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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]
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
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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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Hipwell, A. E., Tung, I., Sherlock, P., Tang, X., McKee, K., McGrath, M., Alshawabkeh, A. N., Bastain, T., Breton, C. V., Cowell, W., et al. (2023) · Psychological Medicine · doi:10.1017/s0033291723000314 · Cited by 5
“Epidemiological studies have reported an increased prevalence of pandemic-related psychiatric morbidity and psychological distress in the general population (Lei et al., 2020; Smith et al., 2020) with effects projected to continue beyond the current pandemic (Cullen, Gulati, & Kelly, 2020).”
BackgroundDouble Trouble Co-Infections: Understanding the Correlation Between COVID-19 and HIV Viruses
Abbasi, S. A. A., Noor, T., Mylavarapu, M., SAHOTRA, M., Bashir, H. A., Bhat, R. R., Jindal, U., Amin, U., Anushree, V., & Siddiqui, H. F. (2023) · Cureus · doi:10.7759/cureus.38678 · Cited by 3
“The virus can have social and emotional effects on pregnant and postpartum women who may be separated from their families and communities due to quarantine measures [105,106].”
BackgroundIfdil, I., Suranata, K., Rangka, I. B., Bakar, A. Y. A., Susiani, K., & Subramaniam, T. S. (2023) · International Journal of Disaster Risk Reduction · doi:10.1016/j.ijdrr.2023.103976 · Cited by 5
Street Vibrancy and Outdoor Activities under COVID-19 Psychological Distress: Lessons from Hong Kong
Zordan, M., Tsou, J.-Y., & Huang, H. (2023) · Land · doi:10.3390/land12101896 · Cited by 5
Goenaga, B., Underwood, B. S., Castorena, C., Cantillo, V., & Arellana, J. (2023) · Latin American Transport Studies · doi:10.1016/j.latran.2023.100005 · Cited by 4
James, D., Henshaw, E. J., Lourie, A., Kennedy, S. J., & Glatley, B. (2023) · Health Science Reports · doi:10.1002/hsr2.1645 · Cited by 4
Lee, D. W., Jang, J., & Shin, J. (2023) · SSM - Population Health · doi:10.1016/j.ssmph.2023.101580 · Cited by 4
“Consequently, policies such as lockdown, social distancing, and its economic consequences have affected individuals ’ mental health and increased the risk of suicide (Cullen et al., 2020; Kumar & Nayar, 2021; McKibbin & Fernando, 2020; O ’ Connor et al., 2021).”
BackgroundHansson, J., MacEachen, E., Landstad, B. J., Vinberg, S., & Tjulin, Å. (2023) · International Journal of Circumpolar Health · doi:10.1080/22423982.2023.2298015 · Cited by 4
“These additional stressors likely have affected the mental health of self-employed people [31] and increased their levels of burnout [27,32].”
BackgroundBath, J., & Markulin, V. (2024) · International Journal of Business and Applied Social Science · doi:10.33642/ijbass.v10n1p1 · Cited by 6
Akca, S. O., Turan, A. P., & Söngüt, S. (2024) · Journal of pediatric nursing · doi:10.1016/j.pedn.2024.02.007 · Cited by 3
New Challenges for Leading the Change for the Psychological Consequences of Pandemics
Çetin, M. (2021) · Advances in logistics, operations, and management science book series · doi:10.4018/978-1-7998-6948-1.ch011 · Cited by 4
The role of mental health to overcoming the coronavirus disease-19 pandemic
Dania, I. A., & Novziransyah, N. (2021) · Universa Medicina · doi:10.18051/univmed.2021.v40.69-76 · Cited by 4
“conditions, while adolescents are also prone to experience distress especially when comorbid with other psychiatric disorders.((21,22)) Health care”
BackgroundThe pandemic and the forensic linguistics caseworker's wellbeing
García, R. G., Elstein, S., & Queralt, S. (2021) · International Journal of Speech Language and the Law · doi:10.1558/ijsll.19548 · Cited by 4
Iversen, C., Redmalm, D., Flinkfeldt, M., & Persson, M. (2021) · Sociologisk Forskning · doi:10.37062/sf.58.22100 · Cited by 4
Schneider, A., & Kroska, E. B. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168247 · Cited by 4
“The pandemic was associated with a multitude of negative outcomes in terms of physical and mental health [2,3].”
BackgroundChan, S. L., Takemura, N., Chau, P. H., Lin, C., & Wang, M. P. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168569 · Cited by 4
“During the COVID-19 pandemic, many countries have locked down due to the high prevalence of confirmed cases and the impact on the physical and mental health of healthcare workers [5].”
BackgroundPoor College Students’ Resilience Phase in Online Learning during the Covid-19 Pandemic
Irawan, A. W., Muslifar, R., & Dwisona, D. (2021) · Jurnal Kajian Bimbingan dan Konseling · doi:10.17977/um001v6i22021p052-059 · Cited by 5
Analyzing the Mental Health of Students in Dealing with the Coronavirus Disease Pandemic (Covid-19)
Chamdani, M., Mahmudah, U., & Fatimah, S. S. (2021) · JPI (Jurnal Pendidikan Indonesia) · doi:10.23887/jpi-undiksha.v10i4.30119 · Cited by 4
DePaula, N., Hagen, L., Roytman, S., Dyson, D., Alnahass, D., Patel, M., & Hill, A. (2022) · Hawaii International Conference on System Sciences (HICSS) · doi:10.24251/hicss.2022.300 · Cited by 4
Martínez, R. M. (2022) · Revista Ciencias de la Salud · doi:10.12804/revistas.urosario.edu.co/revsalud/a.10612 · Cited by 4
Kishore, T., Kunjukunju, A., & Yusof, P. (2022) · The Malaysian Journal of Nursing · doi:10.31674/mjn.2022.v13i04.012 · Cited by 4
Repercusiones en la Salud Mental de los Estudiantes de Tercero de Bachillerato: Un Caso de Estudio
Buele, P. A., Avilés-Castillo, F., & Buele, J. (2021) · Publicare · doi:10.56931/pb.2021.11_5 · Cited by 4
Impact of Psychological Behaviour and Social effects of COVID-19 Lockdown
Bhaskarwar, Y. A. (2021) · Journal of Pharmaceutical Research International · doi:10.9734/jpri/2021/v33i35b31918 · Cited by 4
“This may result in getting infected due to exposure and transmission to other members of the family [12].”
BackgroundHoof, E. V., Laet, H. D., Hochrath, S., Philips, E., Horczak, P., & den Cruyce, N. V. (2021) · Archives of Community Medicine and Public Health · doi:10.17352/2455-5479.000165 · Cited by 3
“As Cullen and colleagues [147] indicate, a prevalence of biomedical concerns is understandable in the immediate acute impact/heroic phase of a new outbreak, as health systems prioritize critical patient care and reducing transmission, but the crucial importance of the psychosocial aspects during a pandemic must never…”
BackgroundMitigating Psychological Impacts of Quarantine During Pandemics
Hameed, B. M. Z., Eraghi, M. M., Filli, M. K., Dash, S., Ibrahim, S., Chandrika, M., & Jajodia, S. (2023) · Journal of Computers Mechanical and Management · doi:10.57159/gadl.jcmm.2.2.23043 · Cited by 4
Talk or Text? Evaluating Response Rates by Remote Survey Method during COVID-19Preprint
Amaral, S., Dinarte, L., Dominguez-Rivera, P., Romero, S., & Perez-Vincent, S. M. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4006505 · Cited by 4
“We use mental health and attitudes toward the effectiveness of physical punishment of children as measures of sensitive information, due to the large incidence of these issues over time and their greater relevance during the pandemic crisis (WHO, 2020; Cullen et al., 2020; Kumar and Nayar, 2021).”
MethodTalk or Text? Evaluating Response Rates by Remote Survey Method during COVID-19
Amaral, S., Diaz, L. D., Domínguez, P., Perez-Vincent, S. M., & Romero, S. (2022) · World Bank, Washington, DC eBooks · doi:10.1596/1813-9450-9999 · Cited by 4
Azlan, S., Ahmad, N. A., Silim, U. A., Abdullah, M. N., Harun, N., Dollah, S. N., Sahril, N., Rezali, M. S., Chan, Y. Y., Redzuan, N. I., et al. (2020) · doi:10.21203/rs.3.rs-101909/v1 · Cited by 3
“While most studies have revealed that maladaptive copings were associated with psychological distress, our study indeed found that behavioral disengagement and self-blame are the main predictors for depression and anxiety (15).”
ResultCultural Responsiveness in Community Counselling
Harrichand, J. J. S., Mwendwa, J. M., & Gummaluri, S. (2025) · Palgrave texts in counselling and psychotherapy · doi:10.1007/978-3-031-81831-8_9 · Cited by 3
BEKMEZCİ, E., Karakoç, H., Koç, Ö., & Özkan, H. (2025) · Mediterranean Nursing and Midwifery · doi:10.4274/mnm.2024.24268 · Cited by 3
“The COVID-19 pandemic has triggered mental health-related problems associated with stress to mental and physical functioning (27,28).”
Emotional contagion, anxiety, and depression during COVID-19: a survey from Egypt
Amer, S. A., Khan, M., Ali, L. I., Moghib, K., Abdul‐Hafez, H. A., Amer, M. A., Salomon, I., & Al-Shroby, W. A. (2025) · BMC Public Health · doi:10.1186/s12889-025-24863-x · Cited by 3
“Previous research has shown that the public’s psychological responses during a pandemic can influence the course of disease transmission, its severity, the occurrence of stress and social disorders, and their repercussions [30, 31].”
Robertson, C., Brainard, J. S., Smith, G. E., Harcourt, S., Hoang, U., Elliot, A. J., de Lusignan, S., Colón‐González, F. J., & LAKE, I. R. (2026) · BMC Health Services Research · doi:10.1186/s12913-026-14362-z · Cited by 3
“Expectations that COVID-19 would be detrimental to MH were common and reasonable [5–7].”
Science Communication in Public Radio: The Case Study of MindTap
Greeves, S. B., & Ledbetter, R. N. (2022) · Frontiers in Communication · doi:10.3389/fcomm.2022.889207 · Cited by 4
“Moreover, since the beginning of the COVID-19 pandemic, mental health challenges have been exacerbated by a rise in social isolation and loneliness (Cullen et al., 2020; Pfefferbaum and North, 2020).”
BackgroundAdversity in Infancy and Childhood Cognitive Development: Evidence From Four Developing Countries
Manalew, W. S., Tennekoon, V., Lee, J., O’Connell, B., & Quinn, M. (2022) · International Journal of Public Health · doi:10.3389/ijph.2022.1604503 · Cited by 3
Fieldwork from Home?: COVID-19 and the Patchwork Future of Japan-Based Fieldwork Pedagogies
Vainio, A., & Pendleton, M. (2023) · Japanese Studies · doi:10.1080/10371397.2023.2267023 · Cited by 3
“…isolation, negative mental health and well-being outcomes and long-term financial difficulties that we now know to have resulted from the pandemic (Cullen et al., 2020; Hussong et al., 2021), by providing structured activities and engagement with the embodied elements of field-based research to…”
BackgroundCOVID-19 KORKUSUNUN YALNIZLIĞA ETKİSİ: ANKSİYETE BOZUKLUĞUNUN DÜZENLEYİCİ ROLÜ
Kızılkaya, S. (2023) · Elektronik Sosyal Bilimler Dergisi · doi:10.17755/esosder.1355284 · Cited by 3
Nomah, D. K., Díaz, Y., Bruguera, A., Moreno‐Fornés, S., Aceitón, J., Reyes‐Urueña, J., Llibre, J. M., Falcó, V., Imaz, A., Fanjul, F. J., et al. (2024) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofad693 · Cited by 3
“These include mental health conditions [13], nutritional status [14], and exposure to pollutants [15], which might notably heighten their risk.”
BackgroundSkinner, A., Occhipinti, J., Song, Y. J. C., & Hickie, I. B. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e28250 · Cited by 3
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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