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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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Cites
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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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Unveiling Coronasomnia: Pandemic Stress and Sleep Problems During the COVID-19 Outbreak
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BackgroundInfluentialConsumo de psicoativos lícitos durante a pandemia de Covid-19
Galloni, L., de Freitas, L. R., & Gonzaga, R. V. (2021) · Revista Brasileira de Ciências Biomédicas · doi:10.46675/rbcbm.v2i1.44 · Cited by 13
“O artigo de Cullen e colaboradores (2020) [13], retrata a situação relatada anteriormente, afirmando que a saúde mental representa um fator importante na adesão de medidas de saúde pública, como a vacinação, além de ser influente em como as pessoas lidam com a infecção pelo vírus e até mesmo a perda de entes queridos.”
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BackgroundPrisons and the COVID-19 pandemic
Gulati, G. M., Dunne, C. P., & Kelly, B. D. (2020) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2020.65 · Cited by 13
“This includes decisions around the redeployment of staff frompsychiatric prison in-reach serviceswho, likemental health services in the community, are likely to play an essential role (Cullen et al. 2020) in helping their patients during this pandemic.”
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“…(e.g., an outbreak of an infectious disease such as COVID-19), understanding psychological reactions is highly relevant as, 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…”
BackgroundInfluentialAnxiety and fear of COVID-19 as potential mechanisms to explain vaccine hesitancy among adults
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Wright, K. B., & Mhonde, R. D. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191912267 · Cited by 12
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The impact of COVID-19 on a cohort of patients treated with clozapine
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Impacto de la pandemia Covid-19 sobre profesores y estudiantes en escuelas de negocios en México
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Cross-platform privacy-preserving CT image COVID-19 diagnosis based on source-free domain adaptation
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Pandya, A., & Lodha, P. (2021) · Indian Journal of Psychological Medicine · doi:10.1177/02537176211005622 · Cited by 10
Palattao, C. A. V., Solano, G. A., Tee, C., & Tee, M. L. (2021) · International Conference on Artificial Intelligence in Information and Communication (ICAIIC) · doi:10.1109/icaiic51459.2021.9415276 · Cited by 12
“Psychological impact is also a matter of concern, since the spread of the virus plays a critical role in the occurrence of emotional distress and social disorder among the population affected [6], [7].”
BackgroundAlonzo, D. M., & Popescu, M. L. (2021) · International Journal of Social Psychiatry · doi:10.1177/00207640211028612 · Cited by 10
“Therefore, it is likely that individuals with preexisting mental health conditions will not only be at increased risk of Covid-19 infection, but will also experience increased risk of negative psychological effects related to the pandemic (Cullen et al., 2020; Taylor, 2019).”
BackgroundUpdated insight into COVID-19 disease and health management to combat the pandemic
Roy, S., & Ramadoss, A. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-85780-2.00017-2 · Cited by 10
Analysis of the Consequences of the COVID-19 Pandemic on People with Severe Mental Disorders
Sánchez-Guarnido, A. J., Hidalgo, N., de la Cruz, J. A., Esteban, I., Mondón, S., & Herruzo, C. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168549 · Cited by 10
“In addition, having a psychotic spectrum disorder is an important risk factor for COVID-19 mortality [25], as people with SMDs are at increased risk for greater physical complications than the general population [26].”
BackgroundSaúde mental docente e intervenções da Psicologia durante a pandemia
Coelho, E. A., da Silva, A. C. P., de Pellegrini, T. B., & Patias, N. D. (2021) · PSI UNISC · doi:10.17058/psiunisc.v5i2.16458 · Cited by 10
Flattening the quality of life curve? A prospective person-centred study from Norway amid COVID-19
Nes, R. B., Yu, B., Hansen, T., Vedaa, Ø., Røysamb, E., & Nilsen, T. S. (2022) · Quality of Life Research · doi:10.1007/s11136-022-03113-2 · Cited by 10
“Excess rates of anxiety, depression, loneliness, and stress have been firmly documented, especially in the early and middle stages of the pandemic [8–14], with emerging evidence showing both exacerbation of pre-existing mental health problems [15, 16] and new symptoms in individuals with no previous disorders [17].”
BackgroundGrubin, F., Maudrie, T. L., Neuner, S., Conrad, M. A., Waugh, E., Barlow, A., Coser, A. D., Hill, K. X., Pioche, S., Haroz, E. E., et al. (2022) · Journal of Prevention · doi:10.1007/s10935-022-00695-y · Cited by 10
“There is an urgent need for targeted psychosocial interventions to address burnout and distress prevention among frontline workers during the COVID-19 pandemic (Cullen et al., 2020; Shah et al., 2020).”
BackgroundMachine Learning Role in Cognitive Mental Health Analysis amid Covid-19 Crisis: A Critical Study
Aggarwal, R., Girdhar, N., & Alpana (2022) · International Conference on Machine Learning, Big Data, Cloud and Parallel Computing (COM-IT-CON) · doi:10.1109/com-it-con54601.2022.9850873 · Cited by 10
Controllability is key: Goal pursuit during COVID‐19 and insights for theories of self‐regulation
McClure, J. H. C., & Cole, S. N. (2022) · Journal of Applied Social Psychology · doi:10.1111/jasp.12920 · Cited by 10
Coping Strategies, well-being and inequalities during the COVID-19 pandemic period
Gıovanıs, E., & Özdamar, Ö. (2023) · Current Psychology · doi:10.1007/s12144-023-04710-1 · Cited by 12
“Recent studies have found a negative impact of the lock-down measures on mental well-being and poverty (e.g., Adams-Prassl et al., 2020; Banks & Xu, 2020; Cullen et al., 2020; Davillas & Jones, 2021; Laborde et al., 2021; Pieh et al., 2021).”
Estresse percebido durante período de distanciamento social: diferenças entre sexo
Pinheiro, G. D. A., Luna, G. I., Santos, R. A. C. D., Pimentel, S. F. P., & Varão, A. C. (2020) · Brazilian Journal of Health Review · doi:10.34119/bjhrv3n4-264 · Cited by 10
Adaptations of an Integrated Behavioral Health Program During COVID-19
Bogucki, O. E., Mattson, A. B., Leasure, W. B., Berg, S. L., Mulholland, H., & Sawchuk, C. N. (2021) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2021.01.006 · Cited by 10
Yang, L.-P., Yang, J., He, J., Zhou, Y., Zhang, Y., Sun, B., Gao, J., & Qian, L. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.771621 · Cited by 9
Mulligan, L. D., Neil, S. T., Johnstone, M., Morris, R. K., & Swift, E. (2022) · Community Mental Health Journal · doi:10.1007/s10597-022-00963-5 · Cited by 10
Cho, E., Lee, D., Cho, I., Lee, J., Ahn, J., & Bang, Y. R. (2022) · Sleep Medicine Research · doi:10.17241/smr.2022.01291 · Cited by 10
“Also, COVID-19 is associated with depression severity in the general population [8].”
BackgroundJiwani, Z., Raval, V. V., Steele, M., & Goldberg, S. B. (2022) · Journal of Social Issues · doi:10.1111/josi.12532 · Cited by 11
“Poormental health can have physical health consequences, including lowering life expectancy (Cullen et al., 2020).”
BackgroundMead, J., Fisher, Z., Tree, J. J., Wong, P. T. P., & Kemp, A. H. (2020) · doi:10.31234/osf.io/z2pxg · Cited by 10
“Recent publications on the COVID-19 pandemic have raised concerns about the deterioration of mental health (Cullen et al., 2020; Galea et al., 2020; Gunnell et al., 2020; Pfefferbaum & North, 2020).”
BackgroundStudent Burnout in Higher Education: From Lockdowns to Classrooms
Jackson, K. M., & Szombathelyi, M. K. (2022) · Education Sciences · doi:10.3390/educsci12120842 · Cited by 11
“The COVID-19 pandemic had the unfortunate effect of amplifying the burnout effects of university students by having a significant and negative impact on mental health, education, and the daily routines of students [18,19].”
BackgroundAlwuqaysi, B., Abdul‐Rahman, A., & Borgo, R. (2023) · JMIR Formative Research · doi:10.2196/44923 · Cited by 16
“The survey was designed based on a review of previous studies and surveys on pandemic effects [21-24].”
MethodSchoonen, A., Masunungure, A., Botha, C., Kemp, C., Twine, C., Kruger, C., Toit, D. D., Fouché, E., Wessels, E., Willemse, F., et al. (2023) · doi:10.4102/aosis.2023.bk412 · Cited by 8
COVID‐19 and Mental Health: A “Pandemic Within a Pandemic”
Fisicaro, F., Lanza, G., Concerto, C., Rodolico, A., Napoli, M. D., Mansueto, G., Cortese, K., Mogavero, M. P., Ferri, R., Bella, R., et al. (2024) · Advances in experimental medicine and biology · doi:10.1007/978-3-031-61943-4_1 · Cited by 10
Chandra, R., Sonawane, J. M., & Lande, J. (2024) · Big Data and Cognitive Computing · doi:10.3390/bdcc8120186 · Cited by 12
Visible light-powered photodynamic antibacterial chlorophyllin-derived metallochlorins
Xue, Y., Xing, K., Tham, M. J. R., Li, B. L., Sikdar, N., Leong, L. P., Lee, C. H., Chu, J. J. H., Ang, W. H., & Leong, D. T. (2024) · Chemical Engineering Journal · doi:10.1016/j.cej.2024.158345 · Cited by 9
Campos, J. Á. D. B., Campos, L. A., Martins, B. G., de Oliveira, A. P., Navarro, F. M., dos Santos, S. C., da Costa, J., Prado, O. Z., & Marôco, J. P. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1012543 · Cited by 9
“The COVID-19 pandemic disrupted routines and forced populations to rapidly adapt to a new and challenging context (Brooks et al., 2020; Cullen et al., 2020; Salari et al., 2020).”
BackgroundHow mentally healthy we are during the pandemic? Findings from changed travel behavior
Yang, X., Chen, P., & Zhang, Y. (2023) · Journal of Transport & Health · doi:10.1016/j.jth.2023.101587 · Cited by 11
Wade, M. T., Julian, J. P., Jeffery, K. S., & Davidson, S. M. (2023) · Land · doi:10.3390/land12061137 · Cited by 11
Li, W., Wan, Z., & Xianyu, Y. (2023) · Medicine · doi:10.1097/md.0000000000035059 · Cited by 9
Srinivasan, V., Ruthuvalan, V., Raja, S., Jayaraj, V., Sridhar, S., Kothandaraman, M., Suganthirababu, P., Abathsagayam, K., Vishnuram, S., Alagesan, J., et al. (2024) · Work · doi:10.3233/wor-230356 · Cited by 9
Canas, A., Wolf, A., Mak, A., Ruddy, J., El-Sadek, S., Gomez, L., Furfaro, D. M., Fullilove, R. E., Burkart, K. M., Zelnick, J., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-61097-0 · Cited by 9
Shayan, N. A., Azizi, A. T., Razaqi, N., Afzali, H., Neyazi, A., Waez, H., Noormohmmadi, M., & Bhattacharya, S. (2021) · Razi International Medical Journal · doi:10.56101/rimj.v1i1.14 · Cited by 9
Analysis of Emotion and Recall in COVID-19 Advertisements: A Neuroscientific Study
González, M. B., Fernández, M. R., & Martín, D. L. S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168721 · Cited by 9
“This resulted in emotional distress, social disorder, defensive responses and fear [32], among other pathologies.”
BackgroundSentiment Analysis about Oximeter as Covid-19 Detection Tools on Twitter Using Sastrawi Library
Siswanto, B., & Dani, Y. (2021) · International Conference on Information Technology, Computer, and Electrical Engineering · doi:10.1109/icitacee53184.2021.9617216 · Cited by 9
Covid-19 Fobisi (Korkusu), Covid-19 Farkındalığı ve Genel Aidiyetleri Düzeyleri
Kurtuluş, E., & Düşünceli, B. (2021) · Üsküdar Üniversitesi Sosyal Bilimler Dergisi · doi:10.32739/uskudarsbd.7.13.96 · Cited by 11
Guelmami, N., Tannoubi, A., Chalghaf, N., Saidane, M., Kong, J. D., Puce, L., Azaiez, F., Bragazzi, N. L., & Alroobaea, R. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.824134 · Cited by 10
Hou, S., Tran, A., Cho, S., Forbes, C., Forster, V. J., Stokoe, M., Allapitan, E., Wakefield, C. E., Wiener, L. S., Heathcote, L. C., et al. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.867151 · Cited by 9
Hsieh, K.-Y., Li, D., Chou, F. H., Hsu, S., Wu, H., Chou, L., Wu, P.-J., Lin, G., Chen, W. J., Liu, C.-L., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19159498 · Cited by 9
Fisher, D. A., Miller, T. R., Grube, J. W., Ringwalt, C. L., Achoki, T., Ngwato, T. P., Shilakoe, L., & Mkhondo, P. (2022) · Global Social Welfare · doi:10.1007/s40609-022-00230-1 · Cited by 9
“Consistent with other studies of pandemics, substantial numbers of the township’s residents reported stress or anxiety, or depression associated with COVID-19 (Cullen et al., 2020; Esterwood & Saeed, 2020; Lima et al., 2020; Qiu et al., 2020; Shah et al., 2020; Yao et al., 2020).”
Anyone but Me: Unrealistic Optimism, Emotions and Anxiety in the Face of COVID-19 Pandemic
Wielgopolan, A., Pastwa, M., Warkocka, A., & Imbir, K. K. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20010301 · Cited by 9
“Regardless of such consequences, many authors suggested that levels of stress and anxiety rose in the general population to very high levels during the pandemic, and it will take a long time for people to recover from such changes [1,2].”
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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