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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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“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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“Since the well-being of healthcare professionals is of utmost importance and very few studies have been conducted to understand their stress levels as this phenomenon is new (Rajkumar, 2020; Pfefferbaum & North, 2020; Cullen et al., 2020; Usher et al., 2020), therefore, the current study has been planned to measure th…”
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“It was termed as a pandemic by the World Health Organization on March 11, 2020 (Cucinotta & Vanelli, 2020; Cullen et al., 2020; Lone & Ahmad, 2020; Mocnik et al., 2020) once it became clear that it was spreading fast over a wide area and the resulting illness was severe.”
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“Researchers have advocated for certain actions to be taken in awareness of the negative responses, such as providing psychological interventions for affected communities, and addressing and monitoring mental health in addition to physical health at healthcare facilities [9, 10].”
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“Thus, providing enough resources to keep the mental health of the society well can be as important as identifying and treating cases of the infection.[8,9] This increasing number of infected individuals and Access this article online”
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Physical Activity and Depression among Korean Female College Students Due to COVID-19
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Mental health issues assessment using tools during COVID-19 pandemic
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“The major psychological impact on public mental health was seen as an increased level of anxiety, stress, and depression [6].”
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“The chance of contracting COVID-19, the difficulty of getting tested and treatment, and the adverse physical and psychological repercussions of the pandemic are all enhanced in those with pre-existing mental disorders and substance use issues [26].”
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“Engaging in self-care behaviors has been encouraged by the CDC and other major health agencies as a means of improving mental health outcomes, particularly for healthcare workers.(13,14) Common self-care behaviors include physical activity, consumption of fresh fruits and vegetables, and purposeful activity aimed to c…”
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“Moreover, to minimize the psychological effect of the pandemic, the government should increase awareness of mental disorders and provide psychological interventions, especially to the people at high risk of psychological problems [58].”
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Pandemi Sürecinde Annelerin Koronavirüs Hastalığı Korkusu ve Anne-Çocuk İletişimi
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Havaei, F., MacPhee, M., Ma, A., & Mao, Y. (2022) · Canadian Journal of Nursing Research · doi:10.1177/08445621221098833 · Cited by 6
“Self-monitoring is an effective strategy to offer more assurance to healthcare workers (Cullen et al., 2020), but healthcare organizations and leaders must be prepared to follow through with appropriate mental health supports for healthcare workers, especially during widespread crisis (Barello et…”
BackgroundSapancı, A., & AKKAYA, G. (2022) · International Journal of Psychology and Educational Studies · doi:10.52380/ijpes.2022.9.2.724 · Cited by 8
Carnall, L. A., Mason, O. J., O’Sullivan, M., & Patton, R. (2022) · Journal of Traumatic Stress · doi:10.1002/jts.22846 · Cited by 5
“These results support other examples in the literature concerning job burnout (e.g., De Lange et al., 2004; Dengping, 2020), which have demonstrated that work intensity is associated with burnout and, subsequently, poorer mental health.”
ResultAmer, S. A., Abd‐Ellatif, E. E., Hughes, P. G., Al-Enazi, H. M. G., AlHasan, A., Amer, M. A., Alruhaimi, A. F., & Elsayed, M. (2022) · Clinical Practice and Epidemiology in Mental Health · doi:10.2174/17450179-v18-e2208200 · Cited by 7
Tulk, C., Bartram, M. H., Leslie, K., Atanackovic, J., Chamberland-Rowe, C., & Bourgeault, I. L. (2023) · Human Resources for Health · doi:10.1186/s12960-023-00797-6 · Cited by 6
“Many healthcare resources including MHSUH staff were diverted for care of COVID-19 patients and preventive health services, such as screening and vaccination [9, 10].”
BackgroundBiagianti, B., Lisi, I., Liberto, A. D., Turtulici, N., Foti, G., Zito, S., Ginex, V., Fornoni, C., Gallo, F., Cantù, F., et al. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.03.024 · Cited by 6
A quantitative simulation–based modeling approach for college counseling centers
Chatterjee, S., Hebaish, Y., Ntaimo, L., Deegear, J., Rucker, M., & Aprahamian, H. (2023) · SIMULATION · doi:10.1177/00375497231159675 · Cited by 6
“Since the advent of the COVID-19 pandemic and its impact on our everyday lives, mental health related problems have seen a sharp increase across the population [1, 2], with a notable negative impact on students [3, 4, 5].”
BackgroundJang, Y., Cho, H.-M., Mok, Y. E., Chi, S., Han, C., Yi, H.-S., & Lee, M. (2023) · Journal of korean Academy of Child and Adolescent Psychiatry · doi:10.5765/jkacap.220036 · Cited by 7
Wang, X., & Wang, X. (2023) · Economic Research-Ekonomska Istraživanja · doi:10.1080/1331677x.2023.2186909 · Cited by 6
“Since a rapid outbreak of Covid-19 triggered frightening situations, governments are taking measures for protecting human lives, especially by recommending social distancing and lockdown policies (Cullen, Gulati, & Kelly, 2020).”
BackgroundLin, W., Tsai, C., & Pan, P. (2023) · BMC Geriatrics · doi:10.1186/s12877-023-04035-5 · Cited by 6
Are Medical and Wellness the Future of Tourism in Qatar?
Abdallah, A., & Al-Hashmi, B. (2023) · Études caribéennes · doi:10.4000/etudescaribeennes.28020 · Cited by 6
McKenney, E. E., Cucchiara, C. L., & Gotham, K. O. (2023) · Journal of American College Health · doi:10.1080/07448481.2023.2283742 · Cited by 5
Santacroce, L. A., & Tamber-Rosenau, B. J. (2024) · Cognitive Research Principles and Implications · doi:10.1186/s41235-023-00525-7 · Cited by 6
“Importantly, the COVID pandemic led to a drastic increase in mental health concerns across the general population (Cullen et al., 2020; Pfefferbaum & North, 2020), and young people (ages 18–34) experienced the highest COVID-related mental distress of any age group (Na et al., 2022).”
BackgroundFernández‐Martínez, S., Armas-Landaeta, C., Pérez‐Aranda, A., Parra, J. G., Monreal‐Bartolomé, A., Carbonell-Aranda, V., García‐Campayo, J., & del Hoyo, Y. L. (2024) · SAGE Open Nursing · doi:10.1177/23779608241278861 · Cited by 8
“Health care providers often experience high levels of sustained stress that present a risk factor for developing mental health problems (Cullen et al., 2020; Williamson et al., 2018).”
BackgroundReno-Chanca, S., Hoey, J. V., de Oliver, J. S. P., Blasko-Ochoa, I., Aguilar, P. S., & Moret‐Tatay, C. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.644212 · Cited by 7
Zaccari, V., Gragnani, A., Pellegrini, V., Caiazzo, T., D’Arienzo, M. C., Magno, A., Femia, G., & Mancini, F. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.755744 · Cited by 6
Ramli, A. A., & Aladdin, A. B. (2021) · International Journal of Academic Research in Business and Social Sciences · doi:10.6007/ijarbss/v11-i12/11960 · Cited by 6
Ghisi, G. L. D. M., dos Santos, R. Z., Körbes, A. S., de Souza, C. A., Karsten, M., OH, P. I., & Benetti, M. (2022) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20210447 · Cited by 6
Effect of the COVID-19 pandemic on violence against pre-hospital emergency health workers
Ekşi, A., Gümüşsoy, S., Altay, S. U., & Kirazlı, G. (2022) · Work · doi:10.3233/wor-220147 · Cited by 6
Gao, M., & Lou, W. (2024) · Journal of Clinical Psychology · doi:10.1002/jclp.23726 · Cited by 7
“These challenges encompass anxiety, depression, social isolation, fear, uncertainty, and post-traumatic stress disorder (Cullen et al., 2020).”
BackgroundThe impact of COVID-19 quarantine on college students’ mental health
Wang, W., Chen, B., & Yang, S. (2025) · BMC Public Health · doi:10.1186/s12889-025-22669-5 · Cited by 7
“The COVID-19 pandemic poses challenges to physical and mental health [16].”
Ariel, D., Marciano, H., Kimhi, S., Eshel, Y., & Adini, B. B. (2025) · Stress and Health · doi:10.1002/smi.70080 · Cited by 5
“In contrast, anxiety, depression (Cullen et al. 2020), a sense of danger (Kimhi et al. 2021), and perceived threats (Kruglanski et al. 2021) can signal greater psychological distress.”
Foschiera, L. N., de Freitas, C. P. P., Luft, C. Z., Godoi, A. R., Dupont, M. F., & Habigzang, L. F. (2022) · Trends in Psychology · doi:10.1007/s43076-022-00213-3 · Cited by 5
“Natural, environmental, or traumatic disasters are accompanied by a significant increase in the levels of illnesses that affect mental health, such as anxiety, stress, and depression (Cullen et al., 2020; Galea et al., 2020).”
Mojahedi, M., Esmaeili, A., Sahranavard, S., & Salmani, F. (2023) · Modern Care Journal · doi:10.5812/modernc-133701 · Cited by 4
Yeon, P., Kim, I.-O., Kang, S.-N., Lee, N.-E., Kim, G.-Y., Shim, H.-R., Chung, C.-Y., Lee, J.-S., Jeon, J. Y., & Shin, W.-S. (2023) · Healthcare · doi:10.3390/healthcare11233039 · Cited by 6
Role of Information Systems in Effective Management of Human Resources during the COVID-19 Pandemic
Selvaraj, V. P., & Venkatakrishnan, S. (2023) · Systems · doi:10.3390/systems11120573 · Cited by 15
Mandić, S., Ricijaš, N., & Dodig, D. (2024) · Psychiatry International · doi:10.3390/psychiatryint5020011 · Cited by 8
“During the pandemic, the prevalence of mental health problems in the general population increased worldwide [45–48], including in Croatia [49–53].”
BackgroundCAREForMe: Contextual Multi-Armed Bandit Recommendation Framework for Mental Health
Yu, S., Nourzad, N., Semple, R. J., Zhao, Y., Zhou, E., & Krishnamachari, B. (2024) · IEEE/ACM International Conference on Mobile Software Engineering and Systems (MOBILESoft) · doi:10.1145/3647632.3647993 · Cited by 5
Fong, D., Chu, T., Heflin, M., Gu, X., & Seneviratne, O. W. (2024) · International Conference on Medical and Health Informatics (ICMHI) · doi:10.1145/3673971.3673995 · Cited by 5
“Psychiatric disorders have always imposed significant challenges to public health [9], and the advent of the COVID-19 pandemic has intensified these issues [1, 6, 14].”
BackgroundMachine Learning for Predicting Personality and Psychological Symptoms from Behavioral Dynamics
Wang, M., Xu, A., Fan, C., & Sun, X. N. (2025) · Electronics · doi:10.3390/electronics14030583 · Cited by 6
“Psychological symptoms not only increase the risk of physical illnesses [6] but also affect cognitive, emotional, and behavioral patterns [7], significantly impacting individual and societal well-being [8].”
Fox‐Harding, C., Harris, S. A., Rogers, S., Vial, S., Beranek, P., Turner, M., & Cruickshank, T. M. (2021) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2021.624267 · Cited by 5
“COVID-19 has impacted the way of life of individuals worldwide, leading to a deterioration in emotional well-being, with several studies, including those in athletic populations, reporting an increase in stress, anxiety and depressive symptomology (Cullen et al., 2020; Holmes et al., 2020; Pierce et al., 2020; Reardon…”
BackgroundCovid-19 Pandemi Sürecinde Bireylerin Sosyal Destek ve Aile İklimi Algılarının İncelenmesi
Kabasakal, Z., & AKTAŞ, A. (2021) · Batı anadolu eğitim bilimleri dergisi · doi:10.51460/baebd.910925 · Cited by 5
Espejo, B., & Checa, I. (2021) · Mathematics · doi:10.3390/math9192512 · Cited by 5
“Likewise, other studies have analyzed the psychological impact on the uninfected community, revealing psychiatric comorbidities associated with a younger age and greater self-blame [22].”
BackgroundImpactos da pandemia no estudo e dinâmica de vida de universitários brasileiros
Francisco, L. P. L., Fernandes, C. B., Vio, N. L., Pascoal, I. D. O., Feijó, M. R., & Camargo, M. L. (2021) · Conjecturas · doi:10.53660/conj-196-614 · Cited by 5
Digital medical education and students’ mental health: effects of the COVID-19 pandemic in Germany
Michaeli, D. T., Keough, G., Strotzer, Q., & Michaeli, T. (2021) · The Journal of Mental Health Training Education and Practice · doi:10.1108/jmhtep-03-2021-0035 · Cited by 5
Currin, J. M., Evans, A. E., Miller, B. M., Owens, C., Giano, Z. D., & Hubach, R. D. (2022) · Current Psychology · doi:10.1007/s12144-022-02830-8 · Cited by 7
“This increase will likely be due to the increase in isolation and loneliness individuals experienced during quarantine (Cullen et al., 2020; DiGiovanni et al., 2004).”
BackgroundAnithasri, A. (2022) · JOURNAL OF COMMUNICABLE DISEASES · doi:10.24321/0019.5138.202223 · Cited by 5
Tigga, N. P., & Garg, S. (2022) · ALPHA PSYCHIATRY · doi:10.5152/alphapsychiatry.2022.21797 · Cited by 5
“Accuracy True Positive True Negative True Positive False Positi ve True Negative False Negative (1)”
BackgroundSlovak parents’ mental health and socioeconomic changes during the COVID-19 pandemic
Vargová, L., Mikulášková, G., Fedáková, D., Lačný, M., Babjáková, J., Šlosáriková, M., Babinčák, P., Ropovik, I., & Adamkovic, M. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.934293 · Cited by 4
Arifin, Z., Winarni, S., Mawarni, A., & Purnami, C. T. (2022) · Jurnal Kesehatan Masyarakat · doi:10.14710/jkm.v10i2.33110 · Cited by 5
Gangeri, L., Alfieri, S., Greco, M., Bosisio, M., Petrigliano, R., Murru, L., & Borreani, C. (2022) · BMC Psychology · doi:10.1186/s40359-022-00930-5 · Cited by 5
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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