mental health during covid 19 essay in hindi

कोविड-19 के दौरान स्वास्थ्य और कुशलता

मौजूदा गतिरोध के दरमियान, हम सब के लिए स्वस्थ जीवनशैली कायम रखना बहुत मुश्किल हो गया है। वित्तीय मामलों, बच्चों की देख-भाल, बुजुर्ग माता-पिता, नौकरी की सुरक्षा पर आए संकट आदि से जुड़ी अनिश्चितता और चिंताओं ने हमारी जीवनचर्या, जीवनशैली और मानसिक स्वास्थ्य सभी को अस्त-व्यस्त कर दिया है। भविष्य की अनिश्चितता, अनवरत चल रही न्यूज कवरेज और सोशल मीडिया पर लगातार आते संदेशों की बाढ़ से हमारी चिंता का बढ़ जाना स्वभाविक है। ऐसी स्थितियों में तनाव होना सामान्य है। तनाव से हमारे सोने और खाने-पीने की आदत बदल जाती है, इससे चिड़चिड़ापन या भावनात्मक ज्वार आता है, मानसिक संबल घट जाता है और लोग शराब या दूसरी लत में पड़ने लगते हैं। अगर आप ऐसा कुछ महसूस कर रहे हैं तो मदद हासिल करने से हिचकिचाएं नहीं।* स्वस्थ जीवनशैली अपनाए रखना और अपनी पुरानी जीवनचर्या में लौट आना भी बहुत महत्वपूर्ण है।

तनाव से निपटने और अपने मानसिक, शारीरिक व सामाजिक स्वास्थ्य को कायम रखने के कुछ नुस्खे-

*भारत – राष्ट्रीय मानसिक स्वास्थ्य और तंत्रिका विज्ञान संस्थान (निमहांस)  ने स्वास्थ्य और परिवार कल्याण मंत्रालय के साथ साझेदारी में यह मानसिक-सामाजिक टोल-फ्री हेल्पलाइन नंबर 08046110007 शुरू किया है।

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कोरोना वायरस पर निबंध (Essay on Coronavirus in Hindi) - Covid-19 महामारी पर हिंदी में निबंध

Updated On: January 09, 2024 05:14 pm IST

• कोरोना वायरस पर निबंध (Essay on Coronavirus in Hindi) 100, …
• कोरोना वायरस पर निबंध (Essay on Coronavirus in Hindi) 100 …
• कोरोना वायरस पर निबंध (Essay on Coronavirus in Hindi) 200 …
• कोरोना वायरस पर निबंध (Essay on Coronavirus in Hindi) 500 …
• कोरोना वायरस पर निबंध 10 लाइन हिंदी में (Essay on …

कोरोना वायरस पर निबंध (Essay on Coronavirus in Hindi) 100, 200 और 500 शब्दों में 

कोरोना वायरस पर निबंध (essay on coronavirus in hindi) 100 शब्दों में , कोरोना वायरस पर निबंध (essay on coronavirus in hindi) 200 शब्दों में, कोरोना वायरस पर निबंध (essay on coronavirus in hindi) 500 शब्दों में, covid-19 पर निबंध - प्रस्तावना , कोरोना वायरस की उत्पत्ति, कोरोना वायरस से बचाव के उपाय.

• अपने हाथों को बार-बार धोएं। हाथ धोने से कोरोना वायरस के फैलने का जोखिम कम हो जाता है। हाथों को कम से कम 20 सेकंड तक साबुन और पानी से धोना चाहिए। यदि साबुन और पानी उपलब्ध नहीं हैं, तो अल्कोहल-आधारित हैंड सैनिटाइज़र का उपयोग किया जा सकता है।
• संक्रमित व्यक्ति से दूर रहें। कोरोना वायरस संक्रमित व्यक्ति के खांसने या छींकने से निकलने वाले महीन बूंदों के माध्यम से फैलता है। यदि आप किसी ऐसे व्यक्ति के संपर्क में हैं जो संक्रमित है, तो अपने लक्षणों पर ध्यान दें और यदि आपके कोई लक्षण दिखाई दें तो तुरंत चिकित्सा सहायता लें।
• सार्वजनिक स्थानों पर मास्क पहनें। मास्क पहनने से कोरोना वायरस के फैलने से बचाव में मदद मिल सकती है।
• अपने चेहरे को छूने से बचें। अपने चेहरे को छूने से कोरोना वायरस आपके शरीर में प्रवेश कर सकता है।
• स्वस्थ आहार खाएं, पर्याप्त नींद लें और नियमित रूप से व्यायाम करें।
• भीड़-भाड़ वाले स्थानों पर जाने से बचें।
• सार्वजनिक परिवहन का उपयोग करने से बचें।

COVID-19 पर निबंध - निष्कर्ष

कोरोना वायरस पर निबंध 10 लाइन हिंदी में (essay on coronavirus in 10 lines in hindi) .

• कोरोना वायरस उन वायरस के समूह से है जो बहुत तेजी से संक्रमित करते हैं।
• कोरोना वायरस की शुरुआत चीन के वुहान शहर से हुई जहां इसे इंसानों ने बनाया।
• भारत में कोरोना वायरस का पहला मामला जनवरी 2020 में सामने आया था।
• कोरोना वायरस खांसने और छींकने से फैलता है और खांसते और छींकते समय हमें अपना मुंह और नाक ढक लेना चाहिए।
• हमें अपनी सुरक्षा के लिए मास्क पहनना चाहिए और अपने हाथों को नियमित रूप से साफ करना चाहिए।
• हमारी सुरक्षा के लिए, सरकार ने इस वायरस के प्रसार को रोकने के लिए पूरे देश को बंद कर दिया था।
• कोरोना वायरस के कारण स्कूल को ऑनलाइन कर दिया गया था और छात्र घर से पढ़ाई करते थे।
• कोरोना वायरस के कारण लॉकडाउन में सभी लोग घर पर थे।
• इस दौरान बहुत से लोगों ने अपने परिवार के सदस्यों के साथ खूब समय बिताया।
• खुद को सुरक्षित रखने के लिए नियमित रूप से हाथ धोना और चेहरे पर मास्क पहनना बहुत जरूरी है।

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Vikram Patel: India’s Mental Health, Before and During COVID-19

Oct 21, 2020 | Announcements , Faculty , India , News

Around the world, the COVID-19 pandemic has hit communities hard, with many people suffering from the virus itself, facing unemployment, or unable to interact with family and friends. As time goes on, the effects of the pandemic are not limited to just our physical health, but have impacted our mental health, as well.

We spoke with Vikram Patel, the Pershing Square Professor of Global Health in the Department of Global Health and Social Medicine at Harvard Medical School, to learn more about the status of mental health in India and South Asia at large, both before and during the pandemic.

Professor Patel will take part in an upcoming seminar on November 9, “The Impact of COVID-19 on Mental Health in China, India, and the United States,” alongside other panelists from Harvard University, Shanghai Jiao Tong University, and Central South University, to compare the current state of mental health across countries.

Can you tell us a little about what you are currently researching?

My main focus has been on scaling-up approaches that we have demonstrated are effective in improving access to quality mental health care — principally, the delivery of psychosocial interventions by frontline providers, such as community health workers, for the prevention and treatment of mental health problems. Much of my work is centered on translating the robust implementation science findings into real-world impact.

In general, how would you summarize the status of mental health in India? What is the prevalence of mental health issues in the region?

Even before the pandemic, we had very good data to inform our understanding of the burden of mental health problems in India, mainly from the Government of India’s National Health Survey conducted about 3 years ago with a large representative sample of over 30,000 participants from around the country.

The survey showed that about 10% of India’s adult population met clinical criteria for a mental health disorder. That would translate to anywhere from 70-100 million people at the time of the survey. The survey also showed that the most common problems were mood and anxiety disorders, and that very high proportions of persons affected had neither received nor sought any kind of care in the previous twelve months, approaching nearly 90% for the mood and anxiety disorders.  

What are the challenges in addressing mental health disorders in India? Are there differences in the approach to mental healthcare across countries of South Asia?

I think there are a lot of similarities in the challenges and opportunities for addressing mental health problems in the different countries of South Asia. The countries share a similar social, historical, and cultural context. Of course, there are also some differences too, but I think the similarities are far greater. From my first-hand experience in India, the barriers to addressing mental health disorders can be categorized in two buckets. The first are supply-side barriers, notably the inadequate number of healthcare workers skilled to provide mental health care. The fact that there are more psychiatrists of Indian origin working in the US than in India itself gives us a sense of the enormous shortage of mental health practitioners. Even these few practitioners are located in urban areas and in the private sector, which negatively affects access to mental healthcare by rural and low-income communities.

There is also the demand-side barrier: communities are reluctant to access mental healthcare, which has been historically organized in a way that is heavily influenced by biomedical framing of “diagnoses, doctors, and drugs.” For the general population, such a framing is foreign to their understanding of mental health issues. Furthermore, most psychiatric beds are located in mental hospitals, built during the colonial era and associated with coercion, removal from society, and sedative medication. This history and imagery has contributed to the stigma about seeking mental healthcare.

Have you observed differences or similarities in how mental health issues impact low-, middle-, and high-income countries?

My main research into mental health focuses on African and South Asian contexts. Based on this experience and my clinical practice in four countries, I have observed that the core phenomena that characterize broad categories of mental health disorders are remarkably similar across contexts and cultures — and, besides, there are similarities in how people respond to interventions. Thus, mental health disorders are universal health experiences with similar “core” features and responses to interventions.

That said, culture and context greatly influence the way mental health disorders are experienced, understood, and responded to, and thus mental healthcare must embrace a diversity of perspectives, experiences, and providers.

How can South Asia’s governments and communities improve efforts toward addressing mental health?

We must move away from the narrow binary biomedical approach to mental health. Each and every one of us must value our own mental health, which is best understood as a dimension, as opposed to only being concerned about suffering from a mental health disorder.

The binary approach of diagnoses and disorders works well for infectious diseases, but not for mental health. If we approach our thinking about mental health across a dimension, we see that there is a range of actions each of us can engage in, from promotion and prevention to care and recovery. The need of the hour is to scale up what works.

There is robust evidence on the effective delivery of psychosocial intervention by frontline workers in community and primary care settings. For people with serious mental illnesses, like schizophrenia, healthcare workers need to think more about ways for social inclusion, and work must be done toward the elimination of coercion and involuntary treatment. And, of course, we must invest in prevention by targeting adverse environments, especially in childhood and adolescence.

You have an upcoming event in November that will delve into the impact of COVID-19 in China, the US, and India. How would you summarize the impact of COVID-19 on mental health in India?

COVID has helped bring the issue of mental health out of the shadows, which is a very welcome development. Much of this attention has been focused on mood and anxiety problems, triggered by the uncertainty and a growing sense of frustration in the face of the pandemic. 

The truth is that uncertainty is affecting everyone, but its impact is disproportionate across populations. Low-income or disadvantaged communities have been much worse hit, for example, due to the potential loss of income and work. This has led to significant adverse mental health consequences, and I fear that this will lead to a steep increase in mental health problems throughout the vulnerable communities of India.

Additionally, during lockdown, many routine healthcare services shut down. People with serious mental illnesses rely on routine care. The shutdown spells disaster for people who need such continuing care. Though the impact has not yet been documented, I fear a steep increase of relapses in this vulnerable group of persons. 

Have there been changes in India regarding the approach to mental health since the onset of COVID-19? 

It’s been a bit of a mixed picture. On one hand, there is a lot of community action that is being led by frontline workers, civil society organizations, and NGOs — India’s greatest assets. These groups are working across the country, and they are sometimes the only source of support for marginalized communities.

On the other hand, it has been a sorry tale of disregard for the disproportionate impact of lockdown and the pandemic on rural, marginalized, and low-income populations. When the definitive history of the pandemic response around the world and in India is written, what will stand out is this disregard by the privileged, from politicians and bureaucrats to the wealthy and even some scientists, to the devastating impact of lockdown on the millions who are voiceless. 

What are your top recommendations to care for one’s own mental health during the pandemic? What are your main concerns?

I think uncertainty is the main stressor that has been affecting people everywhere — including here in the US. Uncertainty is part of the human condition, and from an evolutionary perspective, humans are geared to respond to uncertainty in ways that protect ourselves. In times like these, however, when uncertainty is chronic, pervasive, unanticipated, there is no sense of when it will end, and when every day seems to bring more bad news, combined with concerns about upcoming elections, political polarization, and climate change, these uncertainties significantly affect mental health. 

So, how do we mitigate the adverse effects of these uncertainties on our mental health? We can’t simply wish it away. There are certain things that can be done to help: maintain a routine and structure in your day and minimize the time reading or watching news — as the media deals with so many negatives. Be as aware of your mental health as you are of your physical health, and acknowledge distress and speak to a trusted person when you are distressed. Focus on the present; there is little to be gained by worrying about the future. Meditate, exercise, and do things that are meaningful to yourself and others around you. Right now, it’s a great time to get into community action; it’s something that is desperately needed and can build and enhance your well-being.

In the coming weeks and months, what is needed to avert a mental health crisis in South Asia or even around the world?

I’m extremely concerned about the global mental health crisis that we will face. Even before the pandemic, there was significant, robust data that showed worsening mental health, especially in young people, around the world, and in the US suicide mortality has increased 50% in last decade in this demographic.

The pandemic with its uncertainties and the economic recessions will likely cause this burden of mental health problems to worsen. Even before the pandemic, mental healthcare was not fit for purpose. We now have a historic and urgent opportunity to reimagine the future of mental healthcare. There is always the call for more investment, but that must be guided by the best science on what is cost effective in mental healthcare. We must also pay attention to a human rights perspective, which necessitates us to deliver healthcare in a way that always respects and protects a person’s dignity. ☆

———

Join us on Monday, November 9 at 8:15 PM EST to listen to Vikram Patel and others discuss the impact of COVID-19 on mental health in China, India, and the United States.

Register via zoom : https://harvard.zoom.us/webinar/register/wn_cldc-z0uqsuno0ykyonf5g.

☆ All opinions expressed by our interview subjects are their own and do not reflect the views of the Mittal Institute and its staff.

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How COVID-19 shaped mental health: from infection to pandemic effects

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• Neurological manifestations
• Psychiatric disorders

The Coronavirus Disease 2019 (COVID-19) pandemic has threatened global mental health, both indirectly via disruptive societal changes and directly via neuropsychiatric sequelae after SARS-CoV-2 infection. Despite a small increase in self-reported mental health problems, this has (so far) not translated into objectively measurable increased rates of mental disorders, self-harm or suicide rates at the population level. This could suggest effective resilience and adaptation, but there is substantial heterogeneity among subgroups, and time-lag effects may also exist. With regard to COVID-19 itself, both acute and post-acute neuropsychiatric sequelae have become apparent, with high prevalence of fatigue, cognitive impairments and anxiety and depressive symptoms, even months after infection. To understand how COVID-19 continues to shape mental health in the longer term, fine-grained, well-controlled longitudinal data at the (neuro)biological, individual and societal levels remain essential. For future pandemics, policymakers and clinicians should prioritize mental health from the outset to identify and protect those at risk and promote long-term resilience.

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In 2019, the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO), with 590 million confirmed cases and 6.4 million deaths worldwide as of August 2022 (ref. 1 ). To contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) across the globe, many national and local governments implemented often drastic restrictions as preventive health measures. Consequently, the pandemic has not only led to potential SARS-CoV-2 exposure, infection and disease but also to a wide range of policies consisting of mask requirements, quarantines, lockdowns, physical distancing and closure of non-essential services, with unprecedented societal and economic consequences.

As the world is slowly gaining control over COVID-19, it is timely and essential to ask how the pandemic has affected global mental health. Indirect effects include stress-evoking and disruptive societal changes, which may detrimentally affect mental health in the general population. Direct effects include SARS-CoV-2-mediated acute and long-lasting neuropsychiatric sequelae in affected individuals that occur during primary infection or as part of post-acute COVID syndrome (PACS) 2 —defined as symptoms lasting beyond 3–4 weeks that can involve multiple organs, including the brain. Several terminologies exist for characterizing the effects of COVID-19. PACS also includes late sequalae that constitute a clinical diagnosis of ‘long COVID’ where persistent symptoms are still present 12 weeks after initial infection and cannot be attributed to other conditions 3 .

Here we review both the direct and indirect effects of COVID-19 on mental health. First, we summarize empirical findings on how the COVID-19 pandemic has impacted population mental health, through mental health symptom reports, mental disorder prevalence and suicide rates. Second, we describe mental health sequalae of SARS-CoV-2 virus infection and COVID-19 disease (for example, cognitive impairment, fatigue and affective symptoms). For this, we use the term PACS for neuropsychiatric consequences beyond the acute period, and will also describe the underlying neurobiological impact on brain structure and function. We conclude with a discussion of the lessons learned and knowledge gaps that need to be further addressed.

Impact of the COVID-19 pandemic on population mental health

Independent of the pandemic, mental disorders are known to be prevalent globally and cause a very high disease burden 4 , 5 , 6 . For most common mental disorders (including major depressive disorder, anxiety disorders and alcohol use disorder), environmental stressors play a major etiological role. Disruptive and unpredictable pandemic circumstances may increase distress levels in many individuals, at least temporarily. However, it should be noted that the pandemic not only resulted in negative stressors but also in positive and potentially buffering changes for some, including a better work–life balance, improved family dynamics and enhanced feelings of closeness 7 .

Awareness of the potential mental health impact of the COVID-19 pandemic is reflected in the more than 35,000 papers published on this topic. However, this rapid research output comes with a cost: conclusions from many papers are limited due to small sample sizes, convenience sampling with unclear generalizability implications and lack of a pre-COVID-19 comparison. More reliable estimates of the pandemic mental health impact come from studies with longitudinal or time-series designs that include a pre-pandemic comparison. In our description of the evidence, we, therefore, explicitly focused on findings from meta-analyses that include longitudinal studies with data before the pandemic, as recently identified through a systematic literature search by the WHO 8 .

Self-reported mental health problems

Most studies examining the pandemic impact on mental health used online data collection methods to measure self-reported common indicators, such as mood, anxiety or general psychological distress. Pooled prevalence estimates of clinically relevant high levels of depression and anxiety symptoms during the COVID-19 pandemic range widely—between 20% and 35% 9 , 10 , 11 , 12 —but are difficult to interpret due to large methodological and sample heterogeneity. It also is important to note that high levels of self-reported mental health problems identify increased vulnerability and signal an increased risk for mental disorders, but they do not equal clinical caseness levels, which are generally much lower.

Three meta-analyses, pooling data from between 11 and 61 studies and involving ~50,000 individuals or more 13 , 14 , 15 , compared levels of self-reported mental health problems during the COVID-19 pandemic with those before the pandemic. Meta-analyses report on pooled effect sizes—that is, weighted averages of study-level effect sizes; these are generally considered small when they are ~0.2, moderate when ~0.5 and large when ~0.8. As shown in Table 1 , meta-analyses on mental health impact of the COVID-19 pandemic reach consistent conclusions and indicate that there has been a heterogeneous, statistically significant but small increase in self-reported mental health problems, with pooled effect sizes ranging from 0.07 to 0.27. The largest symptom increase was found when using specific mental health outcome measures assessing depression or anxiety symptoms. In addition, loneliness—a strong correlate of depression and anxiety—showed a small but significant increase during the pandemic (Table 1 ; effect size = 0.27) 16 . In contrast, self-reported general mental health and well-being indicators did not show significant change, and psychotic symptoms seemed to have decreased slightly 13 . In Europe, alcohol purchase decreased, but high-level drinking patterns solidified among those with pre-pandemic high drinking levels 17 . When compared to pre-COVID levels, no change in self-reported alcohol use (effect size = −0.01) was observed in a recent meta-analysis summarizing 128 studies from 58 (predominantly European and North American) countries 18 .

What is the time trajectory of self-reported mental health problems during the pandemic? Although findings are not uniform, various large-scale studies confirmed that the increase in mental health problems was highest during the first peak months of the pandemic and smaller—but not fully gone—in subsequent months when infection rates declined and social restrictions eased 13 , 19 , 20 . Psychological distress reports in the United Kingdom increased again during the second lockdown period 15 . Direct associations between anxiety and depression symptom levels and the average number of daily COVID-19 cases were confirmed in the US Centers for Disease Control and Prevention (CDC) data 21 . Studies that examined longer-term trajectories of symptoms during the first or even second year of the COVID-19 pandemic are more sparse but revealed stability of symptoms without clear evidence of recovery 15 , 22 . The exception appears to be for loneliness, as some studies confirmed further increasing trends throughout the first COVID-19 pandemic year 22 , 23 . As most published population-based studies were conducted in the early time period in which absolute numbers of SARS-CoV2-infected individuals were still low, the mental health impacts described in such studies are most likely due to indirect rather than direct effects of SARS-CoV-2 infection. However, it is possible that, in longer-term or later studies, these direct and indirect effects may be more intertwined.

The extent to which governmental policies and communication have impacted on population mental health is a relevant question. In cross-country comparisons, the extent of social restrictions showed a dose–response relationship with mental health problems 24 , 25 . In a review of 33 studies worldwide, it was concluded that governments that enacted stringent measures to contain the spread of COVID-19 benefitted not only the physical but also the mental health of their population during the pandemic 26 , even though more stringent policies may lead to more short-term mental distress 25 . It has been suggested that effective communication of risks, choices and policy measures may reduce polarization and conspiracy theories and mitigate the mental health impact of such measures 25 , 27 , 28 .

In sum, the general pattern of results is that of an increase in mental health symptoms in the population, especially during the first pandemic months, that remained elevated throughout 2020 and early 2021. It should be emphasized that this increase has a small effect size. However, even a small upward shift in mental health problems warrants attention as it has not yet shown to be returned to pre-pandemic levels, and it may have meaningful cumulative consequences at the population level. In addition, even a small effect size may mask a substantial heterogeneity in mental health impact, which may have affected vulnerable groups disproportionally (see below).

Mental disorders, self-harm and suicide

Whether the observed increase in mental health problems during the COVID-19 pandemic has translated into more mental disorders or even suicide mortality is not easy to answer. Mental disorders, characterized by more severe, disabling and persistent symptoms than self-reported mental health problems, are usually diagnosed by a clinician based on the International Classification of Diseases, 10th Revision (ICD-10) or the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria or with validated semi-structured clinical interviews. However, during the COVID-19 pandemic, research systematically examining the population prevalence of mental disorders has been sparse. Unfortunately, we can also not strongly rely on healthcare use studies as the pandemic impacted on healthcare provision more broadly, thereby making figures of patient admissions difficult to interpret.

On a global scale and based on imputations and modeling from survey data of self-reported mental health problems, the Global Burden of Disease (GBD) study 29 estimated that the COVID-19 pandemic has led to a 28% (95% uncertainty interval (UI): 25–30) increase in major depressive disorders and a 26% (95% UI: 23–28) increase in anxiety disorders. It should be noted that these estimations come with high uncertainty as the assumption that transient pandemic-related increases in mental symptoms extrapolate into incident mental disorders remains disputable. So far, only four longitudinal population-based studies have measured and compared current mental (that is, depressive and anxiety) disorder prevalence—defined using psychiatric diagnostic criteria—before and during the pandemic. Of these, two found no change 30 , 31 , one found a decrease 32 and one found an increase in prevalence of these disorders 33 . These studies were local, limited to high-income countries, often small-scale and used different modes of assessment (for example, online versus in-person) before and during the pandemic. This renders these observational results uncertain as well, but their contrast to the GBD calculations 29 is striking.

Time-series analysis of monthly suicide trends in 21 middle-income to high-income countries across the globe yielded no evidence for an increase in suicide rates in the first 4 months of the pandemic, and there was evidence of a fall in rates in 12 countries 34 . Also in the United States, there was a significant decrease in suicide mortality in the first pandemic months but a slight increase in mortality due to drug overdose and homicide 35 . A living systematic review 36 also concluded that, throughout 2020, there was no observed increase in suicide rates in 20 studies conducted in North America, Europe and Asia. Analyses of electronic health record data in the primary care setting showed reduced rates of self-harm during the first COVID-19 pandemic year 37 . In contrast, emergency department visits for self-harm behavior were unchanged 38 or increased 39 . Such inconsistent findings across healthcare settings may reflect a reluctance in healthcare-seeking behavior for mental healthcare issues. In the living systematic review, eight of 11 studies that examined service use data found a significant decrease in reported self-harm/suicide attempts after COVID lockdown, which returned to pre-lockdown levels in some studies with longer follow-up (5 months) 36 .

In sum, although calculations based on survey data predict a global increase of mental disorder prevalence, objective and consistent evidence for an increased mental disorder, self-harm or suicide prevalence or incidence during the first pandemic year remains absent. This observation, coupled with the only small increase in mental health symptom levels in the overall population, may suggest that most of the general population has demonstrated remarkable resilience and adaptation. However, alternative interpretations are possible. First, there is a large degree of heterogeneity in the mental health impact of COVID-19, and increased mental health in one group (for example, due to better work–family balance and work flexibility) may have masked mental health problems in others. Various societal responses seen in many countries, such as community support activities and bolstering mental health and crisis services, may have had mitigating effects on the mental health burden. Also, the relationship between mental health symptom increases during stressful periods and its subsequent effects on the incidence of mental disorders may be non-linear or could be less visible due to resulting alternative outcomes, such as drug overdose or homicide. Finally, we cannot rule out a lag-time effect, where disorders may take more time to develop or be picked up, especially because some of the personal financial or social consequences of the COVID pandemic may only become apparent later. It should be noted that data from low-income countries and longer-term studies beyond the first pandemic year are largely absent.

Which individuals are most affected by the COVID-19 pandemic?

There is substantial heterogeneity across studies that evaluated how the COVID pandemic impacted on mental health 13 , 14 , 15 . Although our society as a whole may have the ability to adequately bounce back from pandemic effects, there are vulnerable people who have been affected more than others.

First, women have consistently reported larger increases in mental health problems in response to the COVID-19 pandemic than men 13 , 15 , 29 , 40 , with meta-analytic effect sizes being 44% 15 to 75% 13 higher. This could reflect both higher stress vulnerability or larger daily life disruptions due to, for example, increased childcare responsibilities, exposure to home violence or greater economic impact due to employment disruptions that all disproportionately fell to women 41 , thereby exacerbating the already existing pre-pandemic gender inequalities in depression and anxiety levels. In addition, adolescents and young adults have been disproportionately affected compared to younger children and older adults 12 , 15 , 29 , 40 . This may be the result of unfavorable behavioral and social changes (for example, school closure periods 42 ) during a crucial development phase where social interactions outside the family context are pivotal. Alarmingly, even though suicide rates did not seem to increase at the population level, studies in China 43 and Japan 44 indicated significant increases in suicide rates in children and adolescents.

Existing socio-cultural disparities in mental health may have further widened during the COVID pandemic. Whether the impact is larger for individuals with low socio-economic status remains unclear, with contrasting meta-analyses pointing toward this group being protected 15 or at increased risk 40 . Earlier meta-analyses did not find that the mental health impact of COVID-19 differed across Europe, North America, Asia and Oceania 13 , 14 , but data are lacking from Africa and South America. Nevertheless, a large-scale within-country comparison in the United States found that the mental health of Black, Hispanic and Asian respondents worsened relatively more during the pandemic compared to White respondents. Moreover, White respondents were more likely to receive professional mental healthcare during the pandemic, and, conversely, Black, Hispanic, and Asian respondents demonstrated higher levels of unmet mental healthcare needs during this time 45 .

People with pre-existing somatic conditions represent another vulnerable group in which the pandemic had a greater impact (pooled effect size of 0.25) 13 . This includes people with conditions such as epilepsy, multiple sclerosis or cardiometabolic disease as well as those with multiple comorbidities. The disproportionate impact may reflect this groupʼs elevated COVID-19 risk and, consequently, more perceived stress and fear of infection, but it could also reflect disruptions of regular healthcare services.

Healthcare workers faced increased workload, rapidly changing and challenging work environments and exposure to infections and death, accompanied by fear of infecting themselves and their families. High prevalences of (subthreshold) depression (13% 46 ), depressive symptoms (31% 47 ), (subthreshold) anxiety (16% 46 ), anxiety symptoms (23% 47 ) and post-traumatic stress disorder (~22% 46 , 47 ) have been reported in healthcare workers. However, a meta-analysis did not find a larger mental health impact of the pandemic as compared to the general population 40 , and another meta-analysis (of 206 studies) found that the mental health status of healthcare workers was similar to or even better than that of the general population during the first COVID year 48 . However, it is important to note that these meta-analyses could not differentiate between frontline and non-frontline healthcare workers.

Finally, individuals with pre-existing mental disorders may be at increased risk for exacerbation of mental ill-health during the pandemic, possibly due to disease history—illustrating a higher genetic and/or environmental vulnerability—but also due to discontinuity of mental healthcare. Already before the pandemic, mental health systems were under-resourced and disorganized in most countries 6 , 49 , but a third of all WHO member states reported disruptions to mental and substance use services during the first 18 months of the pandemic 50 , with reduced, shortened or postponed appointments and limited capacity for acute inpatient admissions 51 , 52 . Despite this, there is no clear evidence that individuals with pre-existing mental disorders are disproportionately affected by pandemic-related societal disruptions; the effect size for pandemic impact on self-reported mental health problems was similar in psychiatric patients and the general population 13 . In the United States, emergency visits for ten different mental disorders were generally stable during the pandemic compared to earlier periods 53 . In a large Dutch study 22 , 54 with multiple pre-pandemic and during-pandemic assessments, there was no difference in symptom increase among patients relative to controls (see Fig. 1 for illustration). In absolute terms, however, it is important to note that psychiatric patients show much higher symptom levels of depression, anxiety, loneliness and COVID-fear than healthy controls. Again, variation in mental health changes during the pandemic is large: next to psychiatric patients who showed symptom decrease due to, for example, experiencing relief from social pressures, there certainly have been many patients with symptom increases and relapses during the pandemic.

Trajectories of mean depressive symptoms (QIDS score), anxiety symptoms (BAI score), loneliness (De Jong questionnaire score) and Fear of COVID-19 score before and during the first year of the COVID-19 pandemic in healthy controls (blue line, n  = 378) and in patients with depressive and/or anxiety disorders (red line, n  = 908). The x -axis indicates time with one pre-COVID assessment (averaged over up to five earlier assessments conducted between 2006 and 2019) and 11 online assessments during April 2020 through February 2021. Symbols indicate the mean score during the assessment with 95% CIs. As compared to pre-COVID assessment scores, the figure shows a statistically significant increase of depression and loneliness symptoms during the first pandemic peak (April 2020) in healthy controls but not in patients (for more details, see refs. 22 , 54 ). Asterisks indicate where subsequent wave scores differ from the prior wave scores ( P  < 0.05). The figure also illustrates the stability of depressive and anxiety symptoms during the first COVID year, a significant increase in loneliness during this period and fluctuations of Fear of COVID-19 score that positively correlate with infection rates in the Netherlands. Raw data are from the Netherlands Study of Depression and Anxiety (NESDA), which were re-analyzed for the current plots to illustrate differences between two groups (healthy controls versus patients). BAI, Beck Anxiety Inventory; QIDS, Quick Inventory of Depressive Symptoms.

Impact of COVID-19 infection and disease on mental health and the brain

Not only the pandemic but also COVID-19 itself can have severe impact on the mental health of affected individuals and, thus, of the population at large. Below we describe acute and post-acute neuropsychiatric sequelae seen in patients with COVID-19 and link these to neurobiological mechanisms.

Neuropsychiatric sequelae in individuals with COVID-19

Common symptoms associated with acute SARS-CoV-2 infection include headache, anosmia (loss of sense of smell) and dysgeusia (loss of sense of taste). The broader neuropsychiatric impact is dependent on infection severity and is very heterogeneous (Table 2 ). It ranges from no neuropsychiatric symptoms among the large group of asymptomatic COVID-19 cases to milder transient neuropsychiatric symptoms, such as fatigue, sleep disturbance and cognitive impairment, predominantly occurring among symptomatic patients with COVID-19 (ref. 55 ). Cognitive impairment consists of sustained memory impairments and executive dysfunction, including short-term memory loss, concentration problems, word-finding problems and impaired daily problem-solving, colloquially termed ‘brain fog’ by patients and clinicians. A small number of infected individuals become severely ill and require hospitalization. During hospital admission, the predominant neuropsychiatric outcome is delirium 56 . Delirium occurs among one-third of hospitalized patients with COVID-19 and among over half of patients with COVID-19 who require intensive care unit (ICU) treatment. These delirium rates seem similar to those observed among individuals with severe illness hospitalized for other general medical conditions 57 . Delirium is associated with neuropsychiatric sequalae after hospitalization, as part of post-intensive care syndrome 58 , in which sepsis and inflammation are associated with cognitive dysfunction and an increased risk of a broad range of psychiatric symptoms, from anxiety to depression and psychotic symptoms with hallucinations 59 , 60 .

A subset of patients with COVID-19 develop PACS 61 , which can include neuropsychiatric symptoms. A large meta-analysis summarizes 51 studies involving 18,917 patients with a mean follow-up of 77 days (range, 14–182 days) 62 . The most prevalent neuropsychiatric symptom associated with COVID-19 was sleep disturbance, with a pooled prevalence of 27.4%, followed by fatigue (24.4%), cognitive impairment (20.2%), anxiety symptoms (19.1%), post-traumatic stress symptoms (15.7%) and depression symptoms (12.9%) (Table 2 ). Another meta-analysis that assessed patients 12 weeks or more after confirmed COVID-19 diagnosis found that 32% experienced fatigue, and 22% experienced cognitive impairment 63 . To what extent neuropsychiatric symptoms are truly unique for patients with COVID remains unclear from these meta-analyses, as hardly any study included well-matched controls with other types of respiratory infections or inflammatory conditions.

Studies based on electronic health records have examined whether higher levels of neuropsychiatric symptoms truly translate into a higher incidence of clinically overt mental disorders 64 , 65 . In a 1-year follow-up using the US Veterans Affairs database, 153,848 survivors of SARS-CoV-2 infection exhibited an increased incidence of any mental disorder with a relative risk of 1.46 and, specifically, 1.35 for anxiety disorders, 1.39 for depressive disorders and 1.38 for stress and adjustment disorders, compared to a contemporary group and a historical control group ( n  = 5,859,251) 65 . In absolute numbers, the incident risk difference attributable to SARS-CoV-2 for mental disorders was 64 per 1,000 individuals. Taquet et al. 64 analyzed electronic health records from the US-based TriNetX network with over 81 million patients and 236,379 COVID-19 survivors followed for 6 months. In absolute numbers, 6-month incidence of hospital contacts related to diagnoses of anxiety, affective disorder or psychotic disorder was 7.0%, 4.5% and 0.4%, respectively. Risks of incident neurological or psychiatric diagnoses were directly correlated with COVID-19 severity and increased by 78% when compared to influenza and by 32% when compared to other respiratory tract infections. In contrast, a medical record study involving 8.3 million adults confirmed that neuropsychiatric disorders were significantly elevated among COVID-19 hospitalized individuals but to a similar extent as in hospitalized patients with other severe respiratory disease 66 . In line with this, a study using language processing of clinical notes in electronic health records did not find an increase in fatigue, mood and anxiety symptoms among COVID-19 hospitalized individuals when compared to hospitalized patients for other indications and adjusted for sociodemographic features and hospital course 67 . It is important to note that research based only on hospital records might be influenced by increased health-seeking behavior that could be differential across care settings or by increased follow-up by hospitals of patients with COVID-19 (compared to patients with other conditions).

Consequently, whether PACS symptoms form a unique pattern due to specific infection with SARS-CoV-2 remains debatable. Prospective case–control studies that do not rely on hospital records but measure the incidence of neuropsychiatric symptoms and diagnoses after COVID-19 are still scarce, but they are critical for distinguishing causation and confounding when characterizing PACS and the uniqueness of neuropsychiatric sequalae after COVID-19 (ref. 68 ). Recent studies with well-matched control groups illustrate that long-term consequences may not be so unique, as they were similar to those observed in patients with other diseases of similar severity, such as after acute myocardial infarction or in ICU patients 56 , 66 . A first prospective follow-up study of COVID-19 survivors and control patients matched on disease severity, age, sex and ICU admission found similar neuropsychiatric outcomes, regarding both new-onset psychiatric diagnosis (19% versus 20%) and neuropsychiatric symptoms (81% versus 93%). However, moderate but significantly worse cognitive outcomes 6 months after symptom onset were found among survivors of COVID-19 (ref. 69 ). In line with this, a longitudinal study of 785 participants from the UK Biobank showed small but significant cognitive impairment among individuals infected with SARS-CoV-2 compared to matched controls 70 .

Numerous psychosocial mechanisms can lead to neuropsychiatric sequalae of COVID-19, including functional impairment; psychological impact due to, for example, fear of dying; stress of being infected with a novel pandemic disease; isolation as part of quarantine and lack of social support; fear/guilt of spreading COVID-19 to family or community; and socioeconomic distress by lost wages 71 . However, there is also ample evidence that neurobiological mechanisms play an important role, which is discussed below.

Neurobiological mechanisms underlying neuropsychiatric sequelae of COVID-19

Acute neuropsychiatric symptoms among patients with severe COVID-19 have been found to correlate with the level of serum inflammatory markers 72 and coincide with neuroimaging findings of immune activation, including leukoencephalopathy, acute disseminated encephalomyelitis, cytotoxic lesions of the corpus callosum or cranial nerve enhancement 73 . Rare presentations, including meningitis, encephalitis, inflammatory demyelination, cerebral infarction and acute hemorrhagic necrotizing encephalopathy, have also been reported 74 . Hospitalized patients with frank encephalopathies display impaired blood-brain barrier (BBB) integrity with leptomeningeal enhancement on brain magnetic resonance images 75 . Studies of postmortem specimens from patients who succumbed to acute COVID-19 reveal significant neuropathology with signs of hypoxic damage and neuroinflammation. These include evidence of BBB permeability with extravasation of fibrinogen, microglial activation, astrogliosis, leukocyte infiltration and microhemorrhages 76 , 77 . However, it is still unclear to what extent these findings differ from patients with similar illness severity due to acute non-COVID illness, as these brain effects might not be virus-specific effects but rather due to cytokine-mediated neuroinflammation and critical illness.

Post-acute neuroimaging studies in SARS-CoV-2-recovered patients, as compared to control patients without COVID-19, reveal numerous alterations in brain structure on a group level, although effect sizes are generally small. These include minor reduction in gray matter thickness in the various regions of the cortex and within the corpus collosum, diffuse edema, increases in markers of tissue damage in regions functionally connected to the olfactory cortex and reductions in overall brain size 70 , 78 . Neuroimaging studies of post-acute COVID-19 patients also report abnormalities consistent with micro-structural and functional alterations, specifically within the hippocampus 79 , 80 , a brain region critical for memory formation and regulating anxiety, mood and stress responses, but also within gray matter areas involving the olfactory system and cingulate cortex 80 . Overall, these findings are in line with ongoing anosmia, tremors, affect problems and cognitive impairment.

Interestingly, despite findings mentioned above, there is little evidence of SARS-CoV-2 neuroinvasion with productive replication, and viral material is rarely found in the central nervous system (CNS) of patients with COVID-19 (refs. 76 , 77 , 81 ). Thus, neurobiological mechanisms of SARS-CoV-2-mediated neuropsychiatric sequelae remain unclear, especially in patients who initially present with milder forms of COVID-19. Symptomatic SARS-CoV-2 infection is associated with hypoxia, cytokine release syndrome (CRS) and dysregulated innate and adaptive immune responses (reviewed in ref. 82 ). All these effects could contribute to neuroinflammation and endothelial cell activation (Fig. 2 ). Examination of cerebrospinal fluid in patients with neuroimaging findings revealed elevated levels of pro-inflammatory, BBB-destabilizing cytokines, including interleukin-6 (IL-6), IL-1, IL-8 and mononuclear cell chemoattractants 83 , 84 . Whether these cytokines arise from the periphery, due to COVID-19-mediated CRS, or from within the CNS, is unclear. As studies generally lack control patients with other severe illnesses, the specificity of such findings to SARS-CoV-2 also remains unclear. Systemic inflammatory processes, including cytokine release, have been linked to glial activation with expression of chemoattractants that recruit immune cells, leading to neuroinflammation and injury 85 . Cerebrospinal fluid concentrations of neurofilament light, a biomarker of neuronal damage, were reportedly elevated in patients hospitalized with COVID-19 regardless of whether they exhibited neurologic diseases 86 . Acute thromboembolic events leading to ischemic infarcts are also common in patients with COVID-19 due to a potentially increased pro-coagulant process secondary to CRS 87 .

(1) Elevation of BBB-destabilizing cytokines (IL-1β and TNF) within the serum due to CRS or local interactions of mononuclear and endothelial cells. (2) Virus-induced endotheliitis increases susceptibility to microthrombus formation due to platelet activation, elevation of vWF and fibrin deposition. (3) Cytokine, mononuclear and endothelial cell interactions promote disruption of the BBB, which may allow entry of leukocytes expressing IFNg into the CNS (4), leading to microglial activation (5). (6) Activated microglia may eliminate synapses and/or express cytokines that promote neuronal injury. (7) Injured neurons express IL-6 which, together with IL-1β, promote a ‘gliogenic switch’ in NSCs (8), decreasing adult neurogenesis. (9) The combination of microglial (and possibly astrocyte) activation, neuronal injury and synapse loss may lead to dysregulation of NTs and neuronal circuitry. IFNg, interferon-g; NSC, neural stem cell; NT, neurotransmitter; TJ, tight junction; TNF, tumor necrosis factor; vWF, von Willebrand factor.

It is also unclear whether hospitalized patients with COVID-19 may develop brain abnormalities due to hypoxia or CRS rather than as a direct effect of SARS-CoV-2 infection. Hypoxia may cause neuronal dysfunction, cerebral edema, increased BBB permeability, cytokine expression and onset of neurodegenerative diseases 88 , 89 . CRS, with life-threatening levels of serum TNF-α and IL-1 (ref. 90 ) could also impact BBB function, as these cytokines destabilize microvasculature endothelial cell junctional proteins critical for BBB integrity 91 . In mild SARS-CoV-2 infection, circulating immune factors combined with mild hypoxia might impact BBB function and lead to neuroinflammation 92 , as observed during infection with other non-neuroinvasive respiratory pathogens 93 . However, multiple studies suggest that the SARS-CoV-2 spike protein itself may also induce venous and arterial endothelial cell activation and endotheliitis, disrupt BBB integrity or cross the BBB via adoptive transcytosis 94 , 95 , 96 .

Reducing neuropsychiatric sequelae of COVID-19

The increased risk of COVID-19-related neuropsychiatric sequalae was most pronounced during the first pandemic peak but reduced over the subsequent 2 years 64 , 97 . This may be due to reduced impact of newer SARS-CoV-2 strains (that is, Omicron) but also protective effects of vaccination, which limit SARS-CoV-2 spread and may, thus, prevent neuropsychiatric sequalae. Fully vaccinated individuals with breakthrough infections exhibit a 50% reduction in PACS 98 , even though vaccination does not improve PACS-related neuropsychiatric symptoms in patients with a prior history of COVID-19 (ref. 99 ). As patients with pre-existing mental disorders are at increased risk of SARS-CoV-2 infection, they deserve to be among the prioritization groups for vaccination efforts 100 .

Adequate treatment strategies for neuropsychiatric sequelae of COVID-19 are needed. As no specific evidence-based intervention yet exists, the best current treatment approach is that for neuropsychiatric sequelae arising after other severe medical conditions 101 . Stepped care—a staged approach of mental health services comprising a hierarchy of interventions, from least to most intensive, matched to the individual’s need—is efficacious with monitoring of mental health and cognitive problems. Milder symptoms likely benefit from counseling and holistic care, including physiotherapy, psychotherapy and rehabilitation. Individuals with moderate to severe symptoms fulfilling psychiatric diagnoses should receive guideline-concordant care for these disorders 61 . Patients with pre-existing mental disorders also deserve special attention when affected by COVID-19, as they have shown to have an increased risk of COVID-19-related hospitalization, complications and death 102 . This may involve interventions to address their general health, any unfavorable socioenvironmental factors, substance abuse or treatment adherence issues.

Lessons learned, knowledge gaps and future challenges

Ultimately, it is not only the millions of people who have died from COVID-19 worldwide that we remember but also the distress experienced during an unpredictable period with overstretched healthcare systems, lockdowns, school closures and changing work environments. In a world that is more and more globalized, connectivity puts us at risk for future pandemics. What can be learned from the last 2 years of the COVID-19 pandemic about how to handle future and longstanding challenges related to mental health?

Give mental health equal priority to physical health

The COVID-19 pandemic has demonstrated that our population seems quite resilient and adaptive. Nevertheless, even if society as a whole may bounce back, there is a large group of people whose mental health has been and will be disproportionately affected by this and future crises. Although various groups, such as the WHO 8 , the National Health Commission of China 103 , the Asia Pacific Disaster Mental Health Network 104 and a National Taskforce in India 105 , developed mental health policies early on, many countries were late in realizing that a mental health agenda deserves immediate attention in a rapidly evolving pandemic. Implementation of comprehensive and integrated mental health policies was generally inconsistent and suboptimal 106 and often in the shadow of policies directed at containing and reducing the spread of SARS-CoV-2. Leadership is needed to convey the message that mental health is as important as physical health and that we should focus specific attention and early interventions on those at the highest risk. This includes those vulnerable due to factors such as low socioeconomic status, specific developmental life phase (adolescents and young adults), pre-existing risk (poor physical or somatic health and early life trauma) or high exposure to pandemic-related (work) changes—for example, women and healthcare personnel. This means that not only should investment in youth and reducing health inequalities remain at the top of any policy agenda but also that mental health should be explicitly addressed from the start in any future global health crisis situation.

Communication and trust is crucial for mental health

Uncertainty and uncontrollability during the pandemic have challenged rational thinking. Negative news travels fast. Communication that is vague, one-sided and dishonest can negatively impact on mental health and amplify existing distress and anxiety 107 . Media reporting should not overemphasize negative mental health impact—for example, putative suicide rate increases or individual negative experiences—which could make situations worse than they actually are. Instead, communication during crises requires concrete and actionable advice that avoids polarization and strengthens vigilance, to foster resilience and help prevent escalation to severe mental health problems 108 , 109 .

Rapid research should be collaborative and high-quality

Within the scientific community, the topic of mental health during the pandemic led to a multitude of rapid studies that generally had limited methodological quality—for example, cross-sectional designs, small or selective sampling or study designs lacking valid comparison groups. These contributed rather little to our understanding of the mental health impact of the emerging crisis. In future events that have global mental health impact, where possible, collaborative and interdisciplinary efforts with well-powered and well-controlled prospective studies using standardized instruments will be crucial. Only with fine-grained determinants and outcomes can data reliably inform mental health policies and identify who is most at risk.

Do not neglect long-term mental health effects

So far, research has mainly focused on the acute and short-term effects of the pandemic on mental health, usually spanning pandemic effects over several months to 1 year. However, longer follow-up of how a pandemic impacts population mental health is essential. Can societal and economic disruptions after the pandemic increase risk of mental disorders at a later stage when the acute pandemic effects have subsided? Do increased self-reported mental health problems return to pre-pandemic levels, and which groups of individuals remain most affected in the long-term? We need to realize that certain pandemic consequences, particularly those affecting income and school/work careers, may become visible only over the course of several years. Consequently, we should maintain focus and continue to monitor and quantify the effects of the pandemic in the years to come—for example, by monitoring mental healthcare use and suicide. This should include specific at-risk populations (for example, adolescents) and understudied populations in low-income and middle-income countries.

Pay attention to mental health consequences of infectious diseases

Even though our knowledge on PACS is rapidly expanding, there are still many unanswered questions related to who is at risk, the long-term course trajectories and the best ways to intervene early. Consequently, we need to be aware of the neuropsychiatric sequelae of COVID-19 and, for that matter, of any infectious disease. Clinical attention and research should be directed toward alleviating potential neuropsychiatric ramifications of COVID-19. Next to clinical studies, studies using human tissues and appropriate animal models are pivotal to determine the CNS region-specific and neural-cell-specific effects of SARS-CoV-2 infection and the induced immune activation. Indeed, absence of SARS-CoV-2 neuroinvasion is an opportunity to learn and discover how peripheral neuroimmune mechanisms can contribute to neuropsychiatric sequelae in susceptible individuals. This emphasizes the importance of an interdisciplinary approach where somatic and mental health efforts are combined but also the need to integrate clinical parameters after infection with biological parameters (for example, serum, cerebrospinal fluid and/or neuroimaging) to predict who is at risk for PACS and deliver more targeted treatments.

Prepare mental healthcare infrastructure for pandemic times

If we take mental health seriously, we should not only monitor it but also develop the resources and infrastructure necessary for rapid early intervention, particularly for specific vulnerable groups. For adequate mental healthcare to be ready for pandemic times, primary care, community mental health and public mental health should be prepared. In many countries, health services were not able to meet the population’s mental health needs before the pandemic, which substantially worsened during the pandemic. We should ensure rapid access to mental health services but also address the underlying drivers of poor mental health, such as mitigating risks of unemployment, sexual violence and poverty. Collaboration in early stages across disciplines and expertise is essential. Anticipating disruption to face-to-face services, mental healthcare providers should be more prepared for consultations, therapy and follow-up by telephone, video-conferencing platforms and web applications 51 , 52 . The pandemic has shown that an inadequate infrastructure, pre-existing inequalities and low levels of technological literacy hindered the use and uptake of e-health, both in healthcare providers and in patients across different care settings. The necessary investments can ensure rapid upscaling of mental health services during future pandemics for those individuals with a high mental health need due to societal changes, government measures, fear of infection or infection itself.

Even though much attention has been paid to the physical health consequences of COVID-19, mental health has unjustly received less attention. There is an urgent need to prepare our research and healthcare infrastructures not only for adequate monitoring of the long-term mental health effects of the COVID-19 pandemic but also for future crises that will shape mental health. This will require collaboration to ensure interdisciplinary and sound research and to provide attention and care at an early stage for those individuals who are most vulnerable—giving mental health equal priority to physical health from the very start.

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Acknowledgements

The authors thank E. Giltay for assistance on data analyses and production of Fig. 1 . B.W.J.H.P. discloses support for research and publication of this work from the European Union’s Horizon 2020 research and innovation programme-funded RESPOND project (grant no. 101016127).

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Penninx, B.W.J.H., Benros, M.E., Klein, R.S. et al. How COVID-19 shaped mental health: from infection to pandemic effects. Nat Med 28 , 2027–2037 (2022). https://doi.org/10.1038/s41591-022-02028-2

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COVID-19 Was a Turning Point for Health

Our new book focuses on the lessons of the pandemic..

Posted February 15, 2024 | Reviewed by Michelle Quirk

• To think comprehensively about COVID-19 is to think not just about the past but also about the future.
• The narratives we accept about the pandemic will do much to shape our ability to create a healthier world.
• Understanding the pandemic, and learning from it, means coming to terms with the emotions of that time.

In 2021, the United States was at a turning point. We had just lived through the acute phase of a global pandemic. During that time, the country had experienced an economic crisis, civil unrest, a deeply divisive federal election, and a technological revolution in how we live, work, and congregate. The emergence of COVID-19 vaccines allowed us, finally, to look ahead to a post-pandemic world, but what would that world be like? Would it be a return to the pre-COVID-19 status quo, or would it be something radically new?

It was with these questions in mind that, in 2021, I partnered with my colleague Michael Stein to write a series of essays reflecting on the COVID-19 pandemic. Our aim was to engage with the COVID moment through the lens of cutting -edge public health science. By exploring the pandemic’s intersection with topics like digital surveillance, vaccine distribution, big data, and the link between science and political decision-making , we tried to sketch what the moment meant while it unfolded and what its implications might be for the future. If journalism is “the first rough draft of history,” these essays were, in a way, our effort to produce just such a draft, from the perspective of a forward-looking public health. I am delighted to announce that a book based on this series of essays has just been published by Oxford University Press: The Turning Point: Reflections on a Pandemic .

The book includes a series of short chapters, structured in five sections that address the following themes:

This section looks at the COVID-19 moment through the lens of what we might learn from it, toward better addressing future pandemics. It tackles challenges we faced in our approach to testing, our successes and shortcomings in implementing contact tracing, the intersection of the pandemic and mass incarceration, and more. Many of these lessons emerged organically from the day-to-day experience of the pandemic, reflecting “unknown unknowns”—areas where we encountered unexpected deficits in our knowledge, which were revealed by the circumstances of the pandemic. Chapter 8, for example, explores the necessity of public health officials speaking with care, mindful that our words may be used to justify authoritarian approaches in the name of health, a challenge we saw in the actions of the Chinese government during the pandemic.

Our understanding of large-scale health challenges like pandemics depends on more than collections of data and a timeline of events. It depends on our stories. The narratives we accept about the pandemic will do much to shape our ability to create a healthier world before the next contagion strikes. This section explores the stories we told during COVID-19 about what was happening to us and looks ahead to the narratives that will likely define our recollections of the pandemic moment. It addresses narratives around the virtues and limits of expertise, the role of the media as both a shaper of stories and a character in them, the hotly contested narrative around vaccines, and the role scientists, physicians, and epidemiologists played in shaping the story of the pandemic as it unfolded.

This section explores how our values informed what we did during COVID-19 through the ethical considerations that shaped our engagement with the moment. These include the ethical tradeoffs involved in questions of digital surveillance, scientific bias, vaccine mandates, balancing individual autonomy and collective responsibility, and the role of the profit motive in creating critical treatments. At times, these reflections reach back into history, grappling with past moments when we failed in our ethical obligations to support the health of all, as in a chapter discussing how the legacy of medical racism shaped our engagement with communities of color during the pandemic. Such soul-searching is core to our ability to evaluate our performance during COVID-19 and face the future grounded in the values that support effective, ethical public health action.

As human beings, we do not process events through reason alone. We are deeply swayed by emotion . This is particularly true in times of tragedy like COVID-19. Understanding the pandemic, and learning from it, means coming to terms with the emotions of that time, the feelings that attended all we did. Grief and loss, humility and hope, trust and mistrust , compassion and fear —both individual and collective—were all core to the experience of the pandemic. The simple act of recognizing our collective grief, as several chapters in this section try to do, can help us move forward, acknowledging the emotions that attend tragedy as we work toward a better world.

To think comprehensively about COVID-19 is to think not just about the past but about the future. We seek to understand the pandemic to prevent something like it from ever happening again. This means creating a world that is fundamentally healthier than the one that existed in 2019. This final section looks to the future from the perspective of the COVID-19 moment, with an eye toward using the lessons of that time to create a healthier world, as in Chapter 50, which addresses the challenge of rebuilding trust in public health institutions after it was tested during the pandemic. The section also touches on leadership and decision-making, shaping a better health system, shoring up our investment in health, the future of remote work, and next steps in our efforts to support health in the years to come.

I end with a note of gratitude to Michael Stein, who led on the development of this book. It is, as always, a privilege to work with him and learn from him. I look forward to continued collaborations in the months and years to come, and to hearing from readers of The Turning Point as we engage in our collective task of building a healthier world, informed by what we have lived through and looking to the future.

A version of this essay appeared on Substack.

Sandro Galea, M.D., is the Robert A. Knox professor and dean of the Boston University School of Public Health

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• Published: 11 April 2023

Effects of the COVID-19 pandemic on mental health, anxiety, and depression

• Ida Kupcova 1 ,
• Lubos Danisovic 1 ,
• Martin Klein 2 &
• Stefan Harsanyi 1  

BMC Psychology volume  11 , Article number:  108 ( 2023 ) Cite this article

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The COVID-19 pandemic affected everyone around the globe. Depending on the country, there have been different restrictive epidemiologic measures and also different long-term repercussions. Morbidity and mortality of COVID-19 affected the mental state of every human being. However, social separation and isolation due to the restrictive measures considerably increased this impact. According to the World Health Organization (WHO), anxiety and depression prevalence increased by 25% globally. In this study, we aimed to examine the lasting effects of the COVID-19 pandemic on the general population.

A cross-sectional study using an anonymous online-based 45-question online survey was conducted at Comenius University in Bratislava. The questionnaire comprised five general questions and two assessment tools the Zung Self-Rating Anxiety Scale (SAS) and the Zung Self-Rating Depression Scale (SDS). The results of the Self-Rating Scales were statistically examined in association with sex, age, and level of education.

A total of 205 anonymous subjects participated in this study, and no responses were excluded. In the study group, 78 (38.05%) participants were male, and 127 (61.69%) were female. A higher tendency to anxiety was exhibited by female participants (p = 0.012) and the age group under 30 years of age (p = 0.042). The level of education has been identified as a significant factor for changes in mental state, as participants with higher levels of education tended to be in a worse mental state (p = 0.006).

Conclusions

Summarizing two years of the COVID-19 pandemic, the mental state of people with higher levels of education tended to feel worse, while females and younger adults felt more anxiety.

Peer Review reports

Introduction

The first mention of the novel coronavirus came in 2019, when this variant was discovered in the city of Wuhan, China, and became the first ever documented coronavirus pandemic [ 1 , 2 , 3 ]. At this time there was only a sliver of fear rising all over the globe. However, in March 2020, after the declaration of a global pandemic by the World Health Organization (WHO), the situation changed dramatically [ 4 ]. Answering this, yet an unknown threat thrust many countries into a psycho-socio-economic whirlwind [ 5 , 6 ]. Various measures taken by governments to control the spread of the virus presented the worldwide population with a series of new challenges to which it had to adjust [ 7 , 8 ]. Lockdowns, closed schools, losing employment or businesses, and rising deaths not only in nursing homes came to be a new reality [ 9 , 10 , 11 ]. Lack of scientific information on the novel coronavirus and its effects on the human body, its fast spread, the absence of effective causal treatment, and the restrictions which harmed people´s social life, financial situation and other areas of everyday life lead to long-term living conditions with increased stress levels and low predictability over which people had little control [ 12 ].

Risks of changes in the mental state of the population came mainly from external risk factors, including prolonged lockdowns, social isolation, inadequate or misinterpreted information, loss of income, and acute relationship with the rising death toll. According to the World Health Organization (WHO), since the outbreak of the COVID-19 pandemic, anxiety and depression prevalence increased by 25% globally [ 13 ]. Unemployment specifically has been proven to be also a predictor of suicidal behavior [ 14 , 15 , 16 , 17 , 18 ]. These risk factors then interact with individual psychological factors leading to psychopathologies such as threat appraisal, attentional bias to threat stimuli over neutral stimuli, avoidance, fear learning, impaired safety learning, impaired fear extinction due to habituation, intolerance of uncertainty, and psychological inflexibility. The threat responses are mediated by the limbic system and insula and mitigated by the pre-frontal cortex, which has also been reported in neuroimaging studies, with reduced insula thickness corresponding to more severe anxiety and amygdala volume correlated to anhedonia as a symptom of depression [ 19 , 20 , 21 , 22 , 23 ]. Speaking in psychological terms, the pandemic disturbed our core belief, that we are safe in our communities, cities, countries, or even the world. The lost sense of agency and confidence regarding our future diminished the sense of worth, identity, and meaningfulness of our lives and eroded security-enhancing relationships [ 24 ].

Slovakia introduced harsh public health measures in the first wave of the pandemic, but relaxed these measures during the summer, accompanied by a failure to develop effective find, test, trace, isolate and support systems. Due to this, the country experienced a steep growth in new COVID-19 cases in September 2020, which lead to the erosion of public´s trust in the government´s management of the situation [ 25 ]. As a means to control the second wave of the pandemic, the Slovak government decided to perform nationwide antigen testing over two weekends in November 2020, which was internationally perceived as a very controversial step, moreover, it failed to prevent further lockdowns [ 26 ]. In addition, there was a sharp rise in the unemployment rate since 2020, which continued until July 2020, when it gradually eased [ 27 ]. Pre-pandemic, every 9th citizen of Slovakia suffered from a mental health disorder, according to National Statistics Office in 2017, the majority being affective and anxiety disorders. A group of authors created a web questionnaire aimed at psychiatrists, psychologists, and their patients after the first wave of the COVID-19 pandemic in Slovakia. The results showed that 86.6% of respondents perceived the pathological effect of the pandemic on their mental status, 54.1% of whom were already treated for affective or anxiety disorders [ 28 ].

In this study, we aimed to examine the lasting effects of the COVID-19 pandemic on the general population. This study aimed to assess the symptoms of anxiety and depression in the general public of Slovakia. After the end of epidemiologic restrictive measures (from March to May 2022), we introduced an anonymous online questionnaire using adapted versions of Zung Self-Rating Anxiety Scale (SAS) and Zung Self-Rating Depression Scale (SDS) [ 29 , 30 ]. We focused on the general public because only a portion of people who experience psychological distress seek professional help. We sought to establish, whether during the pandemic the population showed a tendency to adapt to the situation or whether the anxiety and depression symptoms tended to be present even after months of better epidemiologic situation, vaccine availability, and studies putting its effects under review [ 31 , 32 , 33 , 34 ].

Materials and Methods

This study utilized a voluntary and anonymous online self-administered questionnaire, where the collected data cannot be linked to a specific respondent. This study did not process any personal data. The questionnaire consisted of 45 questions. The first three were open-ended questions about participants’ sex, age (date of birth was not recorded), and education. Followed by 2 questions aimed at mental health and changes in the will to live. Further 20 and 20 questions consisted of the Zung SAS and Zung SDS, respectively. Every question in SAS and SDS is scored from 1 to 4 points on a Likert-style scale. The scoring system is introduced in Fig.  1 . Questions were presented in the Slovak language, with emphasis on maintaining test integrity, so, if possible, literal translations were made from English to Slovak. The questionnaire was created and designed in Google Forms®. Data collection was carried out from March 2022 to May 2022. The study was aimed at the general population of Slovakia in times of difficult epidemiologic and social situations due to the high prevalence and incidence of COVID-19 cases during lockdowns and social distancing measures. Because of the character of this web-based study, the optimal distribution of respondents could not be achieved.

Categories of Zung SAS and SDS scores with clinical interpretation

During the course of this study, 205 respondents answered the anonymous questionnaire in full and were included in the study. All respondents were over 18 years of age. The data was later exported from Google Forms® as an Excel spreadsheet. Coding and analysis were carried out using IBM SPSS Statistics version 26 (IBM SPSS Statistics for Windows, Version 26.0, Armonk, NY, USA). Subject groups were created based on sex, age, and education level. First, sex due to differences in emotional expression. Second, age was a risk factor due to perceived stress and fear of the disease. Last, education due to different approaches to information. In these groups four factors were studied: (1) changes in mental state; (2) affected will to live, or frequent thoughts about death; (3) result of SAS; (4) result of SDS. For SAS, no subject in the study group scored anxiety levels of “severe” or “extreme”. Similarly for SDS, no subject depression levels reached “moderate” or “severe”. Pearson’s chi-squared test(χ2) was used to analyze the association between the subject groups and studied factors. The results were considered significant if the p-value was less than 0.05.

Ethical permission was obtained from the local ethics committee (Reference number: ULBGaKG-02/2022). This study was performed in line with the principles of the Declaration of Helsinki. All methods were carried out following the institutional guidelines. Due to the anonymous design of the study and by the institutional requirements, written informed consent for participation was not required for this study.

In the study, out of 205 subjects in the study group, 127 (62%) were female and 78 (38%) were male. The average age in the study group was 35.78 years of age (range 19–71 years), with a median of 34 years. In the age group under 30 years of age were 34 (16.6%) subjects, while 162 (79%) were in the range from 31 to 49 and 9 (0.4%) were over 50 years old. 48 (23.4%) participants achieved an education level of lower or higher secondary and 157 (76.6%) finished university or higher. All answers of study participants were included in the study, nothing was excluded.

In Tables  1 and 2 , we can see the distribution of changes in mental state and will to live as stated in the questionnaire. In Table  1 we can see a disproportion in education level and mental state, where participants with higher education tended to feel worse much more than those with lower levels of education. Changes based on sex and age did not show any statistically significant results.

In Table  2 . we can see, that decreased will to live and frequent thoughts about death were only marginally present in the study group, which suggests that coping mechanisms play a huge role in adaptation to such events (e.g. the global pandemic). There is also a possibility that living in times of better epidemiologic situations makes people more likely to forget about the bad past.

Anxiety and depression levels as seen in Tables  3 and 4 were different, where female participants and the age group under 30 years of age tended to feel more anxiety than other groups. No significant changes in depression levels based on sex, age, and education were found.

Compared to the estimated global prevalence of depression in 2017 (3.44%), in 2021 it was approximately 7 times higher (25%) [ 14 ]. Our study did not prove an increase in depression, while anxiety levels and changes in the mental state did prove elevated. No significant changes in depression levels go in hand with the unaffected will to live and infrequent thoughts about death, which were important findings, that did not supplement our primary hypothesis that the fear of death caused by COVID-19 or accompanying infections would enhance personal distress and depression, leading to decreases in studied factors. These results are drawn from our limited sample size and uneven demographic distribution. Suicide ideations rose from 5% pre-pandemic to 10.81% during the pandemic [ 35 ]. In our study, 9.3% of participants experienced thoughts about death and since we did not specifically ask if they thought about suicide, our results only partially correlate with suicidal ideations. However, as these subjects exhibited only moderate levels of anxiety and mild levels of depression, the rise of suicide ideations seems unlikely. The rise in suicidal ideations seemed to be especially true for the general population with no pre-existing psychiatric conditions in the first months of the pandemic [ 36 ]. The policies implemented by countries to contain the pandemic also took a toll on the population´s mental health, as it was reported, that more stringent policies, mainly the social distancing and perceived government´s handling of the pandemic, were related to worse psychological outcomes [ 37 ]. The effects of lockdowns are far-fetched and the increases in mental health challenges, well-being, and quality of life will require a long time to be understood, as Onyeaka et al. conclude [ 10 ]. These effects are not unforeseen, as the global population suffered from life-altering changes in the structure and accessibility of education or healthcare, fluctuations in prices and food insecurity, as well as the inevitable depression of the global economy [ 38 ].

The loneliness associated with enforced social distancing leads to an increase in depression, anxiety, and posttraumatic stress in children in adolescents, with possible long-term sequelae [ 39 ]. The increase in adolescent self-injury was 27.6% during the pandemic [ 40 ]. Similar findings were described in the middle-aged and elderly population, in which both depression and anxiety prevalence rose at the beginning of the pandemic, during the pandemic, with depression persisting later in the pandemic, while the anxiety-related disorders tended to subside [ 41 ]. Medical professionals represented another specific at-risk group, with reported anxiety and depression rates of 24.94% and 24.83% respectively [ 42 ]. The dynamic of psychopathology related to the COVID-19 pandemic is not clear, with studies reporting a return to normal later in 2020, while others describe increased distress later in the pandemic [ 20 , 43 ].

Concerning the general population, authors from Spain reported that lockdowns and COVID-19 were associated with depression and anxiety [ 44 ]. In January 2022 Zhao et al., reported an elevation in hoarding behavior due to fear of COVID-19, while this process was moderated by education and income levels, however, less in the general population if compared to students [ 45 ]. Higher education levels and better access to information could improve persons’ fear of the unknown, however, this fact was not consistent with our expectations in this study, as participants with university education tended to feel worse than participants with lower education. A study on adolescents and their perceived stress in the Czech Republic concluded that girls are more affected by lockdowns. The strongest predictor was loneliness, while having someone to talk to, scored the lowest [ 46 ]. Garbóczy et al. reported elevated perceived stress levels and health anxiety in 1289 Hungarian and international students, also affected by disengagement from home and inadequate coping strategies [ 47 ]. Wathelet et al. conducted a study on French University students confined during the pandemic with alarming results of a high prevalence of mental health issues in the study group [ 48 ]. Our study indicated similar results, as participants in the age group under 30 years of age tended to feel more anxious than others.

In conclusion, we can say that this pandemic changed the lives of many. Many of us, our family members, friends, and colleagues, experienced life-altering events and complicated situations unseen for decades. Our decisions and actions fueled the progress in medicine, while they also continue to impact society on all levels. The long-term effects on adolescents are yet to be seen, while effects of pain, fear, and isolation on the general population are already presenting themselves.

The limitations of this study were numerous and as this was a web-based study, the optimal distribution of respondents could not be achieved, due to the snowball sampling strategy. The main limitation was the small sample size and uneven demographic distribution of respondents, which could impact the representativeness of the studied population and increase the margin of error. Similarly, the limited number of older participants could significantly impact the reported results, as age was an important risk factor and thus an important stressor. The questionnaire omitted the presence of COVID-19-unrelated life-changing events or stressors, and also did not account for any preexisting condition or risk factor that may have affected the outcome of the used assessment scales.

Data Availability

The datasets generated and analyzed during the current study are not publicly available due to compliance with institutional guidelines but they are available from the corresponding author (SH) on a reasonable request.

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Acknowledgements

We would like to provide our appreciation and thanks to all the respondents in this study.

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Ida Kupcova, Lubos Danisovic & Stefan Harsanyi

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Kupcova, I., Danisovic, L., Klein, M. et al. Effects of the COVID-19 pandemic on mental health, anxiety, and depression. BMC Psychol 11 , 108 (2023). https://doi.org/10.1186/s40359-023-01130-5

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• COVID-19 and your mental health

Worries and anxiety about COVID-19 and its impact can be overwhelming. Learn ways to cope during this pandemic.

The COVID-19 pandemic may have brought many changes to how you live your life, and with it, at times, uncertainty, altered daily routines, financial pressures and social isolation. You may worry about getting sick, how long the pandemic will last, whether your job will be affected and what the future will bring. Information overload, rumors and misinformation can make your life feel out of control and make it unclear what to do.

During the COVID-19 pandemic, you may experience stress, anxiety, fear, sadness and loneliness. And mental health disorders, including anxiety and depression, can worsen.

Surveys show a major increase in the number of U.S. adults who report symptoms of stress, anxiety, depression and insomnia during the pandemic, compared with surveys before the pandemic. Some people have increased their use of alcohol or drugs, thinking that can help them cope with their fears about the pandemic. In reality, using these substances can worsen anxiety and depression.

People with substance use disorders, notably those addicted to tobacco or opioids, are likely to have worse outcomes if they get COVID-19 . That's because these addictions can harm lung function and weaken the immune system, causing chronic conditions such as heart disease and lung disease, which increase the risk of serious complications from COVID-19 .

For all of these reasons, it's important to learn self-care strategies and get the care you need to help you cope.

Self-care strategies

Self-care strategies are good for your mental and physical health and can help you take charge of your life. Take care of your body and your mind and connect with others to benefit your mental health.

Take care of your body

Be mindful about your physical health:

• Get enough sleep. Go to bed and get up at the same times each day. Stick close to your typical sleep-wake schedule, even if you're staying at home.
• Participate in regular physical activity. Regular physical activity and exercise can help reduce anxiety and improve mood. Find an activity that includes movement, such as dance or exercise apps. Get outside, such as a nature trail or your own backyard.
• Eat healthy. Choose a well-balanced diet. Avoid loading up on junk food and refined sugar. Limit caffeine as it can aggravate stress, anxiety and sleep problems.
• Avoid tobacco, alcohol and drugs. If you smoke tobacco or if you vape, you're already at higher risk of lung disease. Because COVID-19 affects the lungs, your risk increases even more. Using alcohol to try to cope can make matters worse and reduce your coping skills. Avoid taking drugs to cope, unless your doctor prescribed medications for you.
• Limit screen time. Turn off electronic devices for some time each day, including 30 to 60 minutes before bedtime. Make a conscious effort to spend less time in front of a screen — television, tablet, computer and phone.
• Relax and recharge. Set aside time for yourself. Even a few minutes of quiet time can be refreshing and help to settle your mind and reduce anxiety. Many people benefit from practices such as deep breathing, tai chi, yoga, mindfulness or meditation. Soak in a bubble bath, listen to music, or read or listen to a book — whatever helps you relax. Select a technique that works for you and practice it regularly.

Take care of your mind

Reduce stress triggers:

• Keep your regular routine. Maintaining a regular daily schedule is important to your mental health. In addition to sticking to a regular bedtime routine, keep consistent times for meals, bathing and getting dressed, work or study schedules, and exercise. Also set aside time for activities you enjoy. This predictability can make you feel more in control.
• Limit exposure to news media. Constant news about COVID-19 from all types of media can heighten fears about the disease. Limit social media that may expose you to rumors and false information. Also limit reading, hearing or watching other news, but keep up to date on national and local recommendations. Look for reliable sources, such as the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).
• Stay busy. Healthy distractions can get you away from the cycle of negative thoughts that feed anxiety and depression. Enjoy hobbies that you can do at home, such as reading a book, writing in a journal, making a craft, playing games or cooking a new meal. Or identify a new project or clean out that closet you promised you'd get to. Doing something positive to manage anxiety is a healthy coping strategy.
• Focus on positive thoughts. Choose to focus on the positive things in your life, instead of dwelling on how bad you feel. Consider starting each day by listing things you are thankful for. Maintain a sense of hope, work to accept changes as they occur and try to keep problems in perspective.
• Use your moral compass or spiritual life for support. If you draw strength from a belief system, it can bring you comfort during difficult and uncertain times.
• Set priorities. Don't become overwhelmed by creating a life-changing list of things to achieve while you're home. Set reasonable goals each day and outline steps you can take to reach those goals. Give yourself credit for every step in the right direction, no matter how small. And recognize that some days will be better than others.

Connect with others

Build support and strengthen relationships:

Make connections. If you work remotely from home or you need to isolate yourself from others for a period of time due to COVID-19 , avoid social isolation. Find time each day to make virtual connections by email, texts, phone or video chat. If you're working remotely from home, ask your co-workers how they're doing and share coping tips. Enjoy virtual socializing and talking to those in your home.

If you're not fully vaccinated, be creative and safe when connecting with others in person, such as going for walks, chatting in the driveway and other outdoor activities, or wearing a mask for indoor activities.

If you are fully vaccinated, you can more safely return to many indoor and outdoor activities you may not have been able to do because of the pandemic, such as gathering with friends and family. If you are in an area with a high number of people with COVID-19 in the hospital, the CDC recommends wearing a mask indoors in public or outdoors in crowded areas or in close contact with unvaccinated people. For unvaccinated people, outdoor activities that allow plenty of space between you and others pose a lower risk of spread of the COVID-19 virus than indoor activities do.

• Do something for others. Find purpose in helping the people around you. Helping others is an excellent way to help ourselves. For example, email, text or call to check on your friends, family members and neighbors — especially those who are older. If you know someone who can't get out, ask if there's something needed, such as groceries or a prescription picked up.
• Support a family member or friend. If a family member or friend needs to be quarantined at home or in the hospital due to COVID-19 , come up with ways to stay in contact. This could be through electronic devices or the telephone or by sending a note to brighten the day, for example.

Avoid stigma and discrimination

Stigma can make people feel isolated and even abandoned. They may feel depressed, hurt and angry when friends and others in their community avoid them for fear of getting COVID-19 .

Stigma harms people's health and well-being in many ways. Stigmatized groups may often be deprived of the resources they need to care for themselves and their families during a pandemic. And people who are worried about being stigmatized may be less likely to get medical care.

People who have experienced stigma related to COVID-19 include people of Asian descent, health care workers, people with COVID-19 and those released from quarantine. People who are stigmatized may be excluded or shunned, treated differently, denied job and educational opportunities, and be targets of verbal, emotional and physical abuse.

You can reduce stigma by:

• Getting the facts about COVID-19 from reputable sources such as the CDC and WHO
• Speaking up if you hear or see inaccurate statements about COVID-19 and certain people or groups
• Reaching out to people who feel stigmatized
• Showing support for health care workers

Recognize what's typical and what's not

Stress is a normal psychological and physical reaction to the demands of life. Everyone reacts differently to difficult situations, and it's normal to feel stress and worry during a crisis. But multiple challenges, such as the effects of the COVID-19 pandemic, can push you beyond your ability to cope.

Many people may have mental health concerns, such as symptoms of anxiety and depression during this time. And feelings may change over time.

Despite your best efforts, you may find yourself feeling helpless, sad, angry, irritable, hopeless, anxious or afraid. You may have trouble concentrating on typical tasks, changes in appetite, body aches and pains, or difficulty sleeping or you may struggle to face routine chores.

When these signs and symptoms last for several days in a row, make you miserable and cause problems in your daily life so that you find it hard to carry out normal responsibilities, it's time to ask for help.

Get help when you need it

Hoping mental health problems such as anxiety or depression will go away on their own can lead to worsening symptoms. If you have concerns or if you experience worsening of mental health symptoms, ask for help when you need it, and be upfront about how you're doing. To get help you may want to:

• Call or use social media to contact a close friend or loved one — even though it may be hard to talk about your feelings.
• Contact a minister, spiritual leader or someone in your faith community.
• Contact your employee assistance program, if your employer has one, and ask for counseling or a referral to a mental health professional.
• Call your primary care professional or mental health professional to ask about appointment options to talk about your anxiety or depression and get advice and guidance. Some may provide the option of phone, video or online appointments.
• Contact organizations such as the National Alliance on Mental Illness (NAMI), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the Anxiety and Depression Association of America for help and guidance on information and treatment options.

If you're feeling suicidal or thinking of hurting yourself, seek help. Contact your primary care professional or a mental health professional. Or contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline , available 24 hours a day, seven days a week. Or use the Lifeline Chat . Services are free and confidential.

Continue your self-care strategies

You can expect your current strong feelings to fade when the pandemic is over, but stress won't disappear from your life when the health crisis of COVID-19 ends. Continue these self-care practices to take care of your mental health and increase your ability to cope with life's ongoing challenges.

• How stress affects your health. American Psychological Association. https://www.apa.org/helpcenter/stress-facts. Accessed Oct. 19, 2021.
• Taking care of your emotional health. Centers for Disease Control and Prevention. https://emergency.cdc.gov/coping/selfcare.asp. Accessed Oct. 19, 2021.
• COVID-19 resource and information guide. National Alliance on Mental Illness. https://www.nami.org/Support-Education/NAMI-HelpLine/COVID-19-Information-and-Resources/COVID-19-Resource-and-Information-Guide. Accessed Oct. 19, 2021.
• Combating bias and stigma related to COVID-19. American Psychological Association. https://www.apa.org/topics/covid-19-bias. Accessed Oct. 19, 2021.
• #HealthyAtHome—Mental health. World Health Organization. www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome/healthyathome---mental-health. Accessed Oct. 19, 2021.
• Your healthiest self: Emotional wellness toolkit. National Institutes of Health. https://www.nih.gov/health-information/emotional-wellness-toolkit. Accessed Oct. 19, 2021.
• Coping with stress. Centers for Disease Control and Prevention. www.cdc.gov/mentalhealth/stress-coping/cope-with-stress/. Accessed Oct. 19, 2021.
• Manage stress. U.S. Department of Health and Human Services. https://health.gov/myhealthfinder/topics/health-conditions/heart-health/manage-stress. Accessed March 20, 2020.
• Health effects of cigarette smoking. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm#respiratory. Accessed March 25, 2020.
• Sawchuk CN (expert opinion). Mayo Clinic. March 27, 2020.
• Holman EA, et al. The unfolding COVID-19 pandemic: A probability-based, nationally representative study of mental health in the U.S. Science Advances. 2020; doi:10.1126/sciadv.abd5390.
• Wang QQ, et al. COVID-19 risk and outcomes in patients with substance use disorders: Analyses from electronic health records in the United States. Molecular Psychiatry. 2020; doi:10.1038/s41380-020-00880-7.
• Ettman CK, et al. Prevalence of depression symptoms in U.S. adults before and during the COVID-19 pandemic. JAMA Network Open. 2020; doi:10.1001/jamanetworkopen.2020.19686.
• Czeisler ME, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic — United States, June 24-30, 2020. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm. Accessed Oct. 12, 2020.
• Social stigma associated with COVID-19. World Health Organization. https://www.who.int/docs/default-source/coronaviruse/covid19-stigma-guide.pdf. Accessed Oct. 20, 2021.
• Yashadhana A, et al. Pandemic-related racial discrimination and its health impact among non-Indigenous racially minoritized peoples in high-income contexts: A systematic review. Health Promotion International. 2021; doi:10.1093/heapro/daab144.
• Participate in outdoor and indoor activities. Centers for Disease Control and Prevention. www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/outdoor-activities.html. Accessed Nov. 16, 2021.
• When you've been fully vaccinated. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html. Accessed Nov. 16, 2021.

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Mental Health During the Covid-19 Outbreak in China: a Meta-Analysis

Tongde Hospital of Zhejiang Province, Mental Health Center of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou, Zhejiang Province China

Wanli Huang

Huiping pan, tingting huang, xinwei wang, yongchun ma, associated data.

All data generated or analyzed in this study are available from the corresponding author for the reasonable request.

Background : Covid-19 has started to spread within China since the end of December 2019. Despite government’s immediate actions and strict control, more and more people were infected every day. As such a contagious virus can spread easily and rapidly between people, the whole country was put into lockdown and people were forced into isolation. In order to understand the impact of Covid-19 on mental health well-being, Chinese researchers have conducted several studies. However, no consistent results were obtained. Therefore, a meta-analysis was conducted.

Methods: We searched Embase, PubMed, and Web of Science databases to find literature from December 2019 to April 2020 related to Covid-19 and mental health, among which results such as comments, letters, reviews and case reports were excluded. The incidence of anxiety and depression in the population was synthesized and discussed.

Results: A total of 27,475 subjects were included in 12 studies. Random effect model is used to account for the data. The results showed that the incidence of anxiety was 25% (95% CI: 0.19–0.32), and the incidence of depression was 28% (95% CI: 0.17–0.38). Significant heterogeneity was detected across studies regarding these incidence estimates. Subgroup analysis included the study population and assessment tools, and sensitivity analysis was done to explore the sources of heterogeneity.

Conclusions: Owing to the significant heterogeneity detected in studies regarding this pooled prevalence of anxiety and depression, we must interpret the results with caution. As the epidemic is ongoing, it is vital to set up a comprehensive crisis prevention system, which integrating epidemiological monitoring, screening and psychological crisis prevention and interventions.

At the end of December, the first case of Covid-19 that a novel coronavirus, which could potentially cause acute infectious pneumonia, emerged from Wuhan, China. As early as 30th January 2020, WHO had declared it as a public health emergency of international concerns, and appealing for efforts to prevent this epidemic [ 1 ]. According to the National Health Commission of China, until 4th February 2020, there had been 24,324 people confirmed to be infected by Covid-19 across 31 provinces in Mainland China [ 2 ]. Due to its high infectiveness, widely and rapidly spread was inevitable. By 23rd April, there have been 84,302 confirmed cases in China. Globally, this figure has surged up to 2,510,122, including 172,241 deaths reported to WHO [ 3 ].

China, as the first nation struck by Covid-19, has taken unprecedented measure to control the virus. Three weeks into the epidemic, indoor facilities such as cinemas and shopping malls were closed, public transportation was suspended and communities were kept under close monitored. The whole country was in lockdown, over 50 million people were quarantined, including confirmed as well as suspected patients. Under this circumstance, people were prone to experience loneliness, anxiety and depression caused by social isolation and fear of being infected. The shortage of personal protective equipment and medical equipment had worsened the situation. Not only the general public was in distressed, healthcare professionals were one of the worst affected by supply shortages. They had to come to work and care for patients knowing that they were very likely to be infected due to insufficient protective equipment. Moreover, excessive workload and extreme working condition had undoubtedly added an enormous mental burden for front line workers. The similar situation during influenza outbreak were shown, researchers suggested that about 10–30% of the population concern or had some degree of concern about being exposed to the virus [ 4 ].

Given that no one fully understands the impact of Covid-19 outbreak has on mental health, many researches were conducted within China. According to researches, mental distress was detected within the nation. However, how significant the distress was varied dramatically. For example, according to Wang and Pan, the percentage of anxiety and depression was 28.8% and 16.5%, respectively [ 5 ]. Yet, another research revealed that 50.4% and 44.6% of all had symptoms of anxiety and depression [ 6 ]. As all available research data had presented to be very inconsistent, it would be useful to analyze the data provided, using an integrated approach to build a clear picture of the impact. To our knowledge, this is the first meta-analysis that identifies the impact of Covid-19 outbreak has on mental health.

Search Strategy

This study was performed according to the recommendations of the Moose [ 7 ]. Two reviewers independently searched the EMBASE, Web of Science and PubMed to obtain all potential researches, using keywords including Covid-19, mental health, depression, anxiety, depressive and stress. Reviewers also manually searched the references of selected articles to identify any relevant studies. Only English articles were included in this study.

Inclusion and Exclusion Criteria

Xin Ren and Wanli Huang reviewed the initial retrieved publications independently. The discrepancy was resolved through discussion by all reviewers. Studies that met the following criteria were included: (1) cross-sectional studies; (2) the nationality of the subjects is Chinese and age >18 years old; (3) used a standard instrument to assess for mental health conditions. However, articles had incomplete or unidentified data were excluded, as well as abstracts, reviews, case reports, letters and duplicate publications.

Quality Assessment and Data Extraction

Xin Ren and Wanli Huang reviewed each included article independently, using the 11-item checklist that was recommended by the Agency for Healthcare Research and Quality (AHRQ) [ 8 ]. An item would be scored ‘0’ if it was answered ‘NO’ or ‘UNCLEAR’ whereas ‘1’ will be given to the answer ‘YES’. Article quality was assessed as follows: low quality = 0–3; moderate quality = 4–7; high quality = 8–11. Differences in article quality were discussed to reach an agreeable final score. The following information was extracted: first author, publication time, the sample size, study population, assessment tools, and the number of people who had anxiety and depression.

Statistical Analysis

A random-effect model was used to estimate the pooled proportion of anxiety and depression. Statistical heterogeneity was considered to be present when p   < 0.1 or I 2  > 50%. Publication bias was evaluated visually by funnel plots and considered significant when p < 0.05 in either Begg’s test or Egger’s test. The subgroup analysis was carried out using the study population and assessment tools. STATA 14.0 software (Stata Corporation, College Station, TX, USA) was also used to conduct different analyses and all statistical tests.

Search Results

Our initial search yielded 568 articles in total, 170 of which were removed for duplication. After screening titles and abstracts, further 378 items were taken away. Twenty articles were reviewed, among which 12 were included in this meta-analysis [ 5 , 6 , 9 – 18 ]. No further study was identified by manual search. The flow diagram of studies selection was shown in Fig.  1 .

Flowchart of selection of studies for inclusion in meta-analysis

Study Characteristic

Twelve cross-sectional studies, with 27,475 subjects, met the inclusion criteria and were included for the final meta-analysis. Among the subjects, 21,377 were the general public and 6098 were healthcare professionals. The sample size of the studies ranged from 98 to 7236. Assessment tools used in the studies are list as follows: Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), Self-Rating Anxiety Scale (SAS), Self-rating depression scale (SDS), Impact of Event Scale-Revised (IES-R), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and The insomnia severity index (ISI). The main features of the 12 articles were summarized in Table ​ Table1. 1 . AHRQ scores suggested that all 12 studies scored at eight as high quality.

Characteristics of studies included in the meta-analysis

Overall Prevalence of Anxiety among the Population

The rate of anxiety within the population reported in nine studies ranged from 9% to 45% (Fig.  2 ). Meta-analytic pooling of these rates generated an overall prevalence of 25% (95% CI: 0.19–0.32, P  = 0.00, I2 = 99.4%), which calculated by random-effects model ( P  < 0.05), with significant between-study heterogeneity exist (I2 = 99.4%). Hence, to find out the sources of heterogeneity, we used subgroup analysis (Table ​ (Table2) 2 ) to evaluate potential sources between the study population and assessment tools. First, the summarized proportion of non-medical staff was 24% (95% CI: 0.16–0.32), while medical staff was 27% (95% CI: 0.12–0.43). Second, the summarized proportion of anxiety assessed by GAD-7 scale was 36% (95% CI: 0.27–0.44). Anxiety evaluated by SAS scale and GAD-2 scale was 14% (95% CI: −0.01-0.30) and 11% (95% CI: 0.06–0.15), respectively. No evidence of publication bias was detected by the Begg’s test ( p  = 0.721) and the Egger’s test ( p  = 0.925). Sensitivity analysis was carried out to evaluate the influence of a single study on the results of this meta-analysis. We found that no significant changed was observed of 10 values when any one study was removed from this meta-analysis (Fig. ​ (Fig.3 3 ).

Summarized proportion of anxiety in overall population

Subgroup meta-analysis by study population and assessment tools for the summarized proportion of anxiety in overall population

CI Confidence interval

Sensitivity analysis of anxiety in overall population

Overall Prevalence of Depression among the Population

Eight of the 12 studies with 19,709 subjects were included for the meta-analysis for overall prevalence, which was 28% (95% CI: 0.17–0.38, P = 0.00, I2 = 99.7%) (Fig. ​ (Fig.4). 4 ). Subgroup analysis (Table ​ (Table3) 3 ) was used to identify possible sources of heterogeneity. The rate of depression was 29% (95% CI: 0.16–0.42) among the general public, whereas 25% (95% CI: 0.04–0.45) among healthcare professions. Additionally, studies conducted by different scales yielded different results of depression prevalence as follows: PHQ-9 scale was 50% (95% CI: 0.48–0.53), and PHQ-4 scale was 11% (95% CI: 0.08–0.13). To investigate the publication bias, we used Egger’s test ( p  = 0.594) and the Begg’s test ( p  = 0.348) to investigate the publication bias and the result revealed that such bias did not exist. Sensitivity analysis was carried out to evaluate the influence of individual study had on results of this meta-analysis. We found that no significant changed was observed of 9 values when any one study was removed from this meta-analysis (Fig. ​ (Fig.5 5 ).

Summarized proportion of depression in overall population

Subgroup meta-analysis by study population and assessment tools for the summarized proportion of depression in overall population

Sensitivity analysis of depression in overall population

According to Robert G. Maunder, Severe Acute Respiratory Syndrome (SARS) should not be considered as mental health catastrophe. Since the virus would unlikely to mutate and patients would only become the source of infection when they were symptomatic, authorities had been able to identify cases efficiently and to isolate infected individuals [ 19 ], which limited spread of the disease and therefore had provided reassurance for people.

However, unlike typical respiratory viruses that are most contagious when a patient is symptomatic, Covid-19 was very different. A study looking into 94 Covid-19 patients has proved that human-to-human transmission can occur during the asymptomatic incubation period [ 20 ], which can be as long as 14 days. Alarmingly, according to a case reported by one Germany researcher and as well as studies conducted in China, people who suffered from subclinical or mild symptoms of the disease possessed the same viral load to patients who exhibited symptoms [ 21 , 22 ]. In fact, 44% transmissions of the virus occurred before people got sick [ 20 ]. As a result, traditional containment measures struggle to be effective as expected. Although fatality rate was about 0.3–0.6%, because of its distinctive characteristic that make it so difficult to contain, Covid-19 should be recognized as health catastrophe that would cause people great and sudden sufferings [ 23 ].

According to Hall, R.C.W. et al., during the outbreak of an infection, people’s mental health would be affected profoundly and immensely [ 24 ]. For the general public, myths and misinformation about the virus, fueling health-related fears and concerns, together with shut down of infrastructures trigger a series of emotional stress response including anxiety and other negative emotions. Healthcare professionals, being exposed to this new and highly contagious pathogen, are heavily burdened with excessive workload, shortage of personal protection equipment and feeling lack of support. Some researchers have been done to find out how the Covid-19 outbreak affects people’s mental health. According to one research conducted by Cuiyan Wang et al., 16.5% of respondents (the general public) reported moderate to severe depressive symptoms, and 28.8% reported anxiety symptoms to the same extent [ 5 ]. Another study has shown that a depression rate of 17.7% and an anxiety rate of 6.33%. Furthermore, there were a lot more research data that had presented to be varied considerably in both rates [ 6 , 25 ]. As a result, the study we conducted can help to identify the mental burden of the public and therefore, to improve future mental health care.

In this meta-analysis, the percentage of mental disturbance (anxiety and depression) was calculated, using data from 12 articles, including 27,475 individuals. Overall, the pooled prevalence of anxiety was 25%. Because of the high heterogeneity discovered in this article (I2 = 99.4%), we performed subgroup analysis, which included study population and assessment tools to identify the source of heterogeneity. Nevertheless, heterogeneity of both groups was over 50%. Sensitivity analysis found no significant changed was observed of 10 values when any one study was removed. No publication bias was discovered analyzed by the Begg’s test ( p  = 0.721) and the Egger’s test ( p  = 0.925). Besides, we also calculated the pooled prevalence of depression, which was 28%. Similarly, the heterogeneity was high as well, and subgroup analysis indicated that the result was higher than 50%. Sensitivity analysis revealed that after removing nine values, there was no significant changed observed. Egger’s test ( p  = 0.594) and the Begg’s test ( p  = 0.348) were carried out, but no publication bias was discovered. The results must be interpreted with caution because the significant heterogeneity was detected in studies.

We cannot identify if there is any different impact these infectious diseases had on mental health because there were relatively small numbers of articles that analyzed what was the influence SARS had on mental health, and even fewer articles analyzed the relationship between Middle East Respiratory Syndrome (MERS) and mental health. But fortunately, some researches of Post-SARS psychology had provided valuable information for governments and mental health organizations to prepare for the current outbreak. Authorities had paid crucial attention to maintain people’s well-being mentally and physically. For instance, hot-lines were set up to deal with the Covid-19 related issues, and handbooks with advice on how to look after individual mental health during the outbreak were given out [ 26 ]. Thanks to advanced technologies, daily updates of the disease and latest government advice and policies were accessible anytime online. Extensive information was made available to the general public to ease people’s anxiety. However, as a consequence of large-scale social isolation, people were not only worried about contracting the virus, they were also worried about their love ones [ 27 ]. The uncertainty of how the future would be and how those measures would affect the stability of society and the economy was causing lots of concerns.

This study had several limitations. Firstly, the sample size of this meta-analysis was relatively small. As a result, the unknown risk of bias caused by incomplete data could constrain our results. Secondly, the data collected by QR code or link in these studies only demonstrated the figures of people who concern about mental health but not those who have no interested in joining this kind of surveys. People who have no interested in mental health would not join the studies. Since most data were collected via online platforms or smartphone applications, older people would have troubles to take part in. The statistic can only reflect the mental status of the people who have access to the Internet or smartphone. Thirdly, not all the studies had collected data about subjects’ social status and incomes, which also affect their ability and perception when experiencing psychological distress. Fourthly, it is notable that studies included in this meta-analysis used entirely self-report inventories as assessment tools, which had an inconsistent sensitivity and specificity for detecting anxiety and depressive symptoms. Instruments such as the SCL-90 have low specificity, although it is a cost-effective instrument, particularly in epidemiological surveys. Finally, some studies reported the response rate but did not contact the non-respondents for the reasons why they did not participate in the surveys. Therefore, those non-respondents were too stressed to respond or not interested in the surveys is hard to tell. These factors are partly responsible for the prospective heterogeneity source of pool prevalence of anxiety and depression. Much remain to be learned to cast light upon this phenomenon in the future.

In summary, our meta-analysis showed that the pooled prevalence of anxiety and depression was 25% and 28%, respectively. Given the fact that previous findings indicated both groups of people suffered from stress [ 9 , 25 ], and healthcare professionals continue to experience substantial psychological distress, even 1–2 year after the SARS outbreak [ 28 , 29 ], we should continue perfecting our psychological first aid system. As the epidemic is ongoing, not only the people but also our healthcare systems need to be prepared. This meta-analysis highlights the need for setting up a comprehensive crisis prevention system, which integrating epidemiological monitoring, screening and psychological interventions.

Acknowledgments

The authors thank Wanqi Huang for helping to revise this manuscript.

Availability of Data and Material

Biographies, ms. xin ren.

Xin Ren obtained a bachelor’s degree of clinical medicine from City College of Zhejiang University in 2013. She is now working as a doctor of the Psychosomatic department at the Tongde Hospital. Her main area of interest is mental health in the general population, particularly anxiety and depression.

Ms. Wanli Huang

Wanli Huang graduated from Central South University, Xiangya Medical College in 2010 and completed a master’s degree in psychopathology and mental health from Zhejiang University in 2013. Since 2013, she has worked in the department of psychiatry at Tongde Hospital of Zhejiang Province as a doctor. Her research interests are the pathogenesis and treatment of schizophrenia.

Ms. Huiping Pan

Huiping Pan is Vice Dean of Psychosomatic department at Tongde Hospital of Zhejiang Province. She has engaged in the clinical work of psychiatry for over 20 years. She has been involved in research on the treatment of psychosis, the biological effects of antipsychotics and how to integrate traditional Chinese and western medicine to treat the side effects of antipsychotic drugs.

Ms. Tingting Huang

Tingting Huang graduated from Zhejiang Chinese Medical University and now works in the Psychosomatic Department of Tongde Hospital of Zhejiang. Her main research themes concentrate on how to alleviate side reactions of antipsychotics, using her knowledge about traditional Chinese medicine.

Ms. Xinwei Wang

Xinwei Wang graduated from Zhejiang Chinese Medical University, majored in psychopathology and mental health. Working as a doctor in the Psychosomatic Department of Tongde Hospital of Zhejiang, she currently devote herself to studying the evaluation of treatments and the biological risk factors for psychosis.

Mr. Yongchun Ma

Yongchun Ma graduated from the Institute of Mental Health at King’s College London. He is now the director of the Psychosomatic Department at the Tongde Hospital of Zhejiang Province. Engaging in research on psychosomatic diseases for a long time, he is a member of the Chinese Psychological Crisis Intervention Committee, the Academic Committee of Psychosomatic Medicine of Zhejiang Province and Chinese Psychological Consultant Professional Committee; Young member of Psychosomatic Medicine Branch of Chinese Medical Association and Zhejiang Psychiatric Medical Commission. He specialized in dealing with anxiety disorders and sleep disorders, combining medication and psychotherapy. Recently, his research focus on the subject of helping the students and workers get back to a functional life after recovery and looking into the possibility of establishing a Chinese model of mental rehabilitation.

Authors’ Contributions

Xin Ren and Wanli Huang – Participated in the conception and design of the study, performed the analysis, and wrote the manuscript.

Huiping Pan – Participated in the conception and design of the study, cleaning up the data.

Tingting Huang and Xinwei Wang – collected data.

Yongchun Ma – Participated in the conception and design of the study, collected data, and wrote the manuscript.

Compliance with Ethical Standards

Not applicable.

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Contributor Information

Xin Ren, Email: moc.kooltuo@138nixner .

Wanli Huang, Email: moc.kooltuo@ilgnupgnup .

Huiping Pan, Email: moc.qq@272415096 .

Tingting Huang, Email: moc.qq@588054426 .

Xinwei Wang, Email: moc.qq@289308124 .

Yongchun Ma, Email: moc.361@24560853731 .