At home! At home for weeks! At home for months!
Since January 2020 we have been seeing the effects of this pandemic day by day, week by week, affecting all countries, affecting everyone. At different points in time and to a greater or lesser extent, countries across the world have been imposing restrictions to their citizens. Social isolation and social distancing have become the norm for many of us. This pandemic has induced a considerable degree of fear, worry and concern in the population. We worry about the possibility of losing our jobs. We worry because we have been furloughed or laid off and there is no certainty that our job will be there on our return. Or we are anxious because we have lost our job and we have no idea how we are going to put food on the table, not mentioning the mortgage commitments at the end of the month that might not be met. Not seeing your family makes you extremely sad; you may feel bored and loneliness is a constant. Staying continuously at home with your children is extremely stressful and an unceasing chaos – the pressure of having to home-school them is persistently mounting. We worry that someone in the family might get infected; we fear going out and get extremely anxious when others get too close when out and about. Last but not least, we worry because we don’t know when all of this will end.
As indicated by the WHO, in public mental health terms, the main psychological impact to date is elevated rates of stress and/or anxiety. Certain groups in particular are considered more at risk, such as older adults, people with underlying health conditions and frontline workers, like health and care providers. Levels of loneliness, depression, alcohol and drug use, and self-harm or suicidal behaviour are increasing and expected to rise further throughout this pandemic. Studies into the mental health impact of coronavirus are urgently needed, with immediate research priorities to monitor and report rates of mental health issues both to understand mechanisms and crucially to inform interventions.
Treatments such as antidepressant medication are often the first choice by clinicians as these are usually fast in bringing positive results. Psychological interventions are also considered effective options to reduce or manage some mental health issues, especially cognitive behaviour therapy (CBT); but sometimes these are discarded by health systems in view of limited availability and limited access to adequate healthcare professionals. Digital psychological interventions (DIs), defined as software-based therapeutic activities accessed via technology platforms, such as the internet, virtual reality and mobile phones, are also alternatives. These are typically included in a ‘self-help’ bundle offered to patients before medication or therapist-delivered CBT and/or applied relaxation. DIs features increase patient choice and expands access to the vast majority that require treatment.
To assert their effectiveness and cost-effectiveness, within each mental health problem, DIs require an extensive evidence base which is currently almost non-existent. Under the current lockdown circumstances, and given the rise in mental health concerns during this coronavirus era, DIs could offer the mental health and psychosocial support required. In fact, because of quarantine and associated physical and social isolation measures, the digital response may be fundamental. If adequately clinically and economically evaluated, automated platforms such as apps and online programmes, blended with other therapeutic interventions such as chatlines, forums and messaging services, may reach those with poorer digital resources. An appropriate monitoring and reporting of mental health issues will also determine a suitable evaluation of models of implementation. In the medium/long-term, health services could coordinate efforts and adapt to be able to consistently provide reliable remotely and digitally delivered mental health resources to manage prevalent and incident mental health cases in an adaptive and flexible manner.
Pedro Saramago
Centre for Health Economics, University of York
