety than on depression. The findings of the study supported the conclusion that as people get older, they are less afraid of COVID-19, anxiety, and depression. Women were, on average, more afraid of COVID-19 and depression, but exhibit the same level of anxiety as men (CAYCHO-RODRÍGUEZ et al., 2021aCAYCHO-RODRÍGUEZ, Tomás et al. Cross-cultural measurement invariance of the fear of COVID-19 scale in seven Latin American countries. Death Studies, Feb. 9, 2021a. https://doi.org/10.1080/07481187.2021.1879318
https://doi.org/10.1080/07481187.2021.18...
).

Although many of these manifestations can be considered common and understandable reactions to an event as massively disruptive as a pandemic, for a noticeable size of the population they can be prolonged and become more serious and disabling, and can even lead to an increase in mental disorders. In addition, the most vulnerized populations are the ones most likely to suffer the most harmful effects of a pandemic, not only because of the unfavorable conditions they live and toil in daily, but also because of systemic inequities such as markedly limited access to health care and disrespect of their human rights. Therefore, it is important to analyze the combination of the effects of the COVID-19 pandemic on the mental health and psychosocial well-being while taking into account the diverse populations of Latin America.

Method

In this study, sources that show a shared, international concern about the invisible consequences of the pandemic are identified and analyzed, with a particular focus on epidemiological data that underscore the psychosocial impact on the Latin American population. In order to identify these sources, the authors adhered closely to the methodological criteria specified in the narrative and integrative reviews articulated by Aguilera Eguía (2014AGUILERA EGUÍA, Raúl. ?Revisión sistemática, revisión narrativa o metaanálisis? Revista de la Sociedad Española del Dolor, Madri, v. 21, n. 6, p. 359-360, 2014. https://dx.doi.org/10.4321/S1134-80462014000600010
https://dx.doi.org/10.4321/S1134-8046201...
), and therefore focused on the statements of international mental health organizations and the reports from relevant studies (GALLEGOS et al., 2020GALLEGOS, Miguel et al. Cómo afrontar la pandemia del Coronavirus (COVID-19) en las Américas: recomendaciones y líneas de acción sobre salud mental. Revista Interamericana de Psicología/Interamerican Journal of Psychology, v. 54, n. 1, p. e1304, Apr. 30, 2020. https://doi.org/10.30849/ripijp.v54i1.1304
https://doi.org/10.30849/ripijp.v54i1.13...
; SCHOLTEN et al., 2020SCHOLTEN, Hernán et al. Abordaje psicológico del COVID-19: Una revisión narrativa de la experiencia latinoamericana. Revista Interamericana de Psicología/Interamerican Journal of Psychology, v. 54, n. 1, e1287, May 5, 2020. https://doi.org/10.30849/ripijp.v54i1.1287
https://doi.org/10.30849/ripijp.v54i1.12...
).

Results and discussion

A call out for mental health

The various psychology and psychiatry associations as well as the different international mental health organizations have made an international emergency call for the different governments of the world to dedicate greater efforts in terms of public policies addressing the mental health of the population. Recently, the United Nations produced a report on a fairly neglected area: the needs that countries and their populations will be facing in the field of mental health during COVID-19 (UNITED NATIONS, 2020UNITED NATIONS. Policy brief: COVID-19 and the need for actions on mental health. May 13, 2020. Available at: Available at: https://www.un.org/sites/un2.un.org/files/un_policy_brief-covid_and_mental_health_final.pdf . Accessed on: Apr. 12, 2021.
https://www.un.org/sites/un2.un.org/file...
).

Depression is known to be the most important mental health condition globally with over 264 million people worldwide suffering from it. Moreover, people with severe mental disorders are more likely to die younger than the general population: on average, between 10 and 20 years shorter. Between 76% and 85% of people with mental disorders do not receive adequate psychological treatment in low- and middle-income countries. In global terms, approximately one mental health provider is found for every 10,000 people. Finally, violations of the human rights of people with serious mental health conditions are frequent in all countries of the world (UNITED NATIONS, 2020UNITED NATIONS. Policy brief: COVID-19 and the need for actions on mental health. May 13, 2020. Available at: Available at: https://www.un.org/sites/un2.un.org/files/un_policy_brief-covid_and_mental_health_final.pdf . Accessed on: Apr. 12, 2021.
https://www.un.org/sites/un2.un.org/file...
).

Due to this alarming epidemiological situation in mental health prior to the COVID-19 pandemic, attention has begun to be drawn to the possible non-visible effects of the pandemic on the mental health of the population in the world, and particularly in Latin America. The possible harmful effects on mental health are not only expected in the worsening of the different clinical symptoms, but also in the inability to give a satisfactory response from the health care services, particularly for the most vulnerized populations.

The UK Academy of Medical Sciences has proposed a multidisciplinary research priority agenda on population mental health, with special emphasis on different vulnerable groups facing COVID-19 (HOLMES et al., 2020HOLMES, Emily et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. The Lancet Psychiatry, v. 7, n. 6, p. 547-560, Apr. 15, 2020. https://doi.org/10.1016/S2215-0366(20)30168-1
https://doi.org/10.1016/S2215-0366(20)30...
). So far, there is no specific, concomitant agenda for Latin America, but there are multiple mitigation actions. For example, the Sociedad Interamericana de Psicología (known as SIP; Interamerican Society of Psychology) has raised the need to carry out a set of actions on mental health and has elaborated a series of recommendations to act in different critical situations (GALLEGOS et al., 2020GALLEGOS, Miguel et al. Cómo afrontar la pandemia del Coronavirus (COVID-19) en las Américas: recomendaciones y líneas de acción sobre salud mental. Revista Interamericana de Psicología/Interamerican Journal of Psychology, v. 54, n. 1, p. e1304, Apr. 30, 2020. https://doi.org/10.30849/ripijp.v54i1.1304
https://doi.org/10.30849/ripijp.v54i1.13...
).

Meanwhile, national psychological associations and mental health organizations of the different countries of Latin America have developed diverse action plans in the form of assistance, containment, and psychological support. The initial reports from different regional investigations are quite conclusive with respect to the general increase in symptoms such as stress, distress, anxiety, and depression in large swaths of the population (CAYCHO-RODRÍGUEZ et al., 2021bCAYCHO-RODRÍGUEZ, Tomás et al. Socio-demographic variables, fear of COVID-19, anxiety and depression: prevalence, relationships and explanatory model in the general population of seven Latin American countries. Frontiers in Psychology, v. 12, art. 695989, Nov. 5, 2021b. https://doi.org/10.3389/fpsyg.2021.695989
https://doi.org/10.3389/fpsyg.2021.69598...
; GALLEGOS et al., 2020GALLEGOS, Miguel et al. Cómo afrontar la pandemia del Coronavirus (COVID-19) en las Américas: recomendaciones y líneas de acción sobre salud mental. Revista Interamericana de Psicología/Interamerican Journal of Psychology, v. 54, n. 1, p. e1304, Apr. 30, 2020. https://doi.org/10.30849/ripijp.v54i1.1304
https://doi.org/10.30849/ripijp.v54i1.13...
). In general, the difficulties experienced by the population expressed in diagnosable conditions coincide with the international ones: the problems are not limited to COVID-19 but also expressed as mental disorders.

According to the most recent data, mental and neurological disorders, as well as substance use and suicide, constitute a group of problems of great disability for the population of the Americas. Among them, depressive disorders are the leading cause of disability, followed by anxiety disorders. In addition, there is serious lack of investment in mental health that results in a markedly limited readiness of care (ORGANIZACIÓN PANAMERICANA DE LA SALUD, 2018ORGANIZACIÓN PANAMERICANA DE LA SALUD. La carga de los trastornos mentales en la región de las Américas, 2018. Washington, D. C.: OPS, 2018. Available at: Available at: https://iris.paho.org/bitstream/handle/10665.2/49578/9789275320280_spa.pdf?sequence=9 . Accessed on: May 18, 2020.
https://iris.paho.org/bitstream/handle/1...
). In fact, the pandemic has revealed the inability to respond effectively to health demands by national health systems, and in particular, mental health systems, which disproportionately affects the most vulnerable groups and their social contexts.

The public health crisis generated by the pandemic urges us to consider future scenarios with markedly negative consequences on the mental health of the population in Latin America. Those scenarios will require joint and more forceful efforts on the planning of care and improvement of mental health in the region. So far, most of the reports from international organizations and different scientific societies in the field of mental health have warned about the impact that this pandemic will have on the mental health of the population in different countries and regions of the world.

Faced with this set of circumstances, it is important to underscore the efforts that scientific and professional psychology organizations have carried out during the pandemic, so that they serve as an assessment of the current situation, as well as possible future care and prevention actions on the effects of a pandemic on the mental health of the population. In this regard, recent studies have documented the response of psychology to the pandemic at international levels (ALMONDES et al., 2021ALMONDES, Katie Moraes de et al. Comparative analysis of psychology responding to COVID-19 pandemic in Brics nations. Frontiers in Psychology, v. 12, art. 567585, 3 jun. 2021. https://doi.org/10.3389/fpsyg.2021.567585
https://doi.org/10.3389/fpsyg.2021.56758...
) and in Latin America (CANET-JURIC; CRESTANI CALEGARO, 2021CANET-JURIC, Lorena; CRESTANI CALEGARO, Vítor. Compendio de Actas del I Fórum Latinoamericano de Salud Mental en Pandemia: desafíos, panorama actual y perspectivas futuras. Mar del Plata: Universidad Nacional de Mar del Plata, 2021.; GALLEGOS et al., 2022GALLEGOS, Miguel et al. The impact of COVID-19 on Latin American psychology: research, profession, and public policy. Estudos de Psicologia, Campinas, 2022. In press., in press; INFANTE PEDREIRA; GRAU ÁBALO, 2020INFANTE PEDREIRA, Olga Esther; GRAU ÁBALO, Jorge Amado. La psicología de la salud en el enfrentamiento a la COVID-19 en América Latina. Repositorio de la Universidad César Vallejo, 2020. https://hdl.handle.net/20.500.12692/52877
https://hdl.handle.net/20.500.12692/5287...
; PORTILLO et al., 2022PORTILLO, Nelson et al. Psychology and COVID-19 in the Americas. Springer, 2022. In press., in press; LUNA-SÁNCHEZ et al., 2020LUNA-SÁNCHEZ, Sandra Elizabeth et al. Memorias del Congreso Virtual de la Sociedad Interamericana de Psicología 2020: Aportes de la Psicología ante la COVID-19. San Juan: Sociedad Interamericana Psicología/Universidad Carlos Albizu, 2020.). The analysis of all this information can be very useful in decision-making at the government level and the development of public mental health policies.

Psychosocial problems in Latin America

Before the pandemic, Latin America already had major psychosocial needs that went unmet and expressed themselves in mental problems, difficulties, and disorders that could be readily traced to deep social inequalities, and the markedly limited economic capacity from governments to address their respective situations. The pandemic, which started as a disease among the more affluent classes that travelled overseas, mostly by planes, or who had family living overseas and came back to visit, is now affecting the most vulnerized populations, those who live in precarious, crowded quarters without access to sanitary resources, unable to engage in social distancing, labor in direct service delivery, and rely in public health care services (EGEDE; RUGGIERO; FRUEH, 2020EGEDE, Leonard; RUGGIERO, Kenneth; FRUEH, Christopher. Ensuring mental health access for vulnerable populations in COVID era. Journal of Psychiatric Research, v. 129, p. 147-148, Oct. 2020. https://doi.org/10.1016/j.jpsychires.2020.07.011
https://doi.org/10.1016/j.jpsychires.202...
).

How are the most vulnerable populations to COVID-19 defined? So far, different populations at higher risk have been identified from a medical viewpoint such as the elderly, the immunocompromised, and patients with preexisting conditions including heart disease, diabetes. However, the importance of rethinking the vulnerability category has already been recognized (REDEFINING..., 2020REDEFINING vulnerability in the era of COVID-19 [Editorial]. The Lancet, v. 395, n. 10230, p. 1089, Apr. 4, 2020. https://doi.org/10.1016/S0140-6736(20)30757-1
https://doi.org/10.1016/S0140-6736(20)30...
), given that there have been countless situations of vulnerability that do not correspond to strictly medical issues, nor are they fully explained economically, but they are certainly connected.

We refer to the millions of migrants and forcibly displaced populations, indigenous populations, women victims/survivors of multiple sources of violence and abuse, exposed children and adolescents, the incarcerated and the institutionalized people in hospices and nursing homes, homeless, temporary workers laboring in what is referred to as the gig economy, gender and sexual minoritized populations, people living with mental illnesses and other forms of disabilities. We do not yet have a real dimension of the impact and possible consequences that this pandemic will bring, but we do know that vulnerized groups will bear the brunt of this situation (KELLEY et al., 2020KELLEY, Maureen et al. An appeal for practical social justice in the COVID-19 global response in low-income and middle-income countries. The Lancet Global Health, v. 8, n. 7, p. e888-e889, May 14, 2020. https://doi.org/10.1016/S2214-109X(20)30249-7
https://doi.org/10.1016/S2214-109X(20)30...
).

Some of these particularly vulnerable groups have been identified in prison populations (FOVET et al. 2020FOVET, Thomas et al. Prisons confines: quelles conséquences pour les soins psychiatriques et la santé mentale des personnes détenues en France? L’Encephale, v. 46, n. 3, p. S60-S65, juin 2020. https://doi.org/10.1016/j.encep.2020.05.002
https://doi.org/10.1016/j.encep.2020.05....
), indigenous populations (GONÇALVES JÚNIOR et al., 2020aGONÇALVES JÚNIOR, Jucier et al. The mental health of those whose rights have been taken away: An essay on the mental health of indigenous peoples in the face of the 2019 Coronavirus (2019-nCoV) outbreak. Psychiatry Research, v. 289, art. 113094, July 2020a. https://doi.org/10.1016/j.psychres.2020.113094
https://doi.org/10.1016/j.psychres.2020....
), migrants and refugees (GONÇALVES JÚNIOR et al., 2020bGONÇALVES JÚNIOR, Jucier et al. A crisis within the crisis: The mental health situation of refugees in the world during the 2019 coronavirus (2019-nCoV) outbreak. Psychiatry Research, v. 288, art. 113000, June 2020b. https://doi.org/10.1016/j.psychres.2020.113000
https://doi.org/10.1016/j.psychres.2020....
), older adults (BANERJEE, 2020BANERJEE, Debanjan. ‘Age and ageism in COVID-19’: Elderly mental health-care vulnerabilities and needs.” Asian Journal of Psychiatry, v. 51, art. 102154, June 2020. https://doi.org/10.1016/j.ajp.2020.102154
https://doi.org/10.1016/j.ajp.2020.10215...
; FLINT; KATHLEEN; IABONI, 2020FLINT, Alastair; KATHLEEN, Bingham; IABONI, Andrea. Effect of COVID-19 on the mental health care of older people in Canada. International Psychogeriatrics, v. 32, n. 10, p. 1113-1116, Apr. 24, 2020. https://doi.org/10.1017/S1041610220000708
https://doi.org/10.1017/S104161022000070...
), children and adolescents (FEGERT et al., 2020FEGERT, Jörg et al. Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child and Adolescent Psychiatry and Mental Health, v. 14, art. 20, May 12, 2020. https://doi.org/10.1186/s13034-020-00329-3
https://doi.org/10.1186/s13034-020-00329...
; LOADES et al., 2020LOADES, Maria Elizabeth et al. Rapid systematic review: The impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19. Journal of the American Academy of Child and Adolescent Psychiatry, v. 59, n. 11, p. 1218-1239.e3, June 2, 2020. https://doi.org/10.1016/j.jaac.2020.05.009
https://doi.org/10.1016/j.jaac.2020.05.0...
), sexual minorities (FLENTJE et al., 2020FLENTJE, Annesa et al. Depression and anxiety changes among sexual and gender minority people coinciding with onset of COVID-19 pandemic. Journal of General Internal Medicine, v. 35, n. 9, p. 2788-2790, June 17, 2020. https://doi.org/10.1007/s11606-020-05970-4
https://doi.org/10.1007/s11606-020-05970...
; SILLIMAN; BOSK, 2020SILLIMAN, Rachel; BOSK, Emily. Vulnerable youth and the COVID-19 pandemic. Pediatrics, v. 146, n. 1, p. e20201306, July 1, 2020. https://doi.org/10.1542/peds.2020-1306
https://doi.org/10.1542/peds.2020-1306...
), people with disabilities (PAZ-MALDONADO; FLORES-GIRÓN, 2021PAZ-MALDONADO, Eddy; FLORES-GIRÓN, Hazaria. Barreras que enfrentan las personas en situación de discapacidad durante la COVID-19 en Honduras. Rehabilitación, Feb. 18, 2021. In press. https://doi.org/10.1016/j.rh.2021.02.004
https://doi.org/10.1016/j.rh.2021.02.004...
, in press; WORLD HEALTH ORGANIZATION, 2020WORLD HEALTH ORGANIZATION. Disability considerations during the COVID-19 outbreak [online], 2020. Available at: Available at: www.who.int/docs/default-source/documents/disability/eng-covid-19-disability-briefing-who.pdf?sfvrsn=963e22fe_1 . Accessed on: Oct. 21, 2019.
www.who.int/docs/default-source/document...
) and people with suicidal ideation (BANERJEE; KOSAGISHARAF; RAO, 2021BANERJEE, Debanjan; KOSAGISHARAF, Jagannatha Rao; RAO, T. S. Sathyanarayana. ‘The dual pandemic’ of suicide and COVID-19: A biopsychosocial narrative of risks and prevention. Psychiatry Research, v. 295, art. 113577, Jan. 2021. https://doi.org/10.1016/j.psychres.2020.113577
https://doi.org/10.1016/j.psychres.2020....
; GUNNELL et al., 2020GUNNELL, David et al. Suicide risk and prevention during the COVID-19 pandemic. The Lancet Psychiatry, v. 7, n. 6, p. 468-471, June 1, 2020. https://doi.org/10.1016/S2215-0366(20)30171-1
https://doi.org/10.1016/S2215-0366(20)30...
; THAKUR; JAIN, 2020THAKUR, Vikram; JAIN, Anu. COVID 2019-suicides: A global psychological pandemic.” Brain, Behavior, and Immunity, v. 88, p. 952-953, Aug. 2020. https://doi.org/10.1016/j.bbi.2020.04.062
https://doi.org/10.1016/j.bbi.2020.04.06...
), among others. In general, the studies tend to highlight an increase in various psychological disorders and a decrease in the psychosocial well-being of the general population, but also a greater risk to the mental health of different populations considered markedly vulnerable (GALLEGOS et al., 2020GALLEGOS, Miguel et al. Cómo afrontar la pandemia del Coronavirus (COVID-19) en las Américas: recomendaciones y líneas de acción sobre salud mental. Revista Interamericana de Psicología/Interamerican Journal of Psychology, v. 54, n. 1, p. e1304, Apr. 30, 2020. https://doi.org/10.30849/ripijp.v54i1.1304
https://doi.org/10.30849/ripijp.v54i1.13...
; KOLA et al., 2021KOLA, Lola et al. COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health. The Lancet Psychiatry, v. 8, n. 6, p. 535-550, Feb. 24, 2021. https://doi.org/10.1016/S2215-0366(21)00025-0
https://doi.org/10.1016/S2215-0366(21)00...
; SCHOLTEN et al., 2020SCHOLTEN, Hernán et al. Abordaje psicológico del COVID-19: Una revisión narrativa de la experiencia latinoamericana. Revista Interamericana de Psicología/Interamerican Journal of Psychology, v. 54, n. 1, e1287, May 5, 2020. https://doi.org/10.30849/ripijp.v54i1.1287
https://doi.org/10.30849/ripijp.v54i1.12...
).

These are populations that not only have difficulties in accessing basic health resources to deal with COVID-19, but are also exposed to suffering all kinds of discrimination, stigmatization, inequality, and violence (ANDOH, 2020ANDOH, Efua. How psychologists can combat the racial inequities of the COVID-19 crisis. American Psychological Association, May 1, 2020. Available in: Available in: http://www.apa.org/topics/covid-19/racial-inequities . Accessed on: Aug. 13, 2021.
http://www.apa.org/topics/covid-19/racia...
). Recent studies have vividly exposed these problematic social inequities, ones that ought to become the focus of governmental policies and specialized professional attention, during and beyond this pandemic (AMERICAN PSYCHOLOGICAL ASSOCIATION, 2020AMERICAN PSYCHOLOGICAL ASSOCIATION. How COVID-19 impacts people with disabilities, May 6, 2020. Available at: Available at: http://www.apa.org/topics/covid-19/research-disabilities . Accessed on: July 25, 2020.
http://www.apa.org/topics/covid-19/resea...
; AMERIO et al., 2020AMERIO, Andrea et al. Covid-19 pandemic impact on mental health of vulnerable populations. Acta Biomedica, v. 91, n. 9-S, p. 95-96, July 20, 2020. https://doi.org/10.23750/abm.v91i9-S.10112
https://doi.org/10.23750/abm.v91i9-S.101...
; GONÇALVES JÚNIOR et al., 2020aGONÇALVES JÚNIOR, Jucier et al. The mental health of those whose rights have been taken away: An essay on the mental health of indigenous peoples in the face of the 2019 Coronavirus (2019-nCoV) outbreak. Psychiatry Research, v. 289, art. 113094, July 2020a. https://doi.org/10.1016/j.psychres.2020.113094
https://doi.org/10.1016/j.psychres.2020....
, 2020bGONÇALVES JÚNIOR, Jucier et al. A crisis within the crisis: The mental health situation of refugees in the world during the 2019 coronavirus (2019-nCoV) outbreak. Psychiatry Research, v. 288, art. 113000, June 2020b. https://doi.org/10.1016/j.psychres.2020.113000
https://doi.org/10.1016/j.psychres.2020....
; MENESES-NAVARRO et al., 2020MENESES-NAVARRO, Sergio et al. The challenges facing indigenous communities in Latin America as they confront the COVID-19 pandemic. International Journal for Equity in Health, v. 19, art. 63, May 7, 2020. https://doi.org/10.1186/s12939-020-01178-4
https://doi.org/10.1186/s12939-020-01178...
; ORCUTT et al., 2020ORCUTT, Miriam et al. Global call to action for inclusion of migrants and refugees in the COVID-19 response. The Lancet, v. 395, n. 10235, p. 1482-1483, Apr. 23, 2020. https://doi.org/10.1016/S0140-6736(20)30971-5
https://doi.org/10.1016/S0140-6736(20)30...
).

It is not by chance that it has been proposed to speak conceptually of a syndemic instead of a pandemic. The application of the concept of syndemic to the current health crisis means that it cannot be thought outside of the multiple biological, social, cultural, political, and economic determinations that affect the health of the population (HORTON, 2020bHORTON, Richard. Offline: COVID-19 is not a pandemic. The Lancet, v. 396, n. 10255, p. 874, Sept. 26, 2020b. https://doi.org/10.1016/S0140-6736(20)32000-6
https://doi.org/10.1016/S0140-6736(20)32...
). This implies, at the same time, that the response to the current crisis cannot be reduced exclusively to the knowledge of biomedical sciences such as medicine, virology, infectology, and the like, but requires all the social and humanistic disciplines, among them, psychology, anthropology, sociology, etc. (GALLEGOS et al., 2022GALLEGOS, Miguel et al. The impact of COVID-19 on Latin American psychology: research, profession, and public policy. Estudos de Psicologia, Campinas, 2022. In press., in press).

An important contribution was developed by the regional emergency response team in Mental Health and Psychosocial Support (SMAPS) of the Pan American Health Organization (ORGANIZACIÓN PANAMERICANA DE LA SALUD, 2020ORGANIZACIÓN PANAMERICANA DE LA SALUD. COVID-19: Intervenciones recomendadas en salud mental y apoyo psicosocial (SMAPS) durante la pandemia. Washington, D.C.: OPS, 2020. Available at: Available at: https://iris.paho.org/handle/10665.2/52427 . Accessed on: 12 out. 2021.
https://iris.paho.org/handle/10665.2/524...
), in the form of a guidance document, and adapted to the context of the COVID-19 pandemic. This model of intervention in mental health and psychosocial support, like other recommendation guides, provides the first tool to organize government action strategies and different professional practices. However, due to the sizable inequities that characterize the diverse populations of Latin American and the vertiginous confinement that occurred in most Latin American countries, the SMAPS model was quite limited.

Conclusion

COVID-19 represents a very serious threat to Latin America, mainly because it confronts the region with underlying and unresolved problems, their origins can be readily found equally in the distant and the immediate present. Specifically, social inequality expressed in inequities of access to health care, living arrangement, and financial resources, among others play a crucial role in the ultimate impact on public health in the region. Not only in terms of people’s physical and mental health, but also regarding the excessive burden of psychosocial stress on communities and governments.

How should this pandemic be addressed in Latin America? Among the many possible answers, an urgent one is greater cooperation and coordinated, strategic actions between neighboring countries. Historical animosities among countries and differences in political orientations of neighboring countries may be significant challenges to bring about such urgent actions. Although it seems paradoxical, in the face of a global and interconnected problem, the responses have been, in our view, excessively national and with little regional coordination. But this that has been visible at the regional level, has also been observed at the international level. In fact, at the latter level, it seems particularly problematic the difficulties in arriving at coordinated efforts. It will not be possible to give an effective response if each country closes in on itself, in addition, this type of response can generate greater problems as it may result in the further spread of the virus.

But in addition to this coordinated perspective at the regional level, it will also be necessary to arrive at tangible actions that address forthrightly the numerous psychosocial problems. This psychosocial problems have vulnerized large segments of the Latin American populations, with direct impact on their mental health. COVID-19 in Latin America presents a unique opportunity to expose the large, underlying, yet readily visible injustices that characterizes life in Latin America. The comorbidity between psychosocial problems and mental health problems is a literally deadly combination worldwide and specially in Latin American societies.

It is no coincidence that the data provided by the research that has recently begun to be published demonstrates the high psychological and emotional impact that the pandemic has had on the mental health and psychosocial well-being of the Latin American population. It is crucial that the empirical evidence provided by regional epidemiological studies contributes to the design of public mental health policies in Latin America, both to lessen the negative effects and to prevent the future consequences of a pandemic that has not yet ended. It is also important to recover the psychological and community programs that have been implemented during the pandemic, be they face-to-face or virtual, to extract those experiences that have been beneficial in the mental health care of the Latin American populations, and can serve as guidance for future actions, in particular to address the needs of the most vulnerized populations.

Up to now, it seems fair to say that there have been sizable efforts worldwide to coordinate and advance global health. Although imperfect, it has served as a guide. However, it is conditioned by visions and concerns from other contexts that are not easily translated nor applied to the region. Therefore, it is now necessary to build a regional coordination policy on the most relevant psychosocial problems to guide scientific research, public policy planning, and the professional response that will need to be assigned to and relied upon each sector.

References

  • ALMONDES, Katie Moraes de et al. Comparative analysis of psychology responding to COVID-19 pandemic in Brics nations. Frontiers in Psychology, v. 12, art. 567585, 3 jun. 2021. https://doi.org/10.3389/fpsyg.2021.567585
    » https://doi.org/10.3389/fpsyg.2021.567585
  • AGUILERA EGUÍA, Raúl. ?Revisión sistemática, revisión narrativa o metaanálisis? Revista de la Sociedad Española del Dolor, Madri, v. 21, n. 6, p. 359-360, 2014. https://dx.doi.org/10.4321/S1134-80462014000600010
    » https://dx.doi.org/10.4321/S1134-80462014000600010
  • AMERICAN PSYCHOLOGICAL ASSOCIATION. How COVID-19 impacts people with disabilities, May 6, 2020. Available at: Available at: http://www.apa.org/topics/covid-19/research-disabilities Accessed on: July 25, 2020.
    » http://www.apa.org/topics/covid-19/research-disabilities
  • AMERIO, Andrea et al. Covid-19 pandemic impact on mental health of vulnerable populations. Acta Biomedica, v. 91, n. 9-S, p. 95-96, July 20, 2020. https://doi.org/10.23750/abm.v91i9-S.10112
    » https://doi.org/10.23750/abm.v91i9-S.10112
  • ANDOH, Efua. How psychologists can combat the racial inequities of the COVID-19 crisis. American Psychological Association, May 1, 2020. Available in: Available in: http://www.apa.org/topics/covid-19/racial-inequities Accessed on: Aug. 13, 2021.
    » http://www.apa.org/topics/covid-19/racial-inequities
  • BANERJEE, Debanjan. ‘Age and ageism in COVID-19’: Elderly mental health-care vulnerabilities and needs.” Asian Journal of Psychiatry, v. 51, art. 102154, June 2020. https://doi.org/10.1016/j.ajp.2020.102154
    » https://doi.org/10.1016/j.ajp.2020.102154
  • BANERJEE, Debanjan; KOSAGISHARAF, Jagannatha Rao; RAO, T. S. Sathyanarayana. ‘The dual pandemic’ of suicide and COVID-19: A biopsychosocial narrative of risks and prevention. Psychiatry Research, v. 295, art. 113577, Jan. 2021. https://doi.org/10.1016/j.psychres.2020.113577
    » https://doi.org/10.1016/j.psychres.2020.113577
  • CANET-JURIC, Lorena; CRESTANI CALEGARO, Vítor. Compendio de Actas del I Fórum Latinoamericano de Salud Mental en Pandemia: desafíos, panorama actual y perspectivas futuras. Mar del Plata: Universidad Nacional de Mar del Plata, 2021.
  • CAYCHO-RODRÍGUEZ, Tomás et al. Cross-cultural measurement invariance of the fear of COVID-19 scale in seven Latin American countries. Death Studies, Feb. 9, 2021a. https://doi.org/10.1080/07481187.2021.1879318
    » https://doi.org/10.1080/07481187.2021.1879318
  • CAYCHO-RODRÍGUEZ, Tomás et al. Socio-demographic variables, fear of COVID-19, anxiety and depression: prevalence, relationships and explanatory model in the general population of seven Latin American countries. Frontiers in Psychology, v. 12, art. 695989, Nov. 5, 2021b. https://doi.org/10.3389/fpsyg.2021.695989
    » https://doi.org/10.3389/fpsyg.2021.695989
  • EGEDE, Leonard; RUGGIERO, Kenneth; FRUEH, Christopher. Ensuring mental health access for vulnerable populations in COVID era. Journal of Psychiatric Research, v. 129, p. 147-148, Oct. 2020. https://doi.org/10.1016/j.jpsychires.2020.07.011
    » https://doi.org/10.1016/j.jpsychires.2020.07.011
  • FEGERT, Jörg et al. Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child and Adolescent Psychiatry and Mental Health, v. 14, art. 20, May 12, 2020. https://doi.org/10.1186/s13034-020-00329-3
    » https://doi.org/10.1186/s13034-020-00329-3
  • FLENTJE, Annesa et al. Depression and anxiety changes among sexual and gender minority people coinciding with onset of COVID-19 pandemic. Journal of General Internal Medicine, v. 35, n. 9, p. 2788-2790, June 17, 2020. https://doi.org/10.1007/s11606-020-05970-4
    » https://doi.org/10.1007/s11606-020-05970-4
  • FLINT, Alastair; KATHLEEN, Bingham; IABONI, Andrea. Effect of COVID-19 on the mental health care of older people in Canada. International Psychogeriatrics, v. 32, n. 10, p. 1113-1116, Apr. 24, 2020. https://doi.org/10.1017/S1041610220000708
    » https://doi.org/10.1017/S1041610220000708
  • FOVET, Thomas et al. Prisons confines: quelles conséquences pour les soins psychiatriques et la santé mentale des personnes détenues en France? L’Encephale, v. 46, n. 3, p. S60-S65, juin 2020. https://doi.org/10.1016/j.encep.2020.05.002
    » https://doi.org/10.1016/j.encep.2020.05.002
  • GALLEGOS, Miguel et al. Cómo afrontar la pandemia del Coronavirus (COVID-19) en las Américas: recomendaciones y líneas de acción sobre salud mental. Revista Interamericana de Psicología/Interamerican Journal of Psychology, v. 54, n. 1, p. e1304, Apr. 30, 2020. https://doi.org/10.30849/ripijp.v54i1.1304
    » https://doi.org/10.30849/ripijp.v54i1.1304
  • GALLEGOS, Miguel et al. The impact of COVID-19 on Latin American psychology: research, profession, and public policy. Estudos de Psicologia, Campinas, 2022. In press.
  • GUNNELL, David et al. Suicide risk and prevention during the COVID-19 pandemic. The Lancet Psychiatry, v. 7, n. 6, p. 468-471, June 1, 2020. https://doi.org/10.1016/S2215-0366(20)30171-1
    » https://doi.org/10.1016/S2215-0366(20)30171-1
  • HOLMES, Emily et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. The Lancet Psychiatry, v. 7, n. 6, p. 547-560, Apr. 15, 2020. https://doi.org/10.1016/S2215-0366(20)30168-1
    » https://doi.org/10.1016/S2215-0366(20)30168-1
  • HORTON, Richard. Offline: Why President Trump is wrong about WHO. The Lancet, v. 395, n. 10233, p. 1330, Apr. 25, 2020a. https://doi.org/10.1016/S0140-6736(20)30969-7
    » https://doi.org/10.1016/S0140-6736(20)30969-7
  • HORTON, Richard. Offline: COVID-19 is not a pandemic. The Lancet, v. 396, n. 10255, p. 874, Sept. 26, 2020b. https://doi.org/10.1016/S0140-6736(20)32000-6
    » https://doi.org/10.1016/S0140-6736(20)32000-6
  • INFANTE PEDREIRA, Olga Esther; GRAU ÁBALO, Jorge Amado. La psicología de la salud en el enfrentamiento a la COVID-19 en América Latina. Repositorio de la Universidad César Vallejo, 2020. https://hdl.handle.net/20.500.12692/52877
    » https://hdl.handle.net/20.500.12692/52877
  • GONÇALVES JÚNIOR, Jucier et al. The mental health of those whose rights have been taken away: An essay on the mental health of indigenous peoples in the face of the 2019 Coronavirus (2019-nCoV) outbreak. Psychiatry Research, v. 289, art. 113094, July 2020a. https://doi.org/10.1016/j.psychres.2020.113094
    » https://doi.org/10.1016/j.psychres.2020.113094
  • GONÇALVES JÚNIOR, Jucier et al. A crisis within the crisis: The mental health situation of refugees in the world during the 2019 coronavirus (2019-nCoV) outbreak. Psychiatry Research, v. 288, art. 113000, June 2020b. https://doi.org/10.1016/j.psychres.2020.113000
    » https://doi.org/10.1016/j.psychres.2020.113000
  • KELLEY, Maureen et al. An appeal for practical social justice in the COVID-19 global response in low-income and middle-income countries. The Lancet Global Health, v. 8, n. 7, p. e888-e889, May 14, 2020. https://doi.org/10.1016/S2214-109X(20)30249-7
    » https://doi.org/10.1016/S2214-109X(20)30249-7
  • KOLA, Lola et al. COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health. The Lancet Psychiatry, v. 8, n. 6, p. 535-550, Feb. 24, 2021. https://doi.org/10.1016/S2215-0366(21)00025-0
    » https://doi.org/10.1016/S2215-0366(21)00025-0
  • LOADES, Maria Elizabeth et al. Rapid systematic review: The impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19. Journal of the American Academy of Child and Adolescent Psychiatry, v. 59, n. 11, p. 1218-1239.e3, June 2, 2020. https://doi.org/10.1016/j.jaac.2020.05.009
    » https://doi.org/10.1016/j.jaac.2020.05.009
  • LUNA-SÁNCHEZ, Sandra Elizabeth et al. Memorias del Congreso Virtual de la Sociedad Interamericana de Psicología 2020: Aportes de la Psicología ante la COVID-19. San Juan: Sociedad Interamericana Psicología/Universidad Carlos Albizu, 2020.
  • MENESES-NAVARRO, Sergio et al. The challenges facing indigenous communities in Latin America as they confront the COVID-19 pandemic. International Journal for Equity in Health, v. 19, art. 63, May 7, 2020. https://doi.org/10.1186/s12939-020-01178-4
    » https://doi.org/10.1186/s12939-020-01178-4
  • MORENO, Carmen et al. How mental health care should change as a consequence of the COVID-19 pandemic. The Lancet Psychiatry, v. 7, n. 9, p. 813-824, July 16, 2020. https://doi.org/10.1016/S2215-0366(20)30307-2
    » https://doi.org/10.1016/S2215-0366(20)30307-2
  • ORCUTT, Miriam et al. Global call to action for inclusion of migrants and refugees in the COVID-19 response. The Lancet, v. 395, n. 10235, p. 1482-1483, Apr. 23, 2020. https://doi.org/10.1016/S0140-6736(20)30971-5
    » https://doi.org/10.1016/S0140-6736(20)30971-5
  • ORGANIZACIÓN PANAMERICANA DE LA SALUD. La carga de los trastornos mentales en la región de las Américas, 2018. Washington, D. C.: OPS, 2018. Available at: Available at: https://iris.paho.org/bitstream/handle/10665.2/49578/9789275320280_spa.pdf?sequence=9 Accessed on: May 18, 2020.
    » https://iris.paho.org/bitstream/handle/10665.2/49578/9789275320280_spa.pdf?sequence=9
  • ORGANIZACIÓN PANAMERICANA DE LA SALUD. COVID-19: Intervenciones recomendadas en salud mental y apoyo psicosocial (SMAPS) durante la pandemia. Washington, D.C.: OPS, 2020. Available at: Available at: https://iris.paho.org/handle/10665.2/52427 Accessed on: 12 out. 2021.
    » https://iris.paho.org/handle/10665.2/52427
  • ORGANIZACIÓN PANAMERICANA DE LA SALUD. Alerta epidemiológica: COVID-19 incremento de las hospitalizaciones y de las defunciones en pacientes menores de 60 años. Washington, D.C.: OPS/OMS, 2021. Available at: Available at: https://www.paho.org/es/documentos/alerta-epidemiologica-covid-19-incremento-hospitalizaciones-defunciones-pacientes Accessed on: Mar. 20, 2021.
    » https://www.paho.org/es/documentos/alerta-epidemiologica-covid-19-incremento-hospitalizaciones-defunciones-pacientes
  • PAZ-MALDONADO, Eddy; FLORES-GIRÓN, Hazaria. Barreras que enfrentan las personas en situación de discapacidad durante la COVID-19 en Honduras. Rehabilitación, Feb. 18, 2021. In press. https://doi.org/10.1016/j.rh.2021.02.004
    » https://doi.org/10.1016/j.rh.2021.02.004
  • PORTILLO, Nelson et al. Psychology and COVID-19 in the Americas. Springer, 2022. In press.
  • PULIDO-MARTÍNEZ, Hernán Camilo; BURBANO-VALENTE, Johanna. La crítica de la psicología, trabajo y la pandemia de Covid-19. Fractal: Revista de Psicologia, Niterói, v. 32, n. 3, p. 318-327, 2020. https://doi.org/10.22409/1984-0292/v32i3/45576
    » https://doi.org/10.22409/1984-0292/v32i3/45576
  • REDEFINING vulnerability in the era of COVID-19 [Editorial]. The Lancet, v. 395, n. 10230, p. 1089, Apr. 4, 2020. https://doi.org/10.1016/S0140-6736(20)30757-1
    » https://doi.org/10.1016/S0140-6736(20)30757-1
  • RODRÍGUEZ-BAILÓN, Rosa. Inequality viewed through the mirror of COVID-19 (La desigualdad ante el espejo del COVID-19). International Journal of Social Psychology, v. 35, n. 3, p. 647-655, Aug. 27, 2020. https://doi.org/10.1080/02134748.2020.1796298
    » https://doi.org/10.1080/02134748.2020.1796298
  • SCHOLTEN, Hernán et al. Abordaje psicológico del COVID-19: Una revisión narrativa de la experiencia latinoamericana. Revista Interamericana de Psicología/Interamerican Journal of Psychology, v. 54, n. 1, e1287, May 5, 2020. https://doi.org/10.30849/ripijp.v54i1.1287
    » https://doi.org/10.30849/ripijp.v54i1.1287
  • SILLIMAN, Rachel; BOSK, Emily. Vulnerable youth and the COVID-19 pandemic. Pediatrics, v. 146, n. 1, p. e20201306, July 1, 2020. https://doi.org/10.1542/peds.2020-1306
    » https://doi.org/10.1542/peds.2020-1306
  • ŞIMŞIR, Zeynep et al. The relationship between fear of COVID-19 and mental health problems: A meta-analysis. Death Studies, p. 1-9, Feb. 27, 2021. https://doi.org/10.1080/07481187.2021.1889097
    » https://doi.org/10.1080/07481187.2021.1889097
  • THAKUR, Vikram; JAIN, Anu. COVID 2019-suicides: A global psychological pandemic.” Brain, Behavior, and Immunity, v. 88, p. 952-953, Aug. 2020. https://doi.org/10.1016/j.bbi.2020.04.062
    » https://doi.org/10.1016/j.bbi.2020.04.062
  • UNITED NATIONS. Policy brief: COVID-19 and the need for actions on mental health. May 13, 2020. Available at: Available at: https://www.un.org/sites/un2.un.org/files/un_policy_brief-covid_and_mental_health_final.pdf Accessed on: Apr. 12, 2021.
    » https://www.un.org/sites/un2.un.org/files/un_policy_brief-covid_and_mental_health_final.pdf
  • WORLD HEALTH ORGANIZATION. Disability considerations during the COVID-19 outbreak [online], 2020. Available at: Available at: www.who.int/docs/default-source/documents/disability/eng-covid-19-disability-briefing-who.pdf?sfvrsn=963e22fe_1 Accessed on: Oct. 21, 2019.
    » www.who.int/docs/default-source/documents/disability/eng-covid-19-disability-briefing-who.pdf?sfvrsn=963e22fe_1

  • 2
    Os dados completos dos autores encontram-se ao final do artigo.

Publication Dates

  • Publication in this collection
    11 Feb 2022
  • Date of issue
    Sep-Dec 2021

History

  • Received
    16 Aug 2021
  • Reviewed
    14 Sept 2021
  • Reviewed
    01 Oct 2021
  • Accepted
    01 Oct 2021
Universidade Federal Fluminense, Departamento de Psicologia Campus do Gragoatá, bl O, sala 334, 24210-201 - Niterói - RJ - Brasil, Tel.: +55 21 2629-2845 - Rio de Janeiro - RJ - Brazil
E-mail: revista_fractal@yahoo.com.br