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Mental health in the COVID-19 pandemic
Open accessAbstract
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, 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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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“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”.”
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]
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“2 Notwithstanding possible response bias, these are very high proportions-and it is likely that some people are at even greater risk.”
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“The implications of the COVID-19 pandemic for individual and collective health, including emotional and psychological effects (Cullen, et al., 2020).”
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“Unfortunately, the focus on managing patients, vaccination programmes, and government policies often led to the neglect of mental health in practice and research (Bäuerle et al., 2020; Cullen et al., 2020).”
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“The mental health implications of COVID-19 The unprecedented challenges and uncertainties associated with COVID-19 have reportedly led to substantial mental health deteriorations, both among healthy individuals and those with pre-existing mental health problems (Banks & Xu, 2020; Cullen et al., 2020; McElory et al., 2…”
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“This leads to an increase in the level of stress followed by anxiety, depression, sleeplessness, and more chances to expose in the diseased conditions [9].”
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“Therefore, the mental health of the patient plays an important role during this crisis due to the COVID-19 pandemic [5] since they are predisposed to be vulnerable and lead to serious psychological consequences in the patient in relation to their person, environment and family.”
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“It is noteworthy that depression can affect the most vulnerable individuals, but also those without a psychiatric history [21], especially at the time of social detachment, currently experienced in several regions of Brazil.”
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“In many ways the COVID-19 pandemic mirrors a natural disaster, as students face unprecedented obstacles such as higher instances of physical and mental abuse, neglect, grief, loss and social isolation, all of which can affect mental health (Aber et al., 2011; Copeland et al., 2007; Cullen et al., 2020; Miller, 2020; R…”
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“Finally, the mental health of many individuals has substantially deteriorated (Cullen et al., 2020; Kwong et al., 2020), due to local lockdowns and reduced social contact, among other factors.”
BackgroundCONDICIONAMENTO FÍSICO, AUTONOMIA FUNCIONAL E QUALIDADE DE VIDA EM IDOSOS
Pernambuco, C. S., Scartoni, F. R., Miranda, F. B., Figueira, H. A., & Cortez, A. C. L. (2021) · doi:10.22533/at.ed.2272107062
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“Firstly, giving false hope in time of increasing anxiety (Cullen et al. 2020) and ravaging pandemic is mildly put cynical and can have dire consequences such as an increased scepticism towards experts after such hopes are dispersed, as so many a time we have already witnessed throughout this…”
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“The social-economical effects these necessary decisions are still unknown and it is speculated that these effects will still be felt for many more years to come [1, 2, 3, 4].”
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Niveles de ansiedad y depresión en directivos escolares de las regiones Altoandinas del Perú
Ari, D. L. S., Betancur, H. N. C., CANQUI, L. G. P., & Vilca-Apaza, H.-M. (2021) · Revista Científica ECOCIENCIA · doi:10.21855/ecociencia.84.550
Solomon, B., & Fife, W. J. (2021) · Advances in higher education and professional development book series · doi:10.4018/978-1-7998-7736-3.ch002
The importance of psychology in the COVID-19 pandemic
Silva, A. L. T., da Silva, A. P. C. B., da Silva, B. A. O., Silva, B. K. D., Gomes, F. A. L. R., Araujo, F. L. G., da Silva, G. C., Lins, M. D. S., Tavares, K. L. D. S., & Félix, P. T. (2021) · IJS - International Journal of Sciences · doi:10.29327/229003.2.3-23
Foláyan, M. O., Ibigbami, O. I., Aly, N. M., Zúñiga, R. A. A., Abeldaño, G. F., Ara, E., Ellakany, P., Idigbe, I. E., Ishabiyi, A. O., Jafer, M. A., et al. (2021) · Open Research Africa · doi:10.12688/aasopenres.13296.1
EDUCAÇÃO PERMANENTE: O ENFRENTAMENTO DA COVID-19 E A SAÚDE DOS TRABALHADORES DA UBS
dos Santos, R. D. S. F., de Oliveira, E. P., Viana, L. P., Closset, L., Dias, L. F. C., Martins, M. H. F., & dos Reis, M. D. O. D. C. (2021) · doi:10.36599/itac-pisceh.008
PRODUÇÃO DE PRODUTO EM SAÚDE ONLINE COM TEMA: PRÉ-NATAL DURANTE A PANDEMIA DO COVID-19
dos Santos, B. S., Filho, J. L. R. F., Pinheiro, J. P., de Sousa, L. S., Leite, L. G. F. D. M., Bezerra, L. W. V., & da Silva, W. O. (2021) · doi:10.36599/itac-pisceh.010
dos Santos, R. D. S. F., Pimentel, A. C. O. P., de Souza, C. S., Santos, G. S., Becalli, L. D. H., Andrade, R. P., & de Holanda, V. M. F. (2021) · doi:10.36599/itac-pisceh.015
Principles of Treatment of Patients with Diabetic Polyneuropathy in the COVID-19 Pandemic
Golovacheva, V. A., & Александровна, Г. А. (2021) · Meditsinskiy sovet = Medical Council · doi:10.21518/2079-701x-2021-19-126-133
FISIOTERAPIA RESPIRATÓRIA NA RECUPERAÇÃO DE CASOS LEVES E MODERADOS DE COVID-19
dos Santos, B. S., da Silva, L. A. M., de Parijós, M. N., de Moura, M. L. M., & Silva, P. V. S. (2021) · doi:10.36599/itac-pisceh.004
de Almeida, C. M., Rodrigues, A. L. D., Oliveira, J. V. R., Reis, L. R. M., Rocha, M. J. O., Lima, M. O., & Monteiro, V. A. D. S. (2021) · doi:10.36599/itac-pisceh.019
Stres Pada Perawat Di Era Pandemi Covid-19: Literature Review
Putri, N., & Nafiah, H. (2021) · Prosiding Seminar Nasional Kesehatan · doi:10.48144/prosiding.v1i.936
Zhou, Y., Mohammad, M. R., Khanam, R., & Brad, R. T. (2021) · Research Square · doi:10.21203/rs.3.rs-1123806/v1
Collins, A., O’Driscoll, E., & Lyons, D. (2021) · IntechOpen eBooks · doi:10.5772/intechopen.101499 · Cited by 1
“Will there be an increased demand for supports in the longer term and how will these increased needs be met? Cullen and colleagues [52] issue a word of caution when considering how we ought to address mental health in the aftermath of the pandemic: “we neglect mental health at our peril and to our long-term detriment”.”
BackgroundO PROCESSO DE TRABALHO EM SAÚDE E A EDUCAÇÃO PERMANENTE: DESAFIOS E POSSIBILIDADES
Freire, F. D. F. D. S., Melo, F. N. D. P., Melo, D. F. C., Holanda, D. X. T., Soares, M. K. P., Oliveira, A. K. D. S., Veríssimo, F. A. D. S., & Gomes, A. M. D. A. (2021) · Brazilian Journals Editora eBooks · doi:10.35587/brj.ed.0000642
Editorial_Anxiety and the COVID-19 Pandemic
Sousa, A. D. (2021) · Indian Journal of Mental Health(IJMH) · doi:10.30877/ijmh.8.2.2021.123-127
Andriievskyi, I. I., Maievskyi, O., Stepanenko, R. L., Nesteruk, V. P., & Gunas, I. V. (2021) · Reports of Vinnytsia National Medical University · doi:10.31393/reports-vnmedical-2021-25(4)-03
“have moderate and severe symptoms of depression, 29 % have moderate and severe symptoms of anxiety [10].”
BackgroundIllness and Death in the Covid Epoch
Briggs, D., Telford, L., Lloyd, A., Ellis, A., & Kotzé, J. (2021) · Springer eBooks · doi:10.1007/978-3-030-88825-1_3
Erişti, B. (2021) · Psychology and Psychotherapy Research Study · doi:10.31031/pprs.2021.05.000603
“The research focused on the cognitive [26,27], social, emotional [28], psychological [29-33], economic [34] impacts of the epidemic on students, teachers [35] and school administrators [36] could be given as examples for the aforementioned studies.”
BackgroundUswanas, A. I., Chairunnisa, A. A., Saniyah, D. Z., Wibowo, J. V., & Rochmanti, M. (2021) · International Journal of Research Publications · doi:10.47119/ijrp100921120222652
“…of the studies with 1210 respondents from 194 cities in China in January and February 2020 found that 54% of respondents experienced a psychological impact from COVID-19, 29% reported moderate to severe anxiety symptoms, and 17% reported moderate to severe depressive symptoms (Cullen et al, 2020).”
Vulnerabilities Experienced by Trans Couples in Times of COVID-19
de Lira, A. N., Noronha, S. F., & de Mesquita, L. M. F. (2021) · Springer eBooks · doi:10.1007/978-3-030-84189-8_8
Das, B., Das, B., Chatterjee, A., & Das, A. (2022) · Elsevier eBooks · doi:10.1016/b978-0-12-824557-6.00003-0
“Adding to all these already existing facts, this sudden out-break of COVID-19 introduced thousands of new thoughts in peoples’ minds (Grover et al., 2020; Cullen, Gulati, & Kelly, 2020).”
BackgroundMental health disorders among healthcare workers during the COVID-19 pandemic: literature review
Kusainov, A. A., Rakisheva, A.-U. S., Imanbaeva, A. D., Batyrev, E. I., Shaltakov, D. S., Galiakbarova, Z. B., Tulepova, D. E., Sharipova, M. K., Baikenov, E. B., & Astana (2021) · Vestnik nevrologii psihiatrii i nejrohirurgii (Bulletin of Neurology Psychiatry and Neurosurgery) · doi:10.33920/med-01-2112-03
Fauziah, I., Christanti, P. D., & Krianto, T. (2022) · Women Midwives and Midwifery · doi:10.36749/wmm.2.1.20-28.2022
COVID-19 Lockdown in Enugu, Nigeria
Bisi-Onyemaechi, A. I., Aronu, A. E., Chikani, U. N., Chime, P. U., Uwaezuoke, N. S., Nduagubam, O. C., & Ojinnaka, N. C. (2022) · International Journal of Medicine and Health Development · doi:10.4103/ijmh.ijmh_16_21
Morales-Ancajima, V. C., Vásquez‐Velásquez, C., la Cruz, M. D., Marull, M., Tapia, V., & Gonzales, G. F. (2022) · F1000Research · doi:10.12688/f1000research.109836.1
Mental Health and COVID-19: where are we in 2022
Shah, A. A. (2022) · Journal of the Dow University of Health Sciences · doi:10.36570/jduhs.2022.1.1624
Jain, P. R., Quadri, S. M. K., & Rose, E. M. (2022) · Lecture notes on data engineering and communications technologies · doi:10.1007/978-981-16-9605-3_41 · Cited by 1
اللیثى, أ. ح. م., & درویش, ع. م. م. أ. (2022) · مجلة البحث العلمى فى التربية · doi:10.21608/jsre.2021.109638.1413
Özdi̇l, K., & Öztürk, G. K. (2022) · Women & Health · doi:10.1080/03630242.2022.2072049
“…to interventions against the virus, vaccine and treatment services etc. in the world in general and while sufficient resources could not be provided for these problems, the importance of interventions to reduce psychiatric morbidity in the future was emphasized (Cullen, Gulati, and Kelly 2020).”
BackgroundPallavi, K., & Vijayan, D. (2022) · International Journal for Research in Applied Science and Engineering Technology · doi:10.22214/ijraset.2022.43035
Munandar, D., Narimawati, U., Khan, N., Mohsin, M., & Sailan, M. (2022) · International Journal of Educational Administration Management and Leadership · doi:10.51629/ijeamal.v3i1.88
Metadata
- 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
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-03-30
- Volume
- 113
- Issue
- 5
- Pages
- 311-312
- ISSN
- 0033-5622 (ISSN-L)
- 1460-2725
- 1460-2393
- PMC
- PMC7184387
- 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
- FWCI
- 102.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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