An updated systematic review on the coronavirus pandemic: lessons for psychiatry

Risk stratification always occurs in potentially life-threatening scenarios so that the resources and attention of medical personnel are targeted at more objective goals, such as the infection itself, rather than comorbidities like mental disorders. However, some efforts have been made to address psychological and psychiatric issues during the pandemic. In one such case, on Jan 26, 2020 the National Health Commission of China published (in Chinese only) basic principles for emergency psychological crisis intervention during the COVID-19 outbreak.

We performed a systematic review according to Cochrane group recommendations, and the present report follows PRISMA guidelines. A total of ten articles were included. Every article was either based on (a) describing strategies for coping with the pandemic and/or (b) a more descriptive analysis of the overall clinical scenario, with emphasis in psychiatric comorbidities. Of the ten articles, seven were by Chinese groups,11. Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry. 2020;7:228-9.

2. Jiang X, Deng L, Zhu Y, Ji H, Tao L, Liu L, et al. Psychological crisis intervention during the outbreak period of new coronavirus pneumonia from experience in Shanghai. Psychiatry Res. 2020;286:112903.

3. Xiao C. A novel approach of consultation on 2019 novel coronavirus (COVID-19)-related psychological and mental problems: structured letter therapy. Psychiatry Investig. 2020;17:175-6.

4. Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. 2020;7:e14.

5. Tsai J, Wilson M. COVID-19: a potential public health problem for homeless populations. Lancet Public Health. 2020 Mar 11. pii: S2468-2667(20)30053-0. doi: http://10.1016/S2468-2667(20)30053-0 [Epub ahead of print]
http://10.1016/S2468-2667(20)30053-0...

6. Yang Y, Li W, Zhang Q, Zhang L, Cheung T, Xiang YT. Mental health services for older adults in China during the COVID-19 outbreak. Lancet Psychiatry. 2020;7:e19.
-77. Zhou X. Psychological crisis interventions in Sichuan Province during the 2019 novel coronavirus outbreak. Psychiatry Res. 2020;286:112895. one was by an American group,88. Asmundson GJ, Taylor S. How health anxiety influences responses to viral outbreaks like COVID-19: what all decision-makers, health authorities, and health care professionals need to know. J Anxiety Disord. 2020;71:102211. one was by a Japanese group,99. Shigemura J, Ursano RJ, Morganstein JC, Kurosawa M, Benedek DM. Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan: mental health consequences and target populations. Psychiatry Clin Neurosci. 2020 Feb 8. doi: http://10.1111/pcn.12988 [Epub ahead of print]
http://10.1111/pcn.12988...
and one was by a Korean group.1010. Park SC, Park YC. Mental health care measures in response to the 2019 novel coronavirus outbreak in Korea. Psychiatry Investig. 2020;17:85-6. The main findings are summarized in Table 1.

Table 1
Main findings for psychiatric issues during the COVID-19 pandemic

The main findings highlight the negative emotion and stress experienced by healthcare workers who treat infected patients. The main symptoms included de novo complaints of insomnia, anxiety, and feelings of hopeless, as well as the reactivation of previous disorders, such as depression, anxiety and even suicidal behavior. These mental health problems not only affect patients but also medical workers, which can lead to misunderstandings and poor decision making, and can also hinder the fight against COVID-19, as well as have lasting effects on individual well-being. It was also found that people with health anxiety tend to misinterpret benign bodily sensations and changes as dangerous, which increases hospital visits and, thus, the risk for infection itself. Some authors have focused on specific populations such as the homeless55. Tsai J, Wilson M. COVID-19: a potential public health problem for homeless populations. Lancet Public Health. 2020 Mar 11. pii: S2468-2667(20)30053-0. doi: http://10.1016/S2468-2667(20)30053-0 [Epub ahead of print]
http://10.1016/S2468-2667(20)30053-0...
and older adults.66. Yang Y, Li W, Zhang Q, Zhang L, Cheung T, Xiang YT. Mental health services for older adults in China during the COVID-19 outbreak. Lancet Psychiatry. 2020;7:e19.

Three important factors for overcoming the main difficulties in clinical practice emerge from reports on the Chinese mental health care response to the COVID-19 outbreak11. Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry. 2020;7:228-9.

2. Jiang X, Deng L, Zhu Y, Ji H, Tao L, Liu L, et al. Psychological crisis intervention during the outbreak period of new coronavirus pneumonia from experience in Shanghai. Psychiatry Res. 2020;286:112903.

3. Xiao C. A novel approach of consultation on 2019 novel coronavirus (COVID-19)-related psychological and mental problems: structured letter therapy. Psychiatry Investig. 2020;17:175-6.

4. Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. 2020;7:e14.

5. Tsai J, Wilson M. COVID-19: a potential public health problem for homeless populations. Lancet Public Health. 2020 Mar 11. pii: S2468-2667(20)30053-0. doi: http://10.1016/S2468-2667(20)30053-0 [Epub ahead of print]
http://10.1016/S2468-2667(20)30053-0...

6. Yang Y, Li W, Zhang Q, Zhang L, Cheung T, Xiang YT. Mental health services for older adults in China during the COVID-19 outbreak. Lancet Psychiatry. 2020;7:e19.
-77. Zhou X. Psychological crisis interventions in Sichuan Province during the 2019 novel coronavirus outbreak. Psychiatry Res. 2020;286:112895.: 1) multidisciplinary mental health teams (including psychiatrists, psychiatric nurses, clinical psychologists, and other mental health professionals) must be established; 2) up-to-date communication with reliable data about the COVID-19 outbreak is necessary; and 3) interventions (mainly psychological counseling) are needed for patients and healthcare providers directly involved in the outbreak (e.g., through electronic devices and apps).

Initial publications have addressed the overall psychological characteristics of patients and healthcare providers, as well as rapidly implemented interventions to cope with this catastrophic life-threatening scenario. Hopefully, the success of such efforts will become clear in the near future.

References

  • 1
    Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry. 2020;7:228-9.
  • 2
    Jiang X, Deng L, Zhu Y, Ji H, Tao L, Liu L, et al. Psychological crisis intervention during the outbreak period of new coronavirus pneumonia from experience in Shanghai. Psychiatry Res. 2020;286:112903.
  • 3
    Xiao C. A novel approach of consultation on 2019 novel coronavirus (COVID-19)-related psychological and mental problems: structured letter therapy. Psychiatry Investig. 2020;17:175-6.
  • 4
    Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. 2020;7:e14.
  • 5
    Tsai J, Wilson M. COVID-19: a potential public health problem for homeless populations. Lancet Public Health. 2020 Mar 11. pii: S2468-2667(20)30053-0. doi: http://10.1016/S2468-2667(20)30053-0 [Epub ahead of print]
    » http://10.1016/S2468-2667(20)30053-0
  • 6
    Yang Y, Li W, Zhang Q, Zhang L, Cheung T, Xiang YT. Mental health services for older adults in China during the COVID-19 outbreak. Lancet Psychiatry. 2020;7:e19.
  • 7
    Zhou X. Psychological crisis interventions in Sichuan Province during the 2019 novel coronavirus outbreak. Psychiatry Res. 2020;286:112895.
  • 8
    Asmundson GJ, Taylor S. How health anxiety influences responses to viral outbreaks like COVID-19: what all decision-makers, health authorities, and health care professionals need to know. J Anxiety Disord. 2020;71:102211.
  • 9
    Shigemura J, Ursano RJ, Morganstein JC, Kurosawa M, Benedek DM. Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan: mental health consequences and target populations. Psychiatry Clin Neurosci. 2020 Feb 8. doi: http://10.1111/pcn.12988 [Epub ahead of print]
    » http://10.1111/pcn.12988
  • 10
    Park SC, Park YC. Mental health care measures in response to the 2019 novel coronavirus outbreak in Korea. Psychiatry Investig. 2020;17:85-6.

Publication Dates

  • Publication in this collection
    30 Apr 2020
  • Date of issue
    2020

History

  • Received
    23 Mar 2020
  • Accepted
    29 Mar 2020
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