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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]
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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]
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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
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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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“In terms of future research, for people with or without ACE, fostering Psychological Flexibility skills through evidence-based interventions could be used to improve wellbeing, reduce psychological distress, and increase resilience against prolonged stressors [14,19,71].”
BackgroundBonazza, F., Battistini, C. L., Fior, G., Bergamelli, E., Wiedenmann, F., D’Agostino, A., Papa, G. F. S., Borghi, L., Piscopo, K., Vegni, E. A. M., et al. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008198.2022.2095133 · Cited by 33
“mental health of survivors, and psychological and psychiatric needs should not be overlooked during any phase of pandemic management (Cullen et al., 2020).”
BackgroundThe impact of COVID-19 on healthcare workers’ anxiety levels
Karasu, F., Öztürk Çopur, E., & Ayar, D. (2022) · Journal of Public Health · doi:10.1007/s10389-020-01466-x · Cited by 29
“Increased efforts are needed to manage anxiety and stress in this group and help them prevent burnout, depression and post-traumatic stress disorder in the longer term (Bao et al. 2020; Cullen et al. 2020).”
BackgroundManaging Minds at Work: Development of a Digital Line Manager Training Program
Blake, H., Vaughan, B., Bartle, C., Yarker, J., Munir, F., Marwaha, S., Daly, G. B. J., Russell, S., Meyer, C., Hassard, J., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19138006 · Cited by 35
“mental ill-health [50] and the impact of the pandemic on the labor market [51], we aim to consider the impact of the circumstances of the pandemic on intervention development and future feasibility testing (Action 6: ‘account for the COVID-19 circumstances in your research results’).”
BackgroundKey features of a trauma-informed public health emergency approach: A rapid review
Heris, C. L., Kennedy, M., Graham, S., Bennetts, S. K., Atkinson, C., Mohamed, J., Woods, C., Chennall, R., & Chamberlain, C. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.1006513 · Cited by 31
Using Spiritual Connections to Cope With Stress and Anxiety During the COVID-19 Pandemic
Algahtani, F. D., Alsaif, B. S., Ahmed, A. A., Almishaal, A. A., Obeidat, S. T., Mohamed, R. F., Kamel, R. M., Gul, I., & Hassan, S.-U.-N. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.915290 · Cited by 29
Murray, J., Bauer, A., de Mola, C. L., Martins, R. C., Blumenberg, C., Esposti, M. D., Stein, A. L., Barros, F. C., Hallal, P. C., da Silveira, M. F., et al. (2022) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2022.07.832 · Cited by 29
COVID-19 and Mental Health: An Examination of 911 Calls for Service.
Lersch, K. M. (2021) · Policing: A Journal of Policy and Practice · doi:10.1093/police/paaa049 · Cited by 28
Zaccari, V., D’Arienzo, M. C., Caiazzo, T., Magno, A., Amico, G., & Mancini, F. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.673161 · Cited by 27
Wolstencroft, J., Hull, L., Warner, L., Akhtar, T. N., Mandy, W., Imagine ID Consortium, & Skuse, D. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-049386 · Cited by 32
Prudenzi, A., Graham, C. D., Rogerson, O., & O’Connor, D. B. (2023) · Psychology & Health · doi:10.1080/08870446.2021.2020272 · Cited by 27
“Moreover, 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).”
BackgroundGrocke-Dewey, M., Hardison‐Moody, A., Haynes‐Maslow, L., Maras, S. A., Webber, E. J., Andress, L., Houghtaling, B., Patton-López, M. M., Shanks, J. D., & Shanks, C. B. (2021) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2021.101537 · Cited by 27
“Decreases in MH during the pandemic offers lessons in the intersections of MH and physical health (Cullen et al., 2020; Pfeffer-baum and North, 2020).”
Ghosh, S. B., Al-Sharify, Z. T., Maleka, M. F., Onyeaka, H. N., Maleke, M., Maolloum, A., Godoy, L., Meskini, M., Rami, M. R., Ahmadi, S., et al. (2022) · Environmental Science and Pollution Research · doi:10.1007/s11356-022-21652-6 · Cited by 30
“Currently, 4,736,031 people have lost their lives due to the virus (Worldometer 2021) and the pandemic is recognized as having a significant impact on economic sectors involving human health, global finances as well as the environment (Cheval et al. 2020; Cullen et al. 2020; Gautam and Hens 2020; Hassan et al. 2020).”
BackgroundPAL: Persona-Augmented Emotional Support Conversation Generation
Cheng, J., Sabour, S., Sun, H., Chen, Z., & Huang, M. (2023) · Findings of the Association for Computational Linguistics: ACL (Findings of ACL) · doi:10.18653/v1/2023.findings-acl.34 · Cited by 32
Pandemic gardening: A narrative review, vignettes and implications for future research
Kingsley, J., Donati, K., Litt, J., Shimpo, N., Blythe, C., Vávra, J., Caputo, S., Milbourne, P., Diekmann, L. O., Rose, N., et al. (2023) · Urban forestry & urban greening · doi:10.1016/j.ufug.2023.128062 · Cited by 27
“The 24-hour news cycle coverage of escalating COVID-19 case numbers had the effect of amplifying anxiety and the sense of profound uncertainty (Cullen et al., 2020; Wahaj et al., 2022).”
BackgroundPsychological support in general population during the COVID-19 lockdown in France: Needs and access
Alleaume, C., Verger, P., Peretti‐Watel, P., & the COCONEL Group (2021) · PLoS ONE · doi:10.1371/journal.pone.0251707 · Cited by 27
Anteneh, R. M., Dessie, A. M., Azanaw, M. M., Anley, D. T., Melese, B. D., Feleke, S. F., Abebe, T. G., & Muche, A. A. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1136031 · Cited by 26
Pandemic fatigue impact on COVID-19 spread: A mathematical modelling answer to the Italian scenario
Meacci, L., & Primicerio, M. (2021) · Results in Physics · doi:10.1016/j.rinp.2021.104895 · Cited by 25
Challenges for Healthcare Workers Caring for COVID-19 Patients in Indonesia: A Qualitative Study
Setiawan, H. W., Pratiwi, I. N., Nimah, L., Pawanis, Z., Bakhtiar, A., Fauziningtyas, R., & Ramoo, V. (2021) · INQUIRY The Journal of Health Care Organization Provision and Financing · doi:10.1177/00469580211060291 · Cited by 31
Sagar, S. K., Farhana, N., Rashid, M. U., Ghosh, P., Sultana, M., Ahsan, A., Pinky, S. D., Mahboob, R., Nayon, S. R., Islam, S. M. S., et al. (2022) · Heliyon · doi:10.1016/j.heliyon.2022.e08785 · Cited by 25
Cooking skills during the Covid-19 pandemic
Uggioni, P. L., Clarice Mariano Fernandes, E. L. P. O., Geraldo, A. P. G., Fernandes, A. C., Mazzonetto, A. C., & Bernardo, G. L. (2020) · Revista de Nutrição · doi:10.1590/1678-9865202033e200172 · Cited by 27
Berbés‐Blázquez, M., Schoon, M., Benessaiah, K., Bennett, E. M., Peterson, G., & Ghimire, R. (2022) · Ecology and Society · doi:10.5751/es-13223-270216 · Cited by 24
Ding, W., Zhang, Y., Wang, M., & Wang, S. (2025) · World Journal of Psychiatry · doi:10.5498/wjp.v15.i10.109502 · Cited by 31
Mental health status during COVID-19 pandemic in Fars Province, Iran: timely measures
Mani, A., Estedlal, A., Kamali, M., Ghaemi, S. Z., Zarei, L., Shokrpour, N., Heydari, S. T., & Lankarani, K. B. (2020) · BMC Public Health · doi:10.1186/s12889-020-09928-3 · Cited by 24
“Furthermore, psychological factors play critical roles in adherence to public health measures as such individuals usually cope with the threats of infection as well as its consequent losses [8, 13].”
BackgroundArënliu, A., Uka, F., & Weine, S. M. (2020) · Psychiatria Danubina · doi:10.24869/psyd.2020.570 · Cited by 25
“…of individuals and could have potentially an immediate and long-term impact on physical and mental health, which require attention and intervention from policy makers and service providers (Pfefferbaum & North 2020, Cullen et al. 2020, Usher et al. 2020; Shah et al. 2020, Moreno et al. 2020).”
BackgroundFletcher, T. L., Amspoker, A. B., Wassef, M., Hogan, J., Helm, A., Jackson, C., Jacobs, A., Shammet, R., Speicher, S., Lindsay, J. A., et al. (2021) · The Journal of Rural Health · doi:10.1111/jrh.12628 · Cited by 29
Mind-wandering during contemporary live music: An exploratory study
Deil, J., Markert, N., Normand, P., Kammen, P., Küssner, M. B., & Taruffi, L. (2022) · Musicae Scientiae · doi:10.1177/10298649221103210 · Cited by 24
Hopf, D., Schneider, E., Aguilar‐Raab, C., Scheele, D., Morr, M., Klein, T., Ditzen, B., & Eckstein, M. (2022) · Scientific Reports · doi:10.1038/s41598-022-19224-2 · Cited by 30
“The subsequently planned contrasts revealed a significant linear trend (F(2, 1035) = 26.”
BackgroundMethodKappen, M., Raeymakers, S., Weyers, S., & Vanderhasselt, M. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.09.052 · Cited by 28
Home Alone: Implications of COVID-19 for Mental Health
Paudel, J. (2021) · Social Science & Medicine · doi:10.1016/j.socscimed.2021.114259 · Cited by 25
Public awareness and anxiety during COVID-19 epidemic in China: A cross-sectional study
Liu, Y., Li, P., Lv, Y., Hou, X., Rao, Q., Tan, J., Gong, J., Chao, T., Liao, L., & Cui, W. (2021) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2021.152235 · Cited by 25
Zhang, S., Liu, C., Zhang, C., Jiang, H., Tai, B., & Du, M. (2021) · BMC Oral Health · doi:10.1186/s12903-021-01533-z · Cited by 22
“COVID-19 and the subsequent unprecedented lockdown measures have greatly affected physical and mental status [8, 9], and daily behaviours, including oral healthcare behaviours, may have changed as a result.”
BackgroundAndroniceanu, A., & Marton, D.-M. (2021) · Central European Public Administration Review · doi:10.17573/cepar.2021.1.05 · Cited by 23
“The third step refers to paying special attention to people who are on the frontline against the SARS-CoV-2 virus (Cullen et al., 2020, pp. 311–312).”
BackgroundShaun, M. M. A., Nizum, M. W. R., Munny, S., Fayeza, F., Mali, S. K., Abid, M. T., & Hasan, A.-R. (2021) · Heliyon · doi:10.1016/j.heliyon.2021.e07843 · Cited by 24
Reid, J. A., Chenneville, T., Gardy, S. M., & Baglivio, M. T. (2021) · Crime & Delinquency · doi:10.1177/00111287211054729 · Cited by 25
“…to the health risks associated with contracting the COVID-19 virus, emerging evidence suggests the mental health impact of COVID-19 is substantial (Cullen et al., 2020; Pfefferbaum & North, 2020; Rajkumar, 2020; Vindegaard & Benros, 2020) and extends to children and adolescents (Cost et al.,…”
BackgroundDepression before and during-COVID-19 by Gender in the Korean Population
Cha, W., Joo, H. J., Park, Y.-S., Park, E., & Kim, S.-Y. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19063477 · Cited by 22
Demenech, L. M., Neiva-Silva, L., Brignol, S., Marcon, S. R., Lemos, S. M., Tassitano, R. M., & Dumith, S. C. (2022) · Psychological Medicine · doi:10.1017/s0033291722001933 · Cited by 22
The impact of COVID‐related economic shocks on household mental health in Pakistan
Baranov, V., Grosjean, P. A., Khan, F. J., & Walker, S. (2022) · Health Economics · doi:10.1002/hec.4571 · Cited by 26
Sbrilli, M. D., Haigler, K., & Laurent, H. K. (2021) · Mindfulness · doi:10.1007/s12671-021-01657-x · Cited by 19
Marco-Ahulló, A., Villarrasa-Sapiña, I., & Monfort-Torres, G. (2021) · Retos · doi:10.47197/retos.v43i0.88968 · Cited by 33
COVID-19 Pandemic and Personality: Agreeable People Are More Stressed by the Feeling of Missing
Getzmann, S., Digutsch, J., & Kleinsorge, T. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182010759 · Cited by 21
Creativity, Boredom Proneness and Well-Being in the Pandemic
Brosowsky, N. P., Barr, N., Mugon, J., Scholer, A. A., Seli, P., & Danckert, J. A. (2022) · Behavioral Sciences · doi:10.3390/bs12030068 · Cited by 25
“Clearly, mental health is a serious concern during these extraordinary times [3,4].”
BackgroundAlghamdi, B. S. A., Alatawi, Y. M., Alshehri, F. S., Tayeb, H. O., AboTaleb, H. A., & Binsalman, A. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2021.792533 · Cited by 25
“Pandemics are associated with a major mental health burden (Cullen et al., 2020; Holmes et al., 2020; Perrin et al., 2009; Pfefferbaum and North, 2020).”
Background
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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