Abstract
This special issue of the International Journal of Psychiatry in Medicine (IJPM) speaks to the reality of the liminal space healthcare providers and society at large find ourselves in. Over a year since the World Health Organization declared SARS-CoV-2 (COVID-19) a pandemic, we have lived through the unexpected shock, sacrifice, and loss brought about by an emerging virus that has effected the whole world. Not only have healthcare workers continually adjusted and dealt with the care of the medical consequences of COVID-19, we have also been placed in the front row for the political and societal strains that only made our work more challenging. Just as real as the devastating effects of COVID-19 on individual bodies and minds, we have also confronted the reality of how fragile the social fabric and the belief in science and truth actually are. However, with vaccine distribution continuing and the stealthy pace of scientific discovery, we can also peer around the world and see glimpses of post-pandemic life emerging, one that will benefit greatly from the hard forged lessons and knowledge gained since March, 2020. Between these two realities, this issue of IJPM sheds light on some of those lessons and forces us to confront the immense impact of COVID-19 on the mental health and well-being of patients and those going into the medical work.
A pandemic is a major event because they are not common. While historians and sociologists have lessons about pandemics past that we would be wise to learn from, the reality is that even from the influenza pandemic of 1918–1920 there is a paucity of the scientific data, especially around the impact on mental well-being of those who lived through the world wide impact and who experienced loss in various ways. It is certainly not fair for us to judge those from the early 20th century who were just beginning to understand germ theory. 1 However, it is imperative that we gather scientific data and lessons that will be useful for the next pandemic, or even future surges of COVID-19, whenever those inevitably happen.
In this special issue of IJPM, six articles report on findings related to the impact of Sars-COV-2 and its wide ranging impact on mental health. Bareeqa and colleagues record their findings from a meta-analysis of over sixty-thousand study participants in China regarding elevated levels of depression and anxiety, as well as very high reported levels of stress. Their findings further identify that these feelings were particularly elevated in women and health care workers—populations characterized in part by the responsibility (sometimes burden) of caring for others.
In a paper assessing nonpsychotic postpartum mood and anxiety disorders by Stojanov and team, factors are identified that increased the risk of anxiety and helplessness in Serbia during the pandemic. Among the factors that had an effect were being older than 35, single, unemployed, and dissatisfied with household income. The authors appropriately conclude that their findings raise additional considerations for future pandemics and the mental health of postpartum patients, which will also impact the health of their newborn children.
Kandeger, et al. compared patients with COVID-19 to healthy controls in Turkey to assess which factors led to lower scores for depression and anxiety. While positive chest CT findings were associated with increased anxiety, COVID-19 patients benefited from adaptive coping strategies and perceived social support. The authors used numerous validated tools among patients hospitalized during a surge of COVID-19 to draw their conclusions, including the need for further study on whether the beneficial strategies and social support continue their effects as virus numbers decrease and the new normal takes effect.
In a case series of patients with significant psychiatric illness in the United States, Syed and colleagues present 4 cases of patients diagnosed with COVID-19 who developed delirium or worsening of their serious mental illness. Their report highlights the challenges of navigating polypharmacy and patient needs, as well as collaborating with other health team members to strive for optimal patient outcomes. It addresses the ongoing challenge of appropriate placement for care once patients were medically stable and includes the imperative of interprofessional teamwork among primary hospital team members, mental health experts, and nursing staff.
In a sobering paper out of the United Kingdom, Henry, Parthiban, and Farroha present data showing overall Emergency Department visits decreased during a 5–6 week period compared to the year before, while there was a statistically significant increase in self-harm presentations and the total number of drug overdose admissions. While the authors report the demographics of their area, with a modest majority of white residents, their data also showed that the large majority of presentations for self-harm were from white patients, especially men. This finding raises many societal questions and their overall findings speak to the challenges leaders face in protecting populations from emerging infections while being aware of the risk of self-harm by those who might try.
In this truly international issue, the final article assesses the medical education system of twenty countries and what specialties include mental health content in their curriculum. During this pandemic when patients often only went to healthcare appointments that were absolutely necessary (and sometimes only by televisit), the ability to screen and diagnose mental health issues was vitally important, based on the prevalence and findings reported in the first five articles in this issue. Heinze and colleagues show which specialties include mental health training and which specialties (and countries) have the lowest inclusion of psychiatric aspects in their curricula. Their discussion includes the reality that all specialties do not need to treat all psychiatric conditions, but there should be an awareness of the role those conditions play in other diseases being treated. The authors also raise the question of what changes in post-graduate education need to take place to better equip healthcare providers to treat patients with various ailments.
As this issue is published, some parts of the world are undergoing their worst surges of Sar-CoV-2 yet, while in other regions of the world numbers continue to decrease and a return to a new normal is becoming tangible. 2 Undoubtedly, medical knowledge will continue to accumulate on the devastating and disruptive role this virus has had on societies and individual lives. Questions still abound regarding numerous factors—length of immunity, long term COVID-19 effects, the risk of future surges, to name a few. This special issue is step in the right direction and adds to the knowledge of how to help the people we care for, whether it be from the future effects of Sars-CoV-2 or the next pandemic. May we all be better prepared.