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<p class="title-left"><span class="bold">Mental Health Impact of COVID-19</span></p>
<p class="byline-regular">Keerthika Mathialagan, MBBS<span class="superscript">a</span>; Hirel Bharatkumar Patel, BS<span class="superscript">b</span>; Hema Madhuri Mekala, MD<span class="superscript">c</span>; and Steven Lippmann, MD<span class="superscript">d,</span><span class="asterisk">*</span></p>
<p class="drop-cap-with-body-text"><span class="bold-14pt-for-cap"><span class="bold">T</span></span>he bubonic plague of the 1300s and the Spanish flu during the 1900s had an enormous historical impact and prolonged consequences. The coronavirus disease 2019 (COVID-19) pandemic created a global socioeconomic and health crisis with widespread morbidity and mortality.<span class="htm-cite"><a href="#ref1">1</a></span> With no cure or vaccine, the Centers for Disease Control and Prevention and the World Health Organization (WHO) recommend social distancing, protective masks, virus and antibody testing, contact tracing, and quarantining to mitigate the impact of COVID-19.<span class="htm-cite"><a href="#ref2">2</a></span></p>
<p class="body-text">The COVID-19 pandemic has heightened the prevalence of mental illness, including rates of depression, anxiety, substance abuse, and suicide.<span class="htm-cite"><a href="#ref3">3</a>,<a href="#ref4">4</a></span> Mood and anxiety disorders have escalated 3-fold in 2020, especially in people aged 18–29 years, compared to 2019.<span class="htm-cite"><a href="#ref3">3</a></span> In addition to stress associated with the illness, stay-at-home orders and quarantining increased psychological turmoil through social isolation, job losses, school cancellations, financial crises, and difficulties accessing medical care.<span class="htm-cite"><a href="#ref5">5</a></span></p>
<p class="subheads-subhead-2">Vulnerable Populations</p>
<p class="body-text">Most children and adolescents live in at least partial lockdown, with prolonged closure of schools and isolation impacting their cognitive, educational, emotional, and social well-being. Elderly people are a special risk population, especially those with prior comorbidities. About 80% of COVID-19–related deaths in the United States are among persons ≥<span class="thinspace"> </span>65 years.<span class="htm-cite"><a href="#ref6">6</a></span> Social disconnection among the elderly is detrimental and increases their rate of anxiety and depression.<span class="htm-cite"><a href="#ref7">7</a></span>Health care workers are vulnerable to mental health issues due to fear of illness exposure, lack of social support, stigma, discrimination, and inadequate training or protective gear.<span class="htm-cite"><a href="#ref8">8</a></span> Other vulnerable groups include migrants, refugees, women, children exposed to abuse, and anyone with preexisting mental or physical vulnerabilities.</p>
<p class="subheads-subhead-2">Interventions</p>
<p class="body-text">The United Nations Inter-Agency Standing Committee and WHO provided guidelines for psychological first aid to support distressed people and suggested appropriate management for patients with emotional disorders.<span class="htm-cite"><a href="#ref9">9</a></span> The American Medical Association offers similar recommendations to counter mental health concerns.<span class="htm-cite"><a href="#ref10">10</a></span> It is also important to address the personal issues of health care workers. Partnering new personnel with experienced colleagues will assist in efforts to monitor stress, teach safety practices, and create a safe space for open communication.<span class="htm-cite"><a href="#ref10">10</a></span></p>
<p class="body-text">Beyond group-specific interventions, distress helplines exist, and a Mental Health Gap Action Program provides guidance on addressing mental, neurologic, and substance use conditions.<span class="htm-cite"><a href="#ref11">11</a></span> A Coronavirus Aid, Relief, and Economic Security Act (CARES Act), granting $425 million to the Substance Abuse and Mental Health Services Administration’s remediation efforts, was passed by the US Congress.<span class="htm-cite"><a href="#ref12">12</a></span>The CARES Act responds to the pandemic and assists health care professionals and communities to promote recovery.</p>
<p class="end-matter"><span class="bold-italic">Received:</span> August 4, 2020.</p>
<p class="end-matter"><span class="bold-italic">Published online:</span> December 10, 2020.</p>
<p class="end-matter"><span class="bold-italic">Potential conflicts of interest:</span> None.</p>
<p class="end-matter"><span class="bold-italic">Funding/support:</span> None.</p>
<p class="references_references-heading"><span class="bold">REFERENCES</span></p>
<p class="references-references-text-1-9"><a name="ref1"></a><span class="htm-ref"> 1. </span> WHO Coronavirus Disease (COVID-19) Dashboard. World Health organization website. <a href="https://covid19.who.int/" target="_blank"><span class="hyperlink">https://covid19.who.int/</span></a><span class="hyperlink">.</span> Accessed July 23, 2020.</p>
<p class="references-references-text-1-9"><a name="ref2"></a><span class="htm-ref"> 2. </span>Coronavirus Disease 2019 (COVID- 19): Identify Strategies to Reduce Spread of COVID-19. Centers for Disease Control and Prevention website. <a href="https://www.cdc.gov/coronavirus/2019-ncov/php/contact-tracing/strategies-to-reduce-spread.html" target="_blank"><span class="hyperlink">https://www.cdc.gov/coronavirus/2019-ncov/php/contact-tracing/strategies-to-reduce-spread.html</span></a>. May 15, 2020. Accessed July 23, 2020.</p>
<p class="references-references-text-1-9"><a name="ref3"></a><span class="htm-ref"> 3. </span>COVID-19 Data from NCHS—Mental Health: Household Pulse Survey. Centers for Disease Control and Prevention website. <a href="https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm" target="_blank"><span class="hyperlink">https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm</span></a>. Accessed July 23, 2020.</p>
<p class="references-references-text-1-9"><a name="ref4"></a><span class="htm-ref"> 4. </span>Reger MA, Stanley IH, Joiner TE. Suicide mortality and coronavirus disease 2019—a perfect storm [published online ahead of print April 10, 2020]? <span class="italic">JAMA Psychiatry</span>. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=32275300&dopt=Abstract" target="_blank"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1001/jamapsychiatry.2020.1060" target="_blank"><span class="pubmed-crossref">CrossRef</span></a></p>
<p class="references-references-text-1-9"><a name="ref5"></a><span class="htm-ref"> 5. </span>Pfefferbaum B, North CS. Mental health and the COVID-19 pandemic. <span class="italic">N Engl J Med</span>. 2020;383(6):510–512. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=32283003&dopt=Abstract" target="_blank"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1056/NEJMp2008017" target="_blank"><span class="pubmed-crossref">CrossRef</span></a></p>
<p class="references-references-text-1-9"><a name="ref6"></a><span class="htm-ref"> 6. </span>Coronavirus Disease 2019 (COVID-19) Cases in the US. Centers for Disease Control and Prevention website. <a href="https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html" target="_blank"><span class="hyperlink">https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html</span></a>. Accessed July 23, 2020.</p>
<p class="references-references-text-1-9"><a name="ref7"></a><span class="htm-ref"> 7. </span>Banerjee D. ‘Age and ageism in COVID-19’: elderly mental health-care vulnerabilities and needs. <span class="italic">Asian J Psychiatr</span>. 2020;51:102154. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=32403024&dopt=Abstract" target="_blank"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1016/j.ajp.2020.102154" target="_blank"><span class="pubmed-crossref">CrossRef</span></a></p>
<p class="references-references-text-1-9"><a name="ref8"></a><span class="htm-ref"> 8. </span>Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic—a review. <span class="italic">Asian J Psychiatr</span>. 2020;51:102119. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=32339895&dopt=Abstract" target="_blank"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1016/j.ajp.2020.102119" target="_blank"><span class="pubmed-crossref">CrossRef</span></a></p>
<p class="references-references-text-1-9"><a name="ref9"></a><span class="htm-ref"> 9. </span>Mental health and COVID-19. World Health Organization website. <a href="https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/technical-guidance/mental-health-and-covid-19" target="_blank"><span class="hyperlink">https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/technical-guidance/mental-health-and-covid-19</span></a>. Accessed July 23, 2020.</p>
<p class="references-references-text-10-99"><a name="ref10"></a>10. Managing mental health during COVID-19. American Medical Association website. <a href="https://www.ama-assn.org/delivering-care/public-health/managing-mental-health-during-covid-19" target="_blank"><span class="hyperlink">https://www.ama-assn.org/delivering-care/public-health/managing-mental-health-during-covid-19</span></a>. March 26, 2020. Accessed July 23, 2020.</p>
<p class="references-references-text-10-99"><a name="ref11"></a>11. WHO Mental Health Gap Action Programme (mhGAP). World Health Organization website. <a href="https://www.who.int/mental_health/mhgap/en/" target="_blank"><span class="hyperlink">https://www.who.int/mental_health/mhgap/en/</span></a>. Accessed July 23, 2020.</p>
<p class="references-references-text-10-99"><a name="ref12"></a>12. APA Praises Mental Health Provisions in the COVID-19 Stimulus Aid Package. American Psychiatric Association website. <a href="https://www.psychiatry.org/newsroom/news-releases/apa-praises-mental-health-provisions-in-covid-19-stimulus-aid-package" target="_blank"><span class="hyperlink">https://www.psychiatry.org/newsroom/news-releases/apa-praises-mental-health-provisions-in-covid-19-stimulus-aid-package</span></a>. March 27, 2020. Accessed July 23, 2020.</p><div id="affilDiv"></div>
<p class="front-matter-rule"><span class="superscript">a</span>Department of Psychiatry, Sree Balaji Medical College and Hospital, Chennai, India</p>
<p class="front-matter"><span class="superscript">b</span>Department of Psychiatry, Medical College of Georgia, Augusta, Georgia</p>
<p class="front-matter"><span class="superscript">c</span>Department of Psychiatry, Griffin Memorial Hospital, Norman, Oklahoma</p>
<p class="front-matter"><span class="superscript">d</span>Department of Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky</p>
<p class="front-matter"><span class="asterisk">*</span><span class="italic">Corresponding author:</span> Steven Lippmann, MD, 401 East Chestnut St, Ste 610, Louisville, KY 40202 <span class="hyperlink">(<a href="mailto:steven.lippmann@louisville.edu">steven.lippmann@louisville.edu</a>)</span>.</p>
<p class="front-matter"><span class="italic">Prim Care Companion CNS Disord 2020;22(6):20com02776</span></p>
<p class="front-matter-rule"><span class="bold-italic">To cite:</span> Mathialagan K, Patel HB, Mekala HM, et al. Mental health impact of COVID-19. <span class="italic">Prim Care Companion CNS Disord</span>. 2020;22(6):20com02776. </p>
<p class="doi-line"><span class="bold-italic">To share:</span> https://doi.org/<span class="doi">10.4088/PCC.20com02776</span></p>
<p class="front-matter"><span class="italic">© Copyright 2020 Physicians Postgraduate Press, Inc.</span></p>
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