An updated systematic review on the coronavirus pandemic: lessons for psychiatry

Risk stratification always occurs in potentially life-threatening scenarios so that the resources and attention of medical personnel are targeted at more objective goals, such as the infection itself, rather than comorbidities like mental disorders. However, some efforts have been made to address psychological and psychiatric issues during the pandemic. In one such case, on Jan 26, 2020 the National Health Commission of China published (in Chinese only) basic principles for emergency psychological crisis intervention during the COVID-19 outbreak.

We performed a systematic review according to Cochrane group recommendations, and the present report follows PRISMA guidelines. A total of ten articles were included. Every article was either based on (a) describing strategies for coping with the pandemic and/or (b) a more descriptive analysis of the overall clinical scenario, with emphasis in psychiatric comorbidities. Of the ten articles, seven were by Chinese groups,1-7 one was by an American group,8 one was by a Japanese group,9 and one was by a Korean group.10 The main findings are summarized in Table 1.

Table 1. Main findings for psychiatric issues during the COVID-19 pandemic.

Author	Publication date	Published as	Emphasis on	Core idea	Highlights for COVID-19
Asmundson8	March 2020	Editorial	Health anxiety	People with high health anxiety tend to misinterpret benign bodily sensations and changes as dangerous	Anxiety is one of several psychological factors that influence the way any given person responds to a viral outbreak
Tsai5	April 2020	Letter	Homeless people	Homeless patients generally suffer from chronic illnesses or critical conditions, which make them vulnerable	The increased potential exposure of homeless people to COVID-19 may negatively affect their mental and physical health
Yang6	April 2020	Correspondence	Older patients	Older adults are particularly vulnerable to psychiatric symptoms during a pandemic	Rapid viral transmission and high death rates could exacerbate the risk of mental health problems and worsen existing psychiatric symptoms in older adults
Jiang2	February 2020	Original article	Intervention strategies for pandemics	Psychological crisis intervention may help medical workers, patients, and others affected by a pandemic	Efficient methods of psychological crisis intervention must be supported during the outbreak
Xiao3	February 2020	Correspondence	Intervention strategies for pandemics	Structured letter therapy may be a feasible psychological intervention approach in pandemics	Remote written counseling may become a new type of psychological counseling mode in the context of COVID-19
Park10	February 2020	Editorial	Psychiatric comorbidities	Mental health problems in both patients and healthcare workers during a pandemic	The increase in psychiatric conditions (anxiety, mood disorders, and increased feelings of fear, uncertainty, and stigmatization) can be prevented by medical and psychiatric treatment
Kang4	February 2020	Correspondence	Psychiatric comorbidities	Mental health response after a public health emergency	Assessing psychiatric symptoms as well as developing rapid coping strategies are musts during the pandemic
Shigemura9	February 2020	Letter	Psychiatric comorbidities	The mental/physical health consequences of the pandemic and the most vulnerable populations should be focused on	Fear of the unknown raises anxiety levels in healthy individuals as well as those with preexisting mental health conditions
Xiang1	February 2020	Comment	Psychiatric comorbidities	Mental health parallels between COVID-19 and the 2003 outbreak of severe acute respiratory syndrome (SARS)	In any biological disaster, fear, uncertainty, and stigmatization are common and may act as barriers to appropriate medical and mental health interventions
Zhou7	April 2020	Letter	Intervention strategies	The impact of psychological crisis coping strategies	Mental health is crucial for determining better clinical outcomes for both patients and medical staff. The authors highlight self-help interventions and online therapeutic strategies

The main findings highlight the negative emotion and stress experienced by healthcare workers who treat infected patients. The main symptoms included de novo complaints of insomnia, anxiety, and feelings of hopeless, as well as the reactivation of previous disorders, such as depression, anxiety and even suicidal behavior. These mental health problems not only affect patients but also medical workers, which can lead to misunderstandings and poor decision making, and can also hinder the fight against COVID-19, as well as have lasting effects on individual well-being. It was also found that people with health anxiety tend to misinterpret benign bodily sensations and changes as dangerous, which increases hospital visits and, thus, the risk for infection itself. Some authors have focused on specific populations such as the homeless5 and older adults.6

Three important factors for overcoming the main difficulties in clinical practice emerge from reports on the Chinese mental health care response to the COVID-19 outbreak1-7: 1) multidisciplinary mental health teams (including psychiatrists, psychiatric nurses, clinical psychologists, and other mental health professionals) must be established; 2) up-to-date communication with reliable data about the COVID-19 outbreak is necessary; and 3) interventions (mainly psychological counseling) are needed for patients and healthcare providers directly involved in the outbreak (e.g., through electronic devices and apps).

Initial publications have addressed the overall psychological characteristics of patients and healthcare providers, as well as rapidly implemented interventions to cope with this catastrophic life-threatening scenario. Hopefully, the success of such efforts will become clear in the near future.

Disclosure

The authors report no conflicts of interest.