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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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Mrklas, K., Shalaby, R., Hrabok, M., Gusnowski, A., Vuong, W., Surood, S., Urichuk, L., Li, D., Li, X., Greenshaw, A. J., et al. (2020) · doi:10.2196/preprints.20041 · Cited by 3
Yoo, B. W., Yan, X. G., & Sun, H. Y. (2022) · Research Square · doi:10.21203/rs.3.rs-1541712/v1 · Cited by 3
STRESS MASYARAKAT DI MASA PANDEMIPreprint
Sahputri, A. H. (2021) · doi:10.31219/osf.io/fcdz7 · Cited by 3
Filho, C. I. S. (2020) · doi:10.2196/preprints.22165 · Cited by 3
From ground zero of the pandemic – nurses’ stories via Photovoice
ÇETİN, İ., Polat, H. T., Burucu, R., & Cantekin, I. (2023) · European Journal of Clinical and Experimental Medicine · doi:10.15584/ejcem.2023.1.15 · Cited by 2
Anwar, A. I., Panna, S. S., Katili, D. I., Irwan, I., & Julianto, E. (2024) · Pesquisa Brasileira em Odontopediatria e Clínica Integrada · doi:10.1590/pboci.2024.076 · Cited by 2
“It is very important to explore the impact of COVID-19 on oral health, namely phobias and oral hygiene, dental problems encountered, how people deal with these problems, and whether these problems exacerbate their anxiety [1-4].”
BackgroundChen, L., Li, H., & Zhao, L. (2024) · Applied Sciences · doi:10.3390/app14209244 · Cited by 3
Jang, S. Y., Choi, H. J., Kim, H., & Kim, H. J. (2025) · Psychiatry Investigation · doi:10.30773/pi.2024.0095 · Cited by 2
Factors Affecting the Adoption of Mental Health Apps in Workplaces: A Qualitative Study
Tan, C. J. Y., Müller, A. M., Rajendram, P., & Subramaniam, M. (2025) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-025-00524-z · Cited by 2
Walia, S. K., Choudhary, P., Tiwari, P., & Sharma, A. (2025) · Journal of Hospitality & Tourism Education · doi:10.1080/10963758.2025.2484191 · Cited by 2
Resilience Mechanisms of School Counselors in Wartime: A Grounded Theory Study
Gamliel, R. C., Rubin, O., & Alon, R. (2025) · Psychology in the Schools · doi:10.1002/pits.70030 · Cited by 2
“Times of emergency and crisis challenge school counselors' resilience and well ‐ being, and in turn, may impact the quality of their services in helping traumatized people and systems (Akgül and Ergin 2022; Cullen et al. 2020; Litam et al. 2021).”
Mensah, N., Boateng, F. O., & Gordon, J. F. (2025) · Journal of Pedagogical Sociology and Psychology · doi:10.33902/jpsp.202531125 · Cited by 2
An Exploratory Analysis of Minority Stress Experiences and Mental Ill-Health in Bisexual Adults
Abbott, R. L., Loi, N. M., Bartik, W. J., Larsen, S. A., Sundaraja, C., & Lykins, A. D. (2025) · The Journal of Sex Research · doi:10.1080/00224499.2025.2558770 · Cited by 2
Possibility of increased alcohol-related domestic violence following the COVID-19 pandemic
Keshtkaran, Z., Zare, F., & Delam, H. (2021) · Journal of Substance Use · doi:10.1080/14659891.2021.1968968 · Cited by 2
“In general, maladaptive behaviors, emotional distress, and defensive responses are among the psychological responses to epidemics (Cullen et al., 2020).”
BackgroundIwazaki, J., Aoki, K., Kato, C., & Kimura, K. (2021) · Psychology · doi:10.4236/psych.2021.1212126 · Cited by 2
The Covid-19 pandemic impact on community mental health
Putri, R., Fajri, N., Hanum, S., Hanum, M., Sofia, S., Husnah, H., & Mawarpury, M. (2022) · E3S Web of Conferences · doi:10.1051/e3sconf/202234005006 · Cited by 2
Hernández, E., Kalstrom, B., Murray, A., Nelson, Z., & Squire, D. (2021) · New Directions for Student Services · doi:10.1002/ss.20402 · Cited by 2
“Preliminary studies have suggested that COVID-19 has affected people’s mental health (Cullen et al., 2020).”
BackgroundMoyo, I., Tshivhase, L., & Mavhandu‐Mudzusi, A. H. (2022) · Cogent Psychology · doi:10.1080/23311908.2022.2087827 · Cited by 2
“The lack of preparedness and support, the stigma, and the discrimination that healthcare providers have been subjected to translate to psychological effects on these providers (Brooks et al., 2018; Cullen et al., 2020; Raven et al., 2018).”
BackgroundCalderaro, D. C., Teodoro, M. L. M., Basualto, S., Borges, A. R., Lopes, J. V. Z., Araújo, N. C., Mariz, H. D. A., Valadares, L. D. D. A., Ribeiro, S. L. E., Kahlow, B. S., et al. (2022) · Psychology Health & Medicine · doi:10.1080/13548506.2022.2141280 · Cited by 5
“(Alsoufi et al., 2020; Cullen et al., 2020; Pfefferbaum & North, 2020; Saraswathi et al., 2020; Usher et al., 2020).”
BackgroundDetrimental Effects of COVID-19 Measures on Mental Health and Social-Economic Disparities
Wang, H., & Sanchuli, N. (2022) · International Journal of Mental Health Promotion · doi:10.32604/ijmhp.2022.022319 · Cited by 2
Hung, J. (2022) · Frontiers in Sociology · doi:10.3389/fsoc.2022.1090785 · Cited by 2
“However, relevant literature predominantly focused on assessing to what extent the pandemic and the associated consequences, such as the application of social distancing rules and home quarantine measures, negatively impacted individuals’ mental health (Cullen et al., 2020; Pfefferbaum and North, 2020).”
BackgroundKartol, A., & Söner, O. (2022) · Psicologia Reflexão e Crítica · doi:10.1186/s41155-022-00242-y · Cited by 3
Playing and Socializing—Adults’ Perceptions of the FIFA Digital Game
Pinheiro, A., Oliveira, A., & Alturas, B. (2022) · Informatics · doi:10.3390/informatics10010002 · Cited by 2
Yüce, Z., & Şimşek, N. (2023) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.1079919 · Cited by 2
Siddiqui, H., Garg, S., Julka, P. K., Chaturvedi, A., Choudhri, S., & Arora, R. S. (2023) · Indian Journal of Medical and Paediatric Oncology · doi:10.1055/s-0043-1764368 · Cited by 2
Impactos e efeitos psicológicos da pandemia da COVID-19 na atividade universitária
Ribeiro, Y. P., Silva, J. D. F. A., Barbosa, A. D. S., Pacheco, M. R., Dergan, M. R. A., Silva, J. B. C., de Magalhães, A. C. C., Henrique, A. V. N., dos Santos, V. Q., & Ribeiro, N. A. B. (2023) · Revista Eletrônica Acervo Saúde · doi:10.25248/reas.e12266.2023 · Cited by 2
Strengthening Social Work Skills and Competency Through Exposure to Diversity
Gearing, R. E., Washburn, M., Savani, S., Mytelka, C., Carr, L. C., Robinson, A., Clark, D., & Robbins, S. P. (2023) · Journal of Social Work Education · doi:10.1080/10437797.2023.2199049 · Cited by 2
“Moreover, as we have seen a significant across the board increase in mental illness resulting from the ongoing COVID-19 pandemic (Cullen et al., 2020; Kumar & Nayar, 2021; Pfefferbaum & North, 2020), it is essential that students actively work to decrease stigma related to mental health conditions…”
BackgroundKasaie, A., & Rajendran, S. (2023) · Healthcare Analytics · doi:10.1016/j.health.2023.100242 · Cited by 2
Karakitsiou, G., Plakias, S., Kedraka, K., Arvaniti, A., Kokkotis, C., Tsiakiri, A., & Samakouri, M. A. (2023) · Brain Sciences · doi:10.3390/brainsci13081203 · Cited by 4
“This study, along with others conducted during the COVID-19 pandemic, is deemed of significant importance, since, as can be seen from the literature, the psychological reactions of populations during pandemics play a crucial role in shaping the spread and occurrence of emotional and mental health problems during them…”
ResultPalacz-Poborczyk, I., Chamberlain, K., Naughton, F., Baska, A., Łuszczyńska, A., Quested, E., Hagger, M. S., Pagoto, S., Verboon, P., Robinson, S., et al. (2023) · Psychology and Health · doi:10.1080/08870446.2023.2252874 · Cited by 2
“…and lockdowns have been previously reported as disruptive to maintaining health behaviours (Naughton et al., 2021), with a strong focus on negative mental health outcomes (Arora & grey, 2020; Cullen et al., 2020; Dawson & golijani-Moghaddam, 2020; Lima et al., 2020; Zvolensky et al., 2020).”
Effects of COVID-19 on mental health among students
Marzban, A., Salehi, F., & Razmi, M. R. (2023) · Health Science Monitor · doi:10.61186/hsm.2.3.153 · Cited by 2
Evaluation and Application of Cloud Computing in Mental Health Service Platform
Han, X., Bai, L., & Han, B. (2023) · Procedia Computer Science · doi:10.1016/j.procs.2023.11.151 · Cited by 2
Sun, D., & Zhao, G. (2023) · PLoS ONE · doi:10.1371/journal.pone.0294665 · Cited by 3
Heidaranlu, E., Moayed, M. S., & Parandeh, A. (2023) · Journal of Religion and Health · doi:10.1007/s10943-023-01972-8 · Cited by 2
“…of being threatened by the risk of death, as a sign of COVID-19, was an actual life-threatening factor in increasing mortality, which had a significant impact on the patients’ behavior even unknowingly and led to the aggravation of psychological distress (Cullen et al., 2020; Dong & Bouey, 2020).”
Rico, A. G., Valle, C. D. G., Llamazares, M. D. C. E., Cruz, T. D. L. T., Rico, M. I. L., & Palacio, M. E. M. (2024) · Behavioral Sciences · doi:10.3390/bs14030173 · Cited by 3
“On similar lines, Cullen et al. [55], Liyanage et al. [56], and Gonz á lez et al. [57] stated that high levels of indicators of anxiety and stress were observed during the pandemic.”
BackgroundBhuvan (2024) · DBS Applied Research and Theory Journal · doi:10.22375/dbs.v1i1.99 · Cited by 2
Aranda, T. J. C., Duette, C. E. V., Ríos, A. I., & Torres, E. G. (2024) · psicogente · doi:10.17081/psico.27.51.6535 · Cited by 2
Association between Changes in Daily Life Due to COVID-19 and Depressive Symptoms in South Korea
Son, H., Hong, Y., & Son, H. (2024) · Healthcare · doi:10.3390/healthcare12080840 · Cited by 2
“A population’s psychological responses to an outbreak of an infectious disease not only accelerate the spread of the disease but are also major triggers of emotional distress and social disabilities even after eradication of the infectious disease [5].”
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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