Monday, March 16, 2020

Optimizing mental health during the COVID-19 pandemic

- Jennifer Middleton, MD, MPH

Novel coronavirus cases continue to increase in the United States, consistent with the predictions shared by Dr. Lin in last week's Community Blog post. An increase in anxiety, both in the lay public and in healthcare workers, is an unsurprising consequence of the novel coronavirus' continued spread. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) issued statements in the last week regarding mental health as it relates to this global pandemic. Besides validating the experience of heightened anxiety during this time of stress, both organizations provide helpful tips and resources. These practical strategies apply not only to patients, but also for those of us in primary care on the front lines of caring for those who are ill.

The WHO's tip sheet includes several categories including general population, health care workers, and those in quarantine/isolation. Commonalities across categories include limiting news exposure to once or twice per day from reputable sites, sharing positive stories of healing, and prioritizing self-care. The CDC outlines common symptoms of increased stress and/or anxiety: fear, worry, changes in eating and/or sleep patterns, worsening of chronic health problems, and increased use of alcohol, tobacco and drugs. They also recommend limiting news exposure with the perspective that "strong feelings will fade" while focusing on healthy meals, adequate rest, and exercise.

Both sites devote separate sections to caring for children during this time. They advise maintaining routines as much as possible, answering children's questions in a straightforward, age-appropriate manner, and reassuring them that they are safe and will be cared for. The WHO adds that "[c]hildren will observe adults’ behaviors and emotions for cues on how to manage their own emotions during difficult times," while the CDC advises that parents limit children's media exposure while being a "role model" by maintaining their own self-care.

"Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed," authored by a group of psychiatrists and behavioralists from China, was published last month with the following recommendations:

First, multidisciplinary mental health teams...should deliver mental health support to patients and health workers....Second, clear communication with regular and accurate updates about the 2019-nCoV outbreak should be provided to both health workers and patients in order to address their sense of uncertainty and fear....Third, secure services should be set up to provide psychological counselling (sic) using electronic devices and applications (such as smartphones and WeChat) for affected patients, as well as their families and members of the public...Fourth, suspected and diagnosed patients with 2019-nCoV pneumonia as well as health professionals working in hospitals caring for infected patients should receive regular clinical screening for depression, anxiety, and suicidality by mental health workers. 

Including mental health care in our offices', hospitals', and healthcare systems' COVID-19 planning efforts will likely benefit patients and healthcare workers alike, both in the short- and long-term. Here are additional resources you, your colleagues, your staff, and your patients may find beneficial:

AFP By Topic on Anxiety Disorders
CDC: Coping After a Disaster (activity book for children) 
CDC: Emergency Responders: Tips for taking care of yourself
CDC: Helping Children Cope with Emergencies 
Mind (UK mental health charity): Coronavirus and your wellbeing
SAMHSA: Disaster Preparedness, Response, and Recovery
WHO: Coping with stress during the 2019-nCoV outbreak
WHO: Psychological first aid: Guide for field workers