Mental Health in times of COVID-19: Policy Brief

Issue The COVID-19 pandemic caused profound disruptive changes worldwide. Mental health (MH) and wellbeing (WB) have been particularly affected, namely with increased levels of anxiety, depression, post-traumatic stress disorder and burnout symptoms. Several factors can have contributed to individuals' vulnerability, including perceived uncertainty, the strict measures adopted, the socioeconomic hardship and the direct effects of the virus. Although the pandemic is primarily a public health and a socioeconomic crisis, it could turn into a serious MH crisis with all the associated implications. Description As a Health Observatory, National Institute of Health Doutor Ricardo Jorge, in collaboration with Institute of Environmental Health of Lisbon School of Medicine, and Portuguese Society of Psychiatry and Mental Health, coordinated an observational study to characterize the MH and WB of general population and health professionals residing in Portugal, during pandemic's first wave. Anxiety, depression, post-traumatic stress disorder, burnout and resilience were selected as main outcomes, measured using validated instruments with sound psychometric properties. Results High levels of psychological distress were observed among general population and health professionals. Women, younger, individuals with lower income or unemployed, lower educational level and frontline health professionals were most susceptible to psychological suffering. The research team produced a Policy Brief with a set of 14 recommendations for immediate action to ensure equal access to psychological and emotional support for all citizens, to reduce the impact of mental disorders and to promote MH. Lessons The mitigation of psychological suffering is of paramount importance, from an equitable perspective focus on identified vulnerable sub-groups. Particular attention should also be given to citizens infected with SARS-CoV-2 and patients with COVID-19, who faced direct consequences of the disease. Key messages In a pandemic context, monitorization of population’s mental health is of paramount importance. Health Observatories should have an active and reinforced role in this public health area to mitigate potential negative impacts of pandemics.

Mental health during the COVID-19 pandemic in Portugal

Background Mental health is being impacted by COVID-19, as a result of both the globalized perception of health risk and the massive social and economic measures, required to control the pandemic. A main goal of this study, the SM-COVID19, was to characterize the mental health of the general population and to identify vulnerable groups, during the first lockdown in Portugal. Methods Cross-sectional online survey, conducted between May 22 and July 20, 2020, with a nationwide non-probabilistic sample of adults residing in Portugal (≥18 years old). Data were collected with sound psychometric scales for symptoms of anxiety, depression and post-traumatic stress disorder (PTSD), work-life balance, resilience, work-related variables, and sociodemographics. Logistic regression models were used to assess risk and protective factors for mental health suffering. Results Overall, 3982 individuals participated in the study (female, 79.1%;mean age, 45.15±12.31 years;71.0% completed higher education studies). The prevalence of symptoms of moderate to severe anxiety was 26.5% (95% Confidence Interval (CI): 24.0-29.1), of depression symptoms was 26.0% (95%CI, 23.6-28.7), and of PTSD symptoms was 26.5% (95%CI, 24.0-29.2). Moreover, more than one third of the respondents (41.2%;95%CI: 38.3-44.1) reported symptomatology for at least one of these three psychiatric disorders. Women, individuals who suspended their professional activity (or in layoff or unemployed) during the lockdown, and those with difficulties in managing work and family demands had higher odds for psychological suffering. Conclusions The COVID-19 pandemic is a public health crisis with major interpersonal, social and economic impacts at the individual level. Mental health and wellbeing are being severely affected, as confirmed by the high prevalence of symptoms of psychological suffering herein. Mental health protection measures need to be defined and implemented, mainly targeting the most vulnerable groups. Key messages COVID-19 pandemic is associated with high prevalence of anxiety, depression and PTSD. Observed mental health inequities imply effective vulnerable-groups-focused mental health promotion programs.