Cited by 1,275COVID-19 and Mental HealthMaternal Mental Health During Pregnancy and PostpartumMental Health Treatment and Access

Mental health in the COVID-19 pandemic

Open access
Cullen, W, Gulati, G, Kelly, B D·2020·QJM: An International Journal of Medicine

Abstract

During any outbreak of an infectious disease, the population’s psychological reactions play a critical role in shaping both spread of the disease and the occurrence of emotional distress and social disorder during and after the outbreak. Despite this fact, sufficient resources are typically not provided to manage or attenuate pandemics’ effects on mental health and wellbeing.1 While this might be understandable in the acute phase of an outbreak, when health systems prioritize testing, reducing transmission and critical patient care, psychological and psychiatric needs should not be overlooked during any phase of pandemic management. There are many reasons for this. It is known that psychological factors play an important role in adherence to public health measures (such as vaccination) and in how people cope with the threat of infection and consequent losses.1 These are clearly crucial issues to consider in the management of any infectious disease, including COVID-19. Psychological reactions to pandemics include maladaptive behaviours, emotional distress and defensive responses.1 People who are prone to psychological problems are especially vulnerable. All of these features are in clear evidence during the current COVID-19 pandemic. One study of 1210 respondents from 194 cities in China in January and February 2020 found that 54% of respondents rated the psychological impact of the COVID-19 outbreak as moderate or severe; 29% reported moderate to severe anxiety symptoms; and 17% reported moderate to severe depressive symptoms.2 Notwithstanding possible response bias, these are very high proportions—and it is likely that some people are at even greater risk. During the 2009 H1N1 influenza outbreak (‘swine flu’), a study of mental health patients found that children and patients with neurotic and somatoform disorders were significantly over-represented among those expressing moderate or severe concerns.3 Against this background, and as the COVID-19 pandemic continues to spread around the world, we hypothesize a number of psychological impacts that merit consideration now rather than later. In the first instance, it should be recognized that, even in the normal course of events, people with established mental illness have a lower life expectancy and poorer physical health outcomes than the general population.4 As a result, people with pre-existing mental health and substance use disorders will be at increased risk of infection with COVID-19, increased risk of having problems accessing testing and treatment and increased risk of negative physical and psychological effects stemming from the pandemic. Second, we anticipate a considerable increase in anxiety and depressive symptoms among people who do not have pre-existing mental health conditions, with some experiencing post-traumatic stress disorder in due course. There is already evidence that this possibility has been under-recognized in China during the current pandemic.5 Third, it can be anticipated that health and social care professionals will be at particular risk of psychological symptoms, especially if they work in public health, primary care, emergency services, emergency departments and intensive or critical care. The World Health Organization has formally recognized this risk to healthcare workers,6 so more needs to be done to manage anxiety and stress in this group and, in the longer term, help prevent burnout, depression and post-traumatic stress disorder. There are several steps that can and should be taken now to minimize the psychological and psychiatric effects of the COVID-19 pandemic. First, while it might be ostensibly attractive to re-deploy mental health professionals to work in other areas of healthcare, this should be avoided. Such a move would almost certainly worsen outcomes overall and place people with mental illness at disproportionate risk of deteriorations in physical and mental health. If anything, this group needs enhanced care at this time. Second, we recommend the provision of targeted psychological interventions for communities affected by COVID-19, particular supports for people at high risk of psychological morbidity, enhanced awareness and diagnosis of mental disorders (especially in primary care and emergency departments) and improved access to psychological interventions (especially those delivered online and through smartphone technologies).7 These measures can help diminish or prevent future psychiatric morbidity. Finally, there is a need for particular focus on frontline workers including, but not limited to, healthcare staff. In the USA, the Centers for Disease Control and Prevention offer valuable advice for healthcare workers in order to reduce secondary traumatic stress reactions, including increased awareness of symptoms, taking breaks from work, engaging in self-care, taking breaks from media coverage and asking for help.8 This kind of advice needs to be underpinned by awareness of this risk among employers, enh

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  • Health professionals often experience high levels of sustained stress that constitute a risk for developing mental health problems.

    “Health professionals often experience high levels of sustained stress that constitute a risk for developing mental health problems, as recognized by the World Health Organization [1,2].”

    From Effectiveness of a Web-Based Self-Guided Intervention (MINDxYOU) for Reducing Stress and Promoting Mental Health Among Health Professionals: Results From a Stepped-Wedge Cluster Randomized Trial (2025) · cites this paper as [1]

    In “Mental health in the COVID-19 pandemic” (page not specified), the authors anticipate that health and social care professionals will be at particular risk of psychological symptoms during the pandemic and say the WHO recognized this risk. The passage supports the mental-health risk, but does not establish the broader claim that health professionals often experience high levels of sustained stress outside that context. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • The COVID-19 pandemic has been associated with decreases in positive emotions and quality of life and increases in negative emotions, anxiety, fear, stress, depression, and sleep disturbances.

    “mental health has been characterized by decreases in positive emotions and quality of life [5,6,7,8] as well as increases in negative emotions, anxiety, fear, stress, depression, and sleep disturbances [8,9,10,11,12,13,14].”

    From At the Peak of the Second Wave of COVID-19, Did Millennials Show Different Emotional Responses from Older Adults? (2022) · cites this paper as [9]

    The main text reports moderate-to-severe anxiety and depressive symptoms during the COVID-19 outbreak and anticipates further increases; it also discusses emotional distress and stress. It does not report decreases in positive emotions or quality of life, or an increase in sleep disturbances. Its projected increases should not be presented as already observed. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • In the UK, one in three NHS staff suffered mental health issues related to the pandemic.

    “recent reports in the UK suggest that one in three NHS staff suffered mental health issues related to the pandemic (Al-Ghunaim et al., 2021; Cullen et al., 2020; Pfefferbaum et al., 2020).”

    From Mental health during the COVID-19 pandemic: exploring the role of psychological flexibility and stress-related variables. (2023) · cites this paper as Cullen et al., 2020

    The paper's main text (page not supplied) anticipates that health and social care professionals will be at particular risk of psychological symptoms during the pandemic. It does not report that one in three UK NHS staff experienced mental health issues; the population, prevalence figure, and observed-outcome wording are unsupported. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • Evidence is mounting of potentially long-lasting consequences of the pandemic on mental health, with young people identified as particularly vulnerable-although the evidence is still not definitive.

    “At the same time, evidence is mounting of potentially long-lasting consequences of the pandemic on mental health, with young people identified as particularly vulnerable—although the evidence is still not definitive.2, 21, 24, 25, 26, 27”

    From Psychological responses, mental health, and sense of agency for the dual challenges of climate change and the COVID-19 pandemic in young people in the UK: an online survey study (2022) · cites this paper as [24]

    The paper anticipates anxiety, depression and possible later post-traumatic stress disorder during COVID-19, while framing these effects as hypotheses rather than definitive findings. It does not identify young people as particularly vulnerable to COVID-19’s mental-health effects; its discussion of children concerns a study of the 2009 H1N1 outbreak. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Psychological reactions to the pandemic are critical in shaping both the spread of the disease and the occurrence of emotional distress during and after the outbreak.

    “as mentioned by Cullen, Gulati, and Kelly (2020) [9], those reactions are critical in “shaping both spread of the disease and the occurrence of emotional distress during and after the outbreak”.”

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Authors
Cullen, W., Gulati, G., & Kelly, B. D.
Affiliations
  • University College Dublin (IE)
  • University of Limerick (IE)
  • Trinity College Dublin (IE)
Corresponding author
Kelly, B D
Venue
QJM: An International Journal of Medicine
Published
2020-03-30
Volume
113
Issue
5
Pages
311-312
ISSN
  • 0033-5622 (ISSN-L)
  • 1460-2725
  • 1460-2393
OpenAlex
W3013698566
Cited by
1,275
References
7
Citations by year
2026: 28 · 2025: 82 · 2024: 128 · 2023: 257 · 2022: 318 · 2021: 345 · 2020: 114 · 2019: 1 · 2017: 1
FWCI
102.87
Type
journal article
Language
en
Open access
Locations
  • QJM (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • DSPACE System - Metalibrary (University of the Coast) (submittedVersion, cc-by-nc-sa)
Topics
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
COVID-19 pandemic, mental health, psychological impact of pandemic, anxiety, depressive symptoms, post-traumatic stress disorder, substance use disorders, pre-existing mental illness, infection risk, public health measures, mental health services, China, H1N1 influenza, mental health workforce shortage
MeSH terms
COVID-19, Anxiety, Depressive Disorder, Humans, Mental Health, Pneumonia, Viral, Stress, Psychological, Coronavirus Infections, Pandemics

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