Mental health during the COVID-19 pandemic

From Wikipedia, the free encyclopedia
Jump to navigation Jump to search
See also: Impact of COVID-19 on neurological, psychological and other mental health outcomes
Part of a series on the
COVID-19 pandemic
Scientifically accurate atomic model of the external structure of SARS-CoV-2. Each "ball" is an atom.
Timeline
2019

2020

2021

2022

Locations
By country and territory

By conveyance

International response

National responses

Medical response

Vaccines

Current vaccines

Variants
Variants of concern

'Other variants

Economic impact and recession

By country

Impacts

Society

SARS-CoV-2 (Wikimedia colors).svg COVID-19 portal
The pandemic resulted in spikes in anxiety and depression in the general public.

The COVID-19 pandemic has impacted the mental health of people around the world.[1][2] In 2020 COVID-19 was an unknown. It spread with unprecedented speed across the world, disrupting daily life wherever it appeared. The pandemic has caused widespread anxiety, depression, and post-traumatic stress disorder symptoms.[3][4] The pandemic has damaged social relationships, trust in institutions and in other people, has caused changes in work and income, and has imposed a substantial burden of anxiety and worry on the population.[5] Women and young people face the greatest risk of depression and anxiety.[2][4]

COVID-19 exacerbated problems caused by substance use disorders (SUDs). The pandemic disproportionately affects people with SUD.[6] The health consequences of SUDs (for example, cardiovascular diseases, respiratory diseases, type 2 diabetes, immunosuppression and central nervous system depression, and psychiatric disorders), and the associated environmental challenges (such as housing instability, unemployment, and criminal justice involvement), are associated with an increased risk for contracting COVID-19. Confinement rules, as well as unemployment and fiscal austerity measures during and following the pandemic period, can also affect the illicit drug market and patterns of use among consumers of illicit drugs.

Mitigation measures (i.e. physical distancing, quarantine, and isolation) can worsen loneliness, mental health symptoms, withdrawal symptoms, and psychological trauma.

Causes[edit]

An exhausted anesthesiologist physician in Pesaro, Italy, March 2020
Sign in a gym in Ireland discouraging casual social contact due to the risk of infection. Loss of these kind of interactions has had an impact on many people during the pandemic.

The known causes of mental health issues during the pandemic included fear of infection, stigma associated with infection, isolation (imposed by individuals sheltering on their own or in compliance with lockdowns), and masks. Billions of people shifted to remote work, temporary unemployment, homeschooling or distance education, and lack of physical contact with family members, friends and colleagues.[7]

Unknowns[edit]

As the pandemic began, the risks were uncertain. As sick people flooded into hospitals and official advice evolved, the lack of information increased stress and anxiety.[8] Many uncertainties surrounded the beginning of the pandemic, including estimating infection risk, symptom overlap between COVID-19 and other health problems.[9]

Lack of preparation[edit]

During the first wave of the epidemic, critical supplies were quickly exhausted. The most prominent items were personal protective equipment (PPE) for hospital workers and ventilators for treatment.[8] One study reported that 63.3% of nurses agreed with the statement, “I am worried about inadequate personal protective equipment for healthcare personnel (PPE)”.[10]

Stigma[edit]

As the pandemic began, anyone who interacted with infected people had to address the possibility that they might have been infected themselves and might therefore present an unknown risk to their family and others. In some cases, they were initially stigmatized.[9][11][12]

Isolation[edit]

Many care homes subjected their residents to enforced isolation. They were locked into their rooms around the clock, including at mealtimes when their meals were delivered to their doors. Visitors were not allowed, nor was any socialization among the residents.[13]

Powerlessness[edit]

Nurses worked longer hours during the pandemic, which increasing anxiety in many. Many patients rapidly progressed once in the hospital to the ICU and ultimately, death. The absence of approved therapeutics meant that palliative care (supplemental oxygen, ventilators and extracorporeal membrane oxygenation) were the only options. In some cases, this stimulated frustration and a sense of powerlessness.[14]

Disruption[edit]

Those caring for COVID-19 patients were subject strict biosecurity measures, consigned to wearing gowns, uncomfortable masks and face shields at work. After returning home, many changed clothes before entering and isolated themselves, in an attempt to protect their families. Their jobs demanded constant awareness and vigilance, reduced their autonomy, reduced access to social support, reduced self-care, uncertainty about the effects of long-term exposure to COVID-19 patients, and fear of infecting others.[15][16]

In some jurisdictions, schools were closed during the early months of the pandemic. Such closures increased anxiety, loneliness, stress, sadness, frustration, indiscipline, and hyperactivity among children.[17]

Prevention and management[edit]

Coping with bipolar disorder and other mental health issues during COVID-19 infographic

The Guidelines on Mental Health and Psychosocial Support of the Inter-Agency Standing Committee of the United Nations recommends that mental health support during an emergency "do no harm, promote human rights and equality, use participatory approaches, build on existing resources and capacities, adopt multi-layered interventions and work with integrated support systems."[9]

One author suggested implementing habits that act as "psychological PPE". These habits include healthy eating, healthy coping mechanisms, and practicing mindfulness and relaxation methods.[18]

World Health Organization and Centers for Disease Control guidelines[edit]

WHO and CDC issued guidelines for minimizing mental health issues during the pandemic. The summarized guidelines are:[19][20][21]

For general population[edit]

  • Be empathetic to affected individuals.
  • Use people-first language while describing infected individuals.
  • Minimize watching the news to reduce anxiety. Seek information only from trusted sources, preferably once or twice a day.
  • Protect yourself and be supportive to others.
  • Amplify positive stories of local infected people.
  • Honor healthcare workers who are caring for those with COVID-19.
  • Implement positive thinking.
  • Engage in hobbies.
  • Avoid negative coping strategies, such as avoidance of crowds and pandemic news coverage.

For healthcare workers[edit]

See also: Shortages related to the COVID-19 pandemic § Health workers

What are health care workers experiencing?

  • Feeling pressure is normal in a crisis. Mental health is as important as physical health.
  • Nurses face higher rates of fatigue, sleep problems, depressive disorders, PTSD, and anxiety.
  • Personal Protective Equipment shortages leaving nurses feeling unsafe.
  • Frontline health care works experience higher levels of stress
  • Nurses expressed elevated stress. Hands-on patient care increasresed risk perception. Vaccinated nurses were less fatigued than others.[8] Nurses working with infected patients faced more anxiety, depression, and distress. Non-frontline nurses exhibited less depression.[10]

What actions can healthcare workers take?

  • Adopt coping strategies, get sufficient rest, eat healthy food, be physically active, avoid tobacco, alcohol, or drugs.
  • Stay connected with loved ones, including digitally.
  • Use understandable ways to share messages with people with disabilities.
  • Know how to link people with available resources.
  • Online counseling can reduce the risk of insomnia, anxiety, and depression/burnout.[16]

For team leaders in health facilities[edit]

  • Focus on long-term occupational capacity rather than short term results.
  • Ensure good quality communication and accurate updates.
  • Ensure that staff are aware of mental health resources.
  • Orient staff on how to provide psychological first aid to the affected.
  • Ensure that mental health emergencies are managed in healthcare facilities.
  • Ensure availability of essential psychiatric medications at all levels of health care.
  • Offset feelings of anxiety and depression using strong leadership and clear, honest, and open communication.[22]
  • Use widespread screening to identify workers in need of mental health support.[23]
  • Provide organizational support
  • Facilitate peer support.[23]
  • Rotate work schedules to mitigate stress.[24]
  • Implement interventions tailored to local needs and provide positive, supportive environments.[24]

For child caregivers[edit]

  • Role model healthy behaviors, routines, and coping skills.[25][26][27][28][29][30][31]
  • Use a positive parenting approach based on communication and respect.[27][28][30]
  • Maintain family routines and provide age-appropriate activities to teach children responsibility.[25][29][31][32]
  • Explain COVID-19 and required interventions in age-appropriate ways.[26][27][28][30][31][32][33]
  • Monitor children's social media.[25][28][32]
  • Validate children's thoughts and feelings and help them find positive ways to express emotions.[28][31]
  • Avoid separating children from their parents/caregivers as much as possible. Ensure regular contact with parents and caregivers, for children in isolation.[25][33][34]

For older adults, people with underlying health conditions, and their caregivers[edit]

  • Older adults, those especially in isolation or suffering from pre-existing conditions, may become more anxious, angry, or withdrawn. Provide practical and emotional support through caregivers and healthcare professionals.
  • Share facts on the crisis and give clear information about how to reduce infection risk.
  • Maintain access to current medications.
  • Find out in advance where and how to get practical help.
  • Learn and perform daily home exercises.
  • Keep regular schedules.
  • Keep in touch with loved ones.
  • Continue hobbies or regular tasks.
  • Talk on the phone or online or do a fun online activity with others.
  • Help your community, e.g., by providing food/meals to others.

For people in isolation[edit]

  • Stay connected and maintain social networks.
  • Pay attention to your needs and feelings. Engage in relaxing activities.
  • Avoid listening to rumors.
  • Begin new activities.
  • Maintain routines.

CDC stated that citizens should "try to do enjoyable activities and return to normal life as much as possible" during a crisis.[35] A peer-reviewed study published in 2021 suggests that playing video games may have a positive effect on players' mental health and well-being, providing opportunities for socialization and connection.[36]

Countries[edit]

China[edit]

A psychological intervention plan was developed by the Second Xiangya Hospital, the Institute of Mental Health, the Medical Psychology Research Center of the Second Xiangya Hospital, and the Chinese Medical and Psychological Disease Clinical Medicine Research Center. It focused on building an intervention medical team to provide online courses for medical staff, a hotline team, and interventions.[37] Online education and counselling services were created for social media platforms such as WeChat, Weibo, and TikTok. Printed books about mental health and COVID-19 were republished online. Free electronic copies were available through the Chinese Association for Mental Health.[38]

United States[edit]

The government loosened Health Insurance Portability and Accountability Act (HIPAA) regulations through a limited waiver. It allowed clinicians to evaluate and treat individuals though video chatting services that were not previously permitted, allowing patients to receive remote care.[39] On October 5, 2020, President Donald Trump issued an executive order to address mental and behavioral health issues, establishing a Coronavirus Mental Health Working Group.[40] In the executive order, he cited a CDC report that found that during June 24–30, 2020, 40.9% of more than 5,000 Americans reported at least one adverse mental or behavioral health condition, and 10.7% had seriously considered suicide during the month preceding the survey.[41] On 9 November 2020, a study reported findings from an electronic health record network cohort study using data from nearly 70 million individuals, including 62,354 individuals.[42] Nearly 20% of COVID-19 survivors were diagnosed with a psychiatric condition between 14 and 90 days after diagnosis, including 5.8% first-time psychiatric diagnoses. Among patients without previous psychiatric history, patients hospitalized for COVID-19 had increased incidence of a first psychiatric diagnosis compared to other health events analyzed. Together, these findings suggest that COVID-19 may increase psychiatric sequelae, and those with pre-existing psychiatric conditions may be at increased risk for COVID-19.[43]

Impacts[edit]

Individuals with mental health disorders[edit]

Obsessive–compulsive disorder[edit]

Individuals with obsessive–compulsive disorder (OCD), may face worsened long-term consequences.[44][45] Fears regarding infection and public health tips calling for hand-washing and sterilization triggered related compulsions in some OCD sufferers.[46][47][48] Amid guidelines of social-distancing, quarantine, and feelings of separation, some sufferers experienced more intrusive thoughts, unrelated to contamination obsessions.[49][50]

Post-traumatic stress disorder[edit]

Healthcare workers and COVID–19 patients both experienced higher risk of experiencing PTSD-like symptoms. In late March 2020, researchers in China found that, based on a PTSD checklist questionnaire provided to 714 discharged patients, 96.2% had serious PTSD symptoms. Another study reported a significant increase in PTSD symptoms and diagnosis among nurses who regularly care for COVID-19 patients.[51][52]

Anxiety and depression[edit]

Many nurses reported increased anxiety.[14] Cases of anxiety and depression within healthcare workers who interact with increased by 1.57% and 1.52% respectively.[53] If untreated, anxiety and depression can lead to more severe mental and physical health outcomes.[52]

Children[edit]

See also: Impact of the COVID-19 pandemic on domestic violence

On October 19, 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association declared a “national emergency" for children's mental health.[54]

One study reported that many children who were separated from caregivers during the pandemic experienced a crisis. Children who were isolated or quarantined during past pandemics were more likely to develop acute stress disorders, adjustment disorders and experience grief, with 30% of children meeting the clinical criteria for PTSD.[55] A meta-analysis of 15 studies performed reported that 79.4% of children and teenagers suffered negative consequences: 42.3% were irritable, 41.7% had symptoms of depression, 34.5% struggled with anxiety, and 30.8% had problems with inattention. Many young people struggled with boredom, fear, and sleep problems.[28]

A collection of 29 studies posted in August 2021 by Jamanetwork[56] showed that the prevalence of symptoms of depression and anxiety had doubled during COVID-19. They had also found that older adolescents were affected more and it was the most prevalent in girls.

In an October 2020 global study, negative emotions experienced by students included boredom (45.2%), anxiety (39.8%), frustration (39.1%), anger (25.9%), hopelessness (18.8%), and shame (10.0%). The highest levels of anxiety were found in South America (65.7%) and Oceania (64.4%), followed by North America (55.8%) and Europe (48.7%). The least anxious were students from Africa (38.1%) and Asia (32.7%). A similar order of continents was found for frustration.[57]

School closures caused anxiety for students with special needs as daily routines are disrupted and therapy and social skill groups halted. Others who incorporated school routines into their coping mechanisms experienced an increase in depression and difficulty in readjusting to normal routines. Closures limited mental health service availability, along with educators' ability to identify at-risk youth.[39]

Post-traumatic stress disorder[edit]

Studies from previous years and epidemics reported that children who were isolated were much more likely to develop PTSD.[29][32] PTSD in children can have long-term consequences on brain development and affected kids are more likely to develop psychiatric disorders.[26][30][31]

Autism spectrum disorder[edit]

Pandemic lockdowns impacted mental health outcomes for children with special needs, creating challenges including the lack of understanding about the pandemic and the ability to complete school work.[31] Children on the autism spectrum were more likely to become agitated by the changing environment.[31]

Attention deficit/hyperactivity disorder[edit]

Adolescents and children with attention deficit hyperactivity disorder (ADHD) struggled with staying confined in only one space, creating difficulties for caregivers to find activities that were engaging/meaningful to them.[31]

Students[edit]

A infographic students can use to stay connected to better their mental health

The pandemic impacted students directly due to infection and indirectly through the mitigation efforts.[58] The non academic support and essential services like health and mental health resources schools provide for their students are necessary factors that positively contribute to student's emotional, social, and physical well-being.[59] Long term school closures and limited resources caused by the COVID-19 pandemic resulted in adverse mental health affects for students of all ages.[58]

K-12

In a recent survey researchers found that 38% of K-12 students are more concerned with their well-being, 51% report being more stressed, and 39% feel lonelier. The CDC reported that from March 2020 to October 2020, the number of mental health-related hospital emergency department visits rose 24% for children ages 5 to 11 and 31% for students ages 12 to 17.[60] This is an increasing concern for mental health professionals around the world as they emphasize the importance of mental health issues being identified and treated early because they tend to begin in one's childhood. Schools also have been able to play the role of a safety net in many cases where adults look out for the mental health status of their students. In schools teachers and adults are able to be on the look out and recognize physical/emotional distress, signs of physical abuse, and/or sudden significant or subtle changes in behavior.[61] Should they recognize any apparent disruptions, teachers are able to intervene and provide their students with the necessary resources to help them.[61] However, during the COVID-19 pandemic, with students and teachers out, this system has not been in place.

As COVID-19 mitigation efforts began to ease up and students return to the classroom, teachers have noticed an increase in crying and disruptive behavior in this population of students and also increased occurrences in violence and bullying.[62] Mental health professionals call for schools and education institutions everywhere to implement a number of health promotion programs in their schools that may teach students how to prevent succumbing to adverse mental health issues and how to cope with the reality and continuing effects of COVID-19 so that it does not get in the way of their education and future endeavours.[63]

Higher Education[edit]

The Higher Education Policy Institute conducted a study that reported that 63% of students claimed that their mental health had worsened, and that 38% demonstrated satisfaction with the mental health service access.[64] Physical harm such as overdose, suicide and substance abuse reached an all-time high. Academic stress, dissatisfaction with the quality of teaching and fear of infection were associated with higher depression scores.[58] Higher scores were also associated with frustration and boredom, inadequate resources, inadequate information, insufficient financial resources and perceived stigma.[58]

Involvement in a steady relationship and living with others were associated with lower depressive scores.[58] Research reported that psychological stress following strict confinement was moderated by levels of the pre-pandemic stress hormone cortisol and individual coping skills. Stay-at-home orders that worsened self-reports of stress also increased cognitive abilities including perspective taking and working memory.[65] However, that greater emotion regulation (measured pre-pandemic) was associated with lower acute stress (measured by the Impact of Event Scale-Revised) in response to the early pandemic in the US during lockdown.[66]

Isolation from others and lack of contact with mental health services worsened symptoms. The specific level of impact on students reflected their demographic backgrounds: students from low-income households and students of color experienced greater mental health and academic impacts. Students who struggle with mental health also struggled academically.[67] Students from high-income households and those in successful school districts were more likely to have to mental health (and other) resources.[68]

Those already living with psychopathology were more vulnerable to experience heightened levels of distress during lockdown measures.[69] Specifically, researchers saw an increase in the amount of eating disorders related vulnerabilities.[70] Social isolation that accompanies lockdown and stay at home measures for many resulted in a decrease in physical movement and activity, an increased amount of food in the home, and an increased time spent with a screen. There was an increase of 10% of student's perception of their body and the description of their weight as a risk factor for acquiring an eating disorder and exhibiting symptoms during the months between January 2020 and April 2020.[70]

Studies showed that although college students are not resulting to have significant increases in their BMI, the rates in which college students are concerned about gaining weight and subsequent increases in their BMI have significantly increased.[70]

Essential workers[edit]

Key workers did not shift to remote work[71] despite low availability of PPE and while risks from the virus were undetermined. These workers earn modest wages on average and are more likely to be racial/ethnic minorities.[72]

Low income workers[edit]

Fewer than 5% of US workers without a high school diploma were remote workers during the COVID-19 pandemic. Only 7% of US service workers, the majority of whom were low-wage customer-facing workers, could use remote work. Service industry workers were the least likely to get compensated for time off. The pandemic's nationwide economic implications resulted in business closures and record unemployment rates. Low-wage and part-time workers were those most likely to be unemployed and people of color (especially women) had disproportionate job losses compared to the general population.[73]

Healthcare workers[edit]

Before COVID-19, healthcare workers already faced many stressors, including health risks, the possibility of infecting their household, and the stress of working with extermely sick patients. COVID-19's physical and emotional burden impacted healthcare workers increased rates of anxiety, depression, and burnout that impacted sleep, quality work/empathy towards patients, and suicide rates.[74]

Cases of anxiety and depression within healthcare workers who interact with COVID-19 patients increased by 1.57% and 1.52% respectively.[53][14]

One study reported that frontline nurses experience higher rates of anxiety, emotional exhaustion, depression, and post-traumatic stress disorder.[8]

A cross-sectional study using an online survey in Southern California examined stress levels before and during the pandemic. The study used the 10-item Perceived Stress Scale (PSS) and the Connor-Davidson Resilience Scale to assess psychological stress and resilience in nurses. The experiment concluded that nurses reported feeling moderate and high levels of stress compared to before the pandemic.[75]

A five-part questionnaire conducted among healthcare workers in Ghana to examine the correlation between COVID-19 and mental health. The questionnaire classified participant fears as "none", "mild", "moderate", and "extreme". Participants also answered and ranked questions about depression using the Depression Anxiety Stress Scale (DASS). Because the DASS-21 assessment is split up into three categories, (Depression, Anxiety and Stress), participants provided three numbers, one for each category. The fourth part assessed whether participants perceived that they were provided with a good psychological environment. The fifth part assessed coping success. Over 40% of health staff reported mild to extreme fear. Depression ranked highest with 16%. However, only 30% received their salary, and only 40% were insured in case of infection. 42% of respondents in Ghana proved that their hospitals do not provide sufficient protective equipment.[76]

A South African study showed no difference in anxiety or depression among healthcare workers compared to the general population.[77]

Hospitals in China such as The Second Xiangya Hospital (Psychology Research Center), and the Chinese Medical and Psychological Disease Clinical Medicine Research Center noticed signs of psychological distress and set up a plan to help struggling staff. They suggested coping strategies for stress, a hotline, and education. Healthcare workers stated that all they needed was uninterrupted rest as well as more supplies. Moreover, medical staff in China agreed to use psychologists’ skills to help them deal with distressed patients. They suggested having mental health specialists ready when a patient becomes emotionally distressed.[78]

Initially, healthcare workers experienced fear over possible exposure.[79][80] This fear correlated to significant mental health declines amongst nurses.[81]

Increased patient workloads contributed to mental health impacts. Patient counts in hospitals increased during seasonal waves, sometimes overloading hospitals. A majority of medical professionals experienced higher patient workloads. Limitations on family visitation increased staff demands.

Anxiety in healthcare workers rose. Anxiety directly correlates with worker performance. One study reported that 13% of COVID nurses and 16% of other COVID healthcare workers reported severe anxiety.[82] Another study surveyed workers in March 2020 and again in May and reported that psychological distress and anxiety had increased.[83] Other studies reported that the pandemic had led at least one in five healthcare professionals to report symptoms of anxiety.[84] Specifically, anxiety was assessed in 12 studies, with a pooled prevalence of 23.2%.[84]

One study reported that things changed drastically in a couple of months after the pandemic began.[22] It found thatthe prevalence rates of post-COVID anxiety were about 32%. Participants with moderate to extremely severe anxiety made up 26% of the sample.[22] Individuals who worked during the pandemic reported higher rates of anxiety. In another study, 42% of patient care respondents had significantly more anxiety than providers who did not care directly for patients.[15]

Increased depression and burnout were observed in healthcare workers. In one study more than 28% of the sample reported high levels of emotional exhaustion.[82] More than 50% of the sample reported low levels of depersonalization, except for COVID nurses and physicians, 37% of whom reported depersonalization.[82] Another study reported that the prevalence rates of depression were as high as 22% and that extremely severe depression occurred in 13%.[22]

In a cross-sectional survey, a high percentage of the nurses surveyed reported high stress levels and/or PTSD symptoms.[85] Eight major themes were identified:[85]

  • working in an isolated environment
  • PPE shortage and the discomfort of pronged usage
  • sleep problems
  • intensity of workload
  • cultural and language barriers
  • lack of family support
  • fear of being infected
  • insufficient work experiences with COVID-19.

Many of these concerns are related to the pandemic. Healthcare understaffing not only affects patient health but can rebound against healthcare workers. A study found that 70+% of doctors and nurses perceived moderate-to-severe stress.[86] The study reported that direct dealing with COVID-19 patients significantly increases stress. Without intervention the nursing staff and patients would struggle.

Asian Americans[edit]

Hate crimes targeted towards Asians rose nearly 150% across major U.S. cities from 2019 to 2020.[87] As the pandemic progressed, about 40% of Asian and Black Americans reported feeling people act uncomfortable around them.[88] The harassment against those of Asian descent ranges in its forms; these include both verbal and physical attacks, and even acts of vandalism.[89] Some attest the increase in attack rates to the negative expressions used by President Donald Trump, an example of this being when he referred to the COVID-19 virus as "kung flu."[90]

Asian Americans disproportionately hold positions as high-risk essential workers, and many regions heavily affected by COVID-19 have an abundance of Asian-owned businesses.[91] Suggestions for aiding in the support of Asian Americans throughout this time include ensuring Asian inclusion in businesses, preventing the use of Anti-Asian rhetoric, and encouraging a dialogue that accounts for the acknowledgement of Asian American treatment and support throughout this time.[91]

Suicides[edit]

The pandemic triggered concern over increased suicides, caused by social isolation due to quarantine and social-distancing guidelines, fear, and unemployment and financial factors.[92][93] A 2020 study reported that suicide rates were either the same or lower than before the pandemic began, especially in higher income countries, as often happens in crises.[94]

The number of crisis hotlines calls increased, and some countries established new hotlines. For example, Ireland launched a new hotline aimed at older generations that received around 16,000 calls in its first month in March 2020.[95] The Kids Helpline in the Australian state of Victoria reported a 184% increase in calls from suicidal teenagers between early December 2020 and late May 2021.[96]

A March 2020 survey of over 700,000 people in the UK reported that 1 in 10 people had suicidal thoughts as a result of lockdown. Charities such as the Martin Gallier Project[97] as of November 2020 had intervened in 1,024 suicides during the pandemic.[98]

Suicide cases remained constant or decreased, although the best evidence is often delayed.[99] According to a study conducted on twenty-one high and upper-middle-income countries in April–July 2020, the number of suicides remained static.[100] These results were attributed to factors, including the composition of mental health support, financial assistance, family/community support, use of technology to connect, and time spent with family members. Despite this, isolation, fear, stigma, abuse, and economic fallout increased.[101] Self-reported levels of depression, anxiety, and suicidal thoughts were elevated during lockdown, according to evidence from several countries, but did not appear to have increased suicides.[100]

According to CDC surveys conducted in June 2020, 10.7 percent of adults aged 18 and up said they had seriously considered suicide in the previous 30 days. They ranged in age from 18 to 24 and were classified as members of minority racial/ethnic groups, unpaid caregivers, and essential workers.[41]

Few studies have been conducted to examine suicides in low- and lower-middle-income countries. WHO stated, “in 2016, low- and middle-income countries accounted for 79 percent of global suicides.” This is because of registration system limitations, and lack of real-time suicide data.[100]

Middle income Myanmar and Tunisia were studied along with low-income Malawi. The study reported that, “In Malawi, there was reportedly a 57% increase in January–August 2020, compared with January–August 2019, and in Tunisia, there was a 5% increase in March–May 2020, compared with March–May, 2019. By contrast, in Myanmar, there was a 2% decrease in January–June 2020, compared with January–June 2019.”[100]

Factors[edit]

Damage to the economy is associated with higher suicide rates. The pandemic put many businesses on hold, led to reduced employment, and triggered a major stock market drop.[102]

Stigma is a primary cause. Frontline workers, the elderly, the homeless, migrants, and daily wage workers were more vulnerable.[101] Stigma led to reported suicides in infected individuals in Bangladesh and India.[103]

China[edit]

Studies reported that the outbreak had a significant impact on mental health, with an increase in health anxiety, acute stress reactions, adjustment disorders, depression, panic attacks, and insomnia. Relapses and increased hospitalization rates are occurring in cases of severe mental disorders, obsessive-compulsive disorder, and anxiety disorders. All of which increase suicide risks.[101] National surveys in China (and Italy) revealed a high prevalence of depression and anxiety, both of which increase suicide risks.[101]

One Shanghai district reported 14 cases of suicides among primary and secondary school students as of June 2020, more than annual averages.[104] Domestic media reported additional suicides by young people even though topics like suicide are usually avoided in Chinese society.[104]

Fiji[edit]

In September 2021, mental health organizations and an advisor to the government urged the government to address suicide prevention, although suicides in 2020 were lower than in 2019, as they warned that Fiji was beginning to suffer from a "mental health epidemic."[105]

India[edit]

Alcohol bans reportedly led to suicides in India.[106]

Japan[edit]

One study reported that people had been influenced by anxiety- and trauma-related disorders and by adverse societal dynamics relating to work and PPE shortages.[107]

Overall, suicide rates in Japan appeared to decrease 20% at the beginning, partly offset by a rise in August 2020.[94]

Counseling helplines by telephone or text message are provided by many organizations.[108]

On September 20, 2020, Sankei Shimbun reported that the month of July and August saw more suicides than in the previous year due to the pandemic's economic impact. Estimates for suicide deaths include a 7.7% increase or a 15.1% increase in August 2020, compared to August 2019.[94] Sankei Shimbun further reported that rates increased more among women, with the month of August seeing a 40.1% increase in suicide compared to August 2019.[109]

United States[edit]

As of November 2020, the rate of deaths from suicide appeared to be unchanged in the US.[94] In Clark County, Nevada, 18 high school students committed suicide over nine months of school closures.[110] In March 2020, the federal crisis hotline, Disaster Distress Helpline, received a 338% increase in calls compared to February and an 891% increase in calls compared to March 2019.[111] Suicide rates increased for African Americans.[112]

Lockdowns[edit]

An infographic from the World Health Organization showing statistics related to the impact of COVID-19 on mental health

COVID-19 lockdowns were first used in China and later worldwide by national and state governments.[113] Most workplaces, schools, and public places were closed. Lockdowns closed most mental health centers. Patients who already had mental health disorders may have worsened symptoms.[114] One study reported five major stressors during lockdown: its duration, fear of infection, feelings of frustration and boredom, worries of inadequate supplies, and lack of information.[58]

South Africa[edit]

South Africa implemented a strict lockdown on 26 March 2020 that lasted until 1 June. Of the 860 respondents to an online questionnaire in May 2020, 46% met the diagnostic criteria of anxiety disorder and 47% met the diagnostic criteria of depressive disorder.[77] The participants who met these criteria reported substantial daily life repercussions, but fewer than 20% consulted a formal practitioner.[77] Distress over lockdown and fear of infection were associated with anxiety and depressive symptoms. Pre-existing mental health conditions, younger age, female sex, and living in a non-rural area were associated with more anxiety and depressive symptoms.[77]

Japan[edit]

In July 2020, Japan was in "mild lockdown", which was not enforced and was non-punitive.[115] A study of 11,333 individuals across Japan were asked to evaluate the impact of a one-month lockdown, answering questions related to lifestyle, stress management, and stressors. It suggested that psychological distress indices significantly correlated with items relating to COVID-19.[116]

Italy[edit]

Italy was the first country to enter a nationwide lockdown. According to a questionnaire, 21% of participants reported moderate to extremely high depression, while 19% reported moderate to extremely high anxiety.[117] Moreover, about 41% reported poor sleep before the lockdown, increasing to 52% during the lockdown. A cross-sectional study of 1,826 Italian adults confirmed the lockdown's impact on sleep quality, which was especially prevalent among females, those less educated, and those who experienced financial problems.[118]

Spain[edit]

Spain's outbreak started at the end of February.[119] On March 14, 2020, the Spanish Government declared the state of alarm to limit viral transmission.[120] However, by 9 April Spain reported the second highest rate of confirmed cases and deaths. 36% of participants reported moderate to severe psychological impact, 25% showed mild to severe levels of anxiety, 41% reported depressive symptoms, and 41% felt stressed.[121] A longitudinal study collected data pre-pandemic and during confinement. It reported direct and indirect effects of pre-pandemic cortisol on the changes in self-reported, perceived self-efficacy during confinement. The indirect effects were mediated by increases in working memory span and cognitive empathy.[65]

Vietnam[edit]

As of January 2021, Vietnam had largely returned to everyday life. The government employed effective communication, early development of test kits, contact tracing, and containment based upon epidemiological risk rather than symptoms. By appealing to universal Vietnamese values such as tam giao (Three Teachings), the Vietnamese government encouraged a culture that values public health.[122] However, Vietnamese patients quarantining reported psychological strain associated with the stigma of sickness, financial constraints, and guilt from contracting the virus. Frontline healthcare workers at Bach Mai Hospital in Hanoi who quarantined for greater than three weeks reported comparatively poorer self-image and general attitude when compared to shorter term isolees.[123]

United Kingdom[edit]

A 2022 study assessed the levels of mental wellbeing and potential for clinical need in a sample of UK university students aged 18–25 during the COVID-19 pandemic. Study has found "higher levels of lockdown severity were prospectively associated with higher levels of depressive symptoms. Nearly all students had at least one mental wellbeing concern at either time point." The results suggest that lockdown has caused "a wellbeing crisis in young people."[124]

Mental health aftercare[edit]

Academics theorized that once the pandemic stabilizes or ends, supervisors should allow time for first responders, essential workers, and the general population to reflect and create a meaningful narrative rather than focusing on the trauma. The National Institute for Health and Care Excellence recommended active monitoring of staff for issues such as PTSD, moral injuries, and other associated mental illness.[125] Delivering mental health services through telehealth became common.[126][127][128] Telehealth visits increased by 154% in the final week of March 2020, which is also when the pandemic resulted in many policy changes involving seeking medical care.[129] The benefits of telehealth include accessibility, increased safety due to less in-person contact, and reducing the use of scarce personal protective equipment.[129] The role of telehealth in lowering fatality rates and preventing increased presence in high-risk areas such as hospitals was generally significant.[130]

A recent study of COVID-19 and Open Notes reports promising evidence of patients’ benefits when reading their clinical notes online from mental health care.[131] When patients read their clinical notes from mental health care, they report an increased understanding of their mental health, feeling in control of their care, and enhancing trust in their clinician. Patients’ are also reported to get feelings of greater validation, engagement, remembering their care plan, and acquiring a better awareness of potential side effects of their medications.[131][132][133][134][135][136][137] “Open notes do not offer a magic solution to the challenges of the pandemic, but by partnering with patients and families, through an invitation to read notes and be on the same page as their clinicians, it may offer an important new strategy to improve engagement, increase trust, and demonstrate respect for patients” (Blease et al., 2021[131]).

Long-term consequences[edit]

According to the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support, the pandemic produced long-term consequences. Deterioration of social networks and economies, survivor stigma, anger and aggression, and mistrust of official information are long-term consequences.[9]

While some consequences reflect realistic dangers, but other stem from lack of knowledge.[138] Many community members show altruism and cooperation in a crisis, and some experience satisfaction from helping others.[139] Some may have positive experiences, such as pride about coping. One study examined how individuals cope and find meaning across 30 countries.[140] The study reported that people who were able to reframe their experiences in a positive way had lower levels of depression, anxiety, and stress. Gender, socioeconomic factors, physical health, and country of origin were not associated with outcome measures. Another study of nearly 10,000 participants from 78 countries found similar results, with 40% reporting well-being.[141] Another study reported that positive stressor reframing allowed individuals to view the adversity as a growth opportunity, rather than a crisis to be avoided.[140]

Once recovered from COVID-19, many will continue to experience long-term effects of the virus. Of these effects may include a lost or lessened sense of taste and smell, which is a result of the virus affecting cells in the nose. While this symptom is not fatal, an absence of these senses for a prolonged amount of time can cause lack of appetite, anxiety, and depression.[142] Those admitted to the ICU while battling their direct infection of the COVID-19 virus experience mental health consequences as a result of this stay, including PTSD, anxiety, and depression.[143]

See also[edit]

References[edit]

  1. ^ CDC (11 February 2020). "Coronavirus Disease 2019 (COVID-19)". Centers for Disease Control and Prevention. Retrieved 17 May 2020.
  2. ^ a b Stix G. "Pandemic Year 1 Saw a Dramatic Global Rise in Anxiety and Depression". Scientific American. Retrieved 10 October 2021.
  3. ^ Luo Y, Chua CR, Xiong Z, Ho RC, Ho CS (23 November 2020). "A Systematic Review of the Impact of Viral Respiratory Epidemics on Mental Health: An Implication on the Coronavirus Disease 2019 Pandemic". Frontiers in Psychiatry. 11: 565098. doi:10.3389/fpsyt.2020.565098. PMC 7719673. PMID 33329106.
  4. ^ a b Santomauro DF, Herrera AM, Shadid J, Zheng P, Ashbaugh C, Pigott DM, et al. (November 2021). "Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic". Lancet. 398 (10312): 1700–1712. doi:10.1016/S0140-6736(21)02143-7. PMC 8500697. PMID 34634250. S2CID 238478261.
  5. ^ "OECD". read.oecd-ilibrary.org. Retrieved 7 May 2020.
  6. ^ Jemberie WB, Stewart Williams J, Eriksson M, Grönlund AS, Ng N, Blom Nilsson M, et al. (21 July 2020). "Substance Use Disorders and COVID-19: Multi-Faceted Problems Which Require Multi-Pronged Solutions". Frontiers in Psychiatry. 11: 714. doi:10.3389/fpsyt.2020.00714. PMC 7396653. PMID 32848907. S2CID 220651117.
  7. ^ "The Effects of Working From Home: How to Cope With the New Normal?".
  8. ^ a b c d Labrague LJ (October 2021). "Pandemic fatigue and clinical nurses' mental health, sleep quality and job contentment during the covid-19 pandemic: The mediating role of resilience". Journal of Nursing Management. 29 (7): 1992–2001. doi:10.1111/jonm.13383. PMC 8237073. PMID 34018270.
  9. ^ a b c d "Inter-Agency Standing Committee Guidelines on Mental Health and Psychosocial support" (PDF). MH Innovation. Archived (PDF) from the original on 31 March 2020. Retrieved 28 March 2020.
  10. ^ a b Kamberi F, Sinaj E, Jaho J, Subashi B, Sinanaj G, Jaupaj K, et al. (October 2021). "Impact of COVID-19 pandemic on mental health, risk perception and coping strategies among health care workers in Albania - evidence that needs attention". Clinical Epidemiology and Global Health. 12: 100824. doi:10.1016/j.cegh.2021.100824. PMC 8567021. PMID 34751254. S2CID 237014324.
  11. ^ "ICN COVID-19 Update: New guidance on mental health and psychosocial support will help to alleviate effects of stress on hard-pressed staff". ICN - International Council of Nurses. Archived from the original on 28 March 2020. Retrieved 28 March 2020.
  12. ^ "Emergency Responders: Tips for taking care of yourself". emergency.cdc.gov. 10 January 2020. Archived from the original on 27 March 2020. Retrieved 28 March 2020.
  13. ^ Leary JE. "Managing the Impact of Isolation in Nursing Homes Due to COVID-19 | HealthCity". healthcity.bmc.org. Retrieved 25 January 2022.
  14. ^ a b c Cho M, Kim O, Pang Y, Kim B, Jeong H, Lee J, et al. (June 2021). "Factors affecting frontline Korean nurses' mental health during the COVID-19 pandemic". International Nursing Review. 68 (2): 256–265. doi:10.1111/inr.12679. PMC 8251381. PMID 33894067.
  15. ^ a b Wu PE, Styra R, Gold WL (April 2020). "Mitigating the psychological effects of COVID-19 on health care workers". CMAJ. 192 (17): E459–E460. doi:10.1503/cmaj.200519. PMC 7207194. PMID 32295761.
  16. ^ a b Spoorthy MS, Pratapa SK, Mahant S (June 2020). "Mental health problems faced by healthcare workers due to the COVID-19 pandemic-A review". Asian Journal of Psychiatry. 51: 102119. doi:10.1016/j.ajp.2020.102119. PMC 7175897. PMID 32339895.
  17. ^ "CG REPORT 3: The Impact of Pandemic Restrictions on Childhood Mental Health". Collateral Global. Retrieved 27 January 2022.
  18. ^ "The Use of Psychological PPE in the Face of - ProQuest". www.proquest.com. ProQuest 2451175792. Retrieved 23 January 2022.
  19. ^ "Mental health and psychosocial considerations during the COVID-19 outbreak" (PDF). World Health Organization. Archived (PDF) from the original on 26 March 2020. Retrieved 28 March 2020.
  20. ^ "Coronavirus Disease 2019 (COVID-19)". Centers for Disease Control and Prevention. 11 February 2020. Archived from the original on 29 March 2020. Retrieved 28 March 2020.
  21. ^ Chew QH, Wei KC, Vasoo S, Sim K (October 2020). "Psychological and Coping Responses of Health Care Workers Toward Emerging Infectious Disease Outbreaks: A Rapid Review and Practical Implications for the COVID-19 Pandemic". The Journal of Clinical Psychiatry. 81 (6). doi:10.4088/JCP.20r13450. PMID 33084255. S2CID 224825968.
  22. ^ a b c d Woon LS, Sidi H, Nik Jaafar NR, Leong Bin Abdullah MF (December 2020). "Mental Health Status of University Healthcare Workers during the COVID-19 Pandemic: A Post-Movement Lockdown Assessment". International Journal of Environmental Research and Public Health. 17 (24): 9155. doi:10.3390/ijerph17249155. PMC 7762588. PMID 33302410.
  23. ^ a b Stuijfzand S, Deforges C, Sandoz V, Sajin CT, Jaques C, Elmers J, Horsch A (August 2020). "Psychological impact of an epidemic/pandemic on the mental health of healthcare professionals: a rapid review". BMC Public Health. 20 (1): 1230. doi:10.1186/s12889-020-09322-z. PMC 7422454. PMID 32787815.
  24. ^ a b Zaçe D, Hoxhaj I, Orfino A, Viteritti AM, Janiri L, Di Pietro ML (April 2021). "Interventions to address mental health issues in healthcare workers during infectious disease outbreaks: A systematic review". Journal of Psychiatric Research. 136: 319–333. doi:10.1016/j.jpsychires.2021.02.019. PMC 7880838. PMID 33636688.
  25. ^ a b c d Ghosh R, Dubey MJ, Chatterjee S, Dubey S (June 2020). "Impact of COVID -19 on children: special focus on the psychosocial aspect". Minerva Pediatrica. 72 (3): 226–235. doi:10.23736/s0026-4946.20.05887-9. PMID 32613821. S2CID 220307198.
  26. ^ a b c Guessoum SB, Lachal J, Radjack R, Carretier E, Minassian S, Benoit L, Moro MR (September 2020). "Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown". Psychiatry Research. 291: 113264. doi:10.1016/j.psychres.2020.113264. PMC 7323662. PMID 32622172.
  27. ^ a b c Imran N, Aamer I, Sharif MI, Bodla ZH, Naveed S (26 June 2020). "Psychological burden of quarantine in children and adolescents: A rapid systematic review and proposed solutions". Pakistan Journal of Medical Sciences. 36 (5): 1106–1116. doi:10.12669/pjms.36.5.3088. PMC 7372688. PMID 32704298.
  28. ^ a b c d e f Panda PK, Gupta J, Chowdhury SR, Kumar R, Meena AK, Madaan P, et al. (January 2021). "Psychological and Behavioral Impact of Lockdown and Quarantine Measures for COVID-19 Pandemic on Children, Adolescents and Caregivers: A Systematic Review and Meta-Analysis". Journal of Tropical Pediatrics. 67 (1). doi:10.1093/tropej/fmaa122. PMC 7798512. PMID 33367907.
  29. ^ a b c Sethy M, Mishra R (September 2020). "An Integrated Approach to Deal with Mental Health Issues of Children and Adolescent during COVID-19 Pandemic". Journal of Clinical and Diagnostic Research. 14 (9). doi:10.7860/jcdr/2020/45418.14002. ISSN 2249-782X.
  30. ^ a b c d Shah K, Mann S, Singh R, Bangar R, Kulkarni R (August 2020). "Impact of COVID-19 on the Mental Health of Children and Adolescents". Cureus. 12 (8): e10051. doi:10.7759/cureus.10051. PMC 7520396. PMID 32999774.
  31. ^ a b c d e f g h Singh S, Roy D, Sinha K, Parveen S, Sharma G, Joshi G (November 2020). "Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations". Psychiatry Research. 293: 113429. doi:10.1016/j.psychres.2020.113429. PMC 7444649. PMID 32882598.
  32. ^ a b c d Pedrosa AL, Bitencourt L, Fróes AC, Cazumbá ML, Campos RG, de Brito SB, Simões E, Silva AC (2020). "Emotional, Behavioral, and Psychological Impact of the COVID-19 Pandemic". Frontiers in Psychology. 11: 566212. doi:10.3389/fpsyg.2020.566212. PMC 7561666. PMID 33117234.
  33. ^ a b Fegert JM, Vitiello B, Plener PL, Clemens V (12 May 2020). "Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality". Child and Adolescent Psychiatry and Mental Health. 14 (1): 20. doi:10.1186/s13034-020-00329-3. PMC 7216870. PMID 32419840.
  34. ^ Marques de Miranda D, da Silva Athanasio B, Sena Oliveira AC, Simoes-E-Silva AC (December 2020). "How is COVID-19 pandemic impacting mental health of children and adolescents?". International Journal of Disaster Risk Reduction. 51: 101845. doi:10.1016/j.ijdrr.2020.101845. PMC 7481176. PMID 32929399.
  35. ^ "Coping with a Disaster or Traumatic Event". Centers for Disease Control and Prevention. U.S. Department of Health & Human Services. 13 September 2019.
  36. ^ Barr M, Copeland-Stewart A (6 May 2021). "Playing Video Games During the COVID-19 Pandemic and Effects on Players' Well-Being". Games and Culture. 17: 122–139. doi:10.1177/15554120211017036. ISSN 1555-4120.
  37. ^ Chen Q, Liang M, Li Y, Guo J, Fei D, Wang L, et al. (April 2020). "Mental health care for medical staff in China during the COVID-19 outbreak". The Lancet. Psychiatry. 7 (4): e15–e16. doi:10.1016/S2215-0366(20)30078-X. PMC 7129426. PMID 32085839.
  38. ^ Liu S, Yang L, Zhang C, Xiang YT, Liu Z, Hu S, Zhang B (April 2020). "Online mental health services in China during the COVID-19 outbreak". The Lancet. Psychiatry. 7 (4): e17–e18. doi:10.1016/S2215-0366(20)30077-8. PMC 7129099. PMID 32085841.
  39. ^ a b Golberstein E, Wen H, Miller BF (September 2020). "Coronavirus Disease 2019 (COVID-19) and Mental Health for Children and Adolescents". JAMA Pediatrics. 174 (9): 819–820. doi:10.1001/jamapediatrics.2020.1456. PMID 32286618.
  40. ^ Trump DJ (5 October 2020). "Executive Order on Saving Lives Through Increased Support For Mental- and Behavioral-Health Needs".
  41. ^ a b Czeisler MÉ, Lane RI, Petrosky E, Wiley JF, Christensen A, Njai R, et al. (August 2020). "Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic - United States, June 24-30, 2020". MMWR. Morbidity and Mortality Weekly Report. 69 (32): 1049–1057. doi:10.15585/mmwr.mm6932a1. PMC 7440121. PMID 32790653.
  42. ^ Taquet M, Luciano S, Geddes JR, Harrison PJ (February 2021). "Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62354 COVID-19 cases in the USA". The Lancet. Psychiatry. 8 (2): 130–140. doi:10.1016/s2215-0366(20)30462-4. PMC 7820108. PMID 33181098. S2CID 226846568.
  43. ^ Taquet M, Luciano S, Geddes JR, Harrison PJ (February 2021). "Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA". The Lancet. Psychiatry. 8 (2): 130–140. doi:10.1016/S2215-0366(20)30462-4. PMC 7820108. PMID 33181098.
  44. ^ Rosman K (3 April 2020). "For Those With O.C.D., a Threat That Is Both Heightened and Familiar". The New York Times. Retrieved 27 April 2020.
  45. ^ Fineberg NA, Van Ameringen M, Drummond L, Hollander E, Stein DJ, Geller D, et al. (July 2020). "How to manage obsessive-compulsive disorder (OCD) under COVID-19: A clinician's guide from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS) and the Obsessive-Compulsive and Related Disorders Research Network (OCRN) of the European College of Neuropsychopharmacology". Comprehensive Psychiatry. 100: 152174. doi:10.1016/j.comppsych.2020.152174. PMC 7152877. PMID 32388123.
  46. ^ Pyrek E (15 April 2020). "COVID-19 proving extra challenging for people with OCD and other mental health conditions". La Crosse Tribune. Retrieved 27 April 2020.
  47. ^ Moore G (22 April 2020). "Battling anxiety in the age of COVID-19". Australian Associated Press. Retrieved 27 April 2020.
  48. ^ Sparrow W (24 March 2020). "'COVID-19 Is Giving Everyone A Small Glimpse Of What It's Like To Live With OCD'". Women's Health. Retrieved 27 April 2020.
  49. ^ Welch C (15 April 2020). "Are we coping with social distancing? Psychologists are watching warily". National Geographic. Retrieved 27 April 2020.
  50. ^ Zakarin J (2 April 2020). "A Pandemic Is Hell For Everyone, But Especially For Those With OCD". The Huffington Post. Retrieved 27 April 2020.
  51. ^ Ezzat A, Li Y, Holt J, Komorowski M (June 2021). "The global mental health burden of COVID-19 on critical care staff". British Journal of Nursing. 30 (11): 634–642. doi:10.12968/bjon.2021.30.11.634. PMID 34109816. S2CID 235394087.
  52. ^ a b Melnyk BM, Tan A, Hsieh AP, Gawlik K, Arslanian-Engoren C, Braun LT, et al. (May 2021). "Critical Care Nurses' Physical and Mental Health, Worksite Wellness Support, and Medical Errors". American Journal of Critical Care. 30 (3): 176–184. doi:10.4037/ajcc2021301. PMID 34161980. S2CID 235584247.
  53. ^ a b Shaukat N, Ali DM, Razzak J (July 2020). "Physical and mental health impacts of COVID-19 on healthcare workers: a scoping review". International Journal of Emergency Medicine. 13 (1): 40. doi:10.1186/s12245-020-00299-5. PMC 7370263. PMID 32689925.
  54. ^ "AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health". www.aap.org. Retrieved 27 January 2022.
  55. ^ Liu JJ, Bao Y, Huang X, Shi J, Lu L (May 2020). "Mental health considerations for children quarantined because of COVID-19". The Lancet. Child & Adolescent Health. 4 (5): 347–349. doi:10.1016/S2352-4642(20)30096-1. PMC 7118598. PMID 32224303.
  56. ^ Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S (November 2021). "Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis". JAMA Pediatrics. 175 (11): 1142–1150. doi:10.1001/jamapediatrics.2021.2482. PMC 8353576. PMID 34369987.
  57. ^ Aristovnik A, Keržič D, Ravšelj D, Tomaževič N, Umek L (October 2020). "Impacts of the COVID-19 Pandemic on Life of Higher Education Students: A Global Perspective". Sustainability. 12 (20): 8438. doi:10.3390/su12208438.
  58. ^ a b c d e f De Man J, Buffel V, van de Velde S, Bracke P, Van Hal GF, Wouters E (January 2021). "Disentangling depression in Belgian higher education students amidst the first COVID-19 lockdown (April-May 2020)". Archives of Public Health. 79 (1): 3. doi:10.1186/s13690-020-00522-y. PMC 7789891. PMID 33413635. CC-BY icon.svg Text was copied from this source, which is available under a Creative Commons Attribution 4.0 International License.
  59. ^ "Mental Health of K-12 Students During the Pandemic · The Hunt Institute". The Hunt Institute. Retrieved 24 February 2022.
  60. ^ "Mental Toll of Pandemic May Outpace Other Strains for K12 Students". EVERFI. 14 October 2020. Retrieved 24 February 2022.
  61. ^ a b "Teen Mental Health During COVID-19 | Johns Hopkins Bloomberg School of Public Health". publichealth.jhu.edu. Retrieved 4 March 2022.
  62. ^ "COVID Harmed Kids' Mental Health—And Schools Are Feeling It". pew.org. Retrieved 4 March 2022.
  63. ^ Pieh C, Plener PL, Probst T, Dale R, Humer E (June 2021). "Assessment of Mental Health of High School Students During Social Distancing and Remote Schooling During the COVID-19 Pandemic in Austria". JAMA Network Open. 4 (6): e2114866. doi:10.1001/jamanetworkopen.2021.14866. PMC 8239947. PMID 34181016.
  64. ^ "Covid: Many students say their mental health is worse due to pandemic". BBC News. 31 March 2021. Retrieved 6 April 2021.
  65. ^ a b Baliyan S, Cimadevilla JM, de Vidania S, Pulopulos MM, Sandi C, Venero C (March 2021). "Differential Susceptibility to the Impact of the COVID-19 Pandemic on Working Memory, Empathy, and Perceived Stress: The Role of Cortisol and Resilience". Brain Sciences. 11 (3): 348. doi:10.3390/brainsci11030348. PMC 7998983. PMID 33803413.
  66. ^ Tyra AT, Griffin SM, Fergus TA, Ginty AT (June 2021). "Individual differences in emotion regulation prospectively predict early COVID-19 related acute stress". Journal of Anxiety Disorders. 81: 102411. doi:10.1016/j.janxdis.2021.102411. PMID 33962141.
  67. ^ Terada Y (23 June 2020). "Covid-19's Impact on Students' Academic and Mental Well-Being". Edutopia. Retrieved 18 April 2021.
  68. ^ "Coronavirus Impact on Students and Education Systems". NAACP. Retrieved 18 April 2021.
  69. ^ Quattrocchi A (4 January 2022). "Perspective | COVID-19 sparks mental health crisis on college campuses nationwide". EducationNC. Retrieved 24 February 2022.
  70. ^ a b c Keel PK, Gomez MM, Harris L, Kennedy GA, Ribeiro J, Joiner TE (November 2020). "Gaining "The Quarantine 15:" Perceived versus observed weight changes in college students in the wake of COVID-19". The International Journal of Eating Disorders. 53 (11): 1801–1808. doi:10.1002/eat.23375. PMC 7461524. PMID 32856752.
  71. ^ Tomer A, Kane JW (10 June 2020). "To protect frontline workers during and after COVID-19, we must define who they are". Brookings. Retrieved 30 November 2021.
  72. ^ Bourdon O, Raymond C, Marin MF, Olivera-Figueroa L, Lupien SJ, Juster RP (April 2020). "A time to be chronically stressed? Maladaptive time perspectives are associated with allostatic load". Biological Psychology. 152: 107871. doi:10.1016/j.biopsycho.2020.107871. PMID 32070718. S2CID 211116656.
  73. ^ "Young women and workers in hospitality and retail trade were hardest hit". OECD Economic Surveys: Finland. 16 January 2021. doi:10.1787/9817f5e0-en. ISBN 9789264362222. ISSN 1999-0545. S2CID 242804004.
  74. ^ Shreffler J, Petrey J, Huecker M (August 2020). "The Impact of COVID-19 on Healthcare Worker Wellness: A Scoping Review". The Western Journal of Emergency Medicine. 21 (5): 1059–1066. doi:10.5811/westjem.2020.7.48684. PMC 7514392. PMID 32970555.
  75. ^ Kim SC, Quiban C, Sloan C, Montejano A (March 2021). "Predictors of poor mental health among nurses during COVID-19 pandemic". Nursing Open. 8 (2): 900–907. doi:10.1002/nop2.697. PMC 7753542. PMID 33570266.
  76. ^ Ofori AA, Osarfo J, Agbeno EK, Manu DO, Amoah E (1 January 2021). "Psychological impact of COVID-19 on health workers in Ghana: A multicentre, cross-sectional study". SAGE Open Medicine. 9: 20503121211000919. doi:10.1177/20503121211000919. PMC 7958156. PMID 33786183.
  77. ^ a b c d De Man J, Smith MR, Schneider M, Tabana H (January 2022). "An exploration of the impact of COVID-19 on mental health in South Africa". Psychology, Health & Medicine. 27 (1): 120–130. doi:10.1080/13548506.2021.1954671. PMID 34319182. S2CID 236471921.
  78. ^ "Impact of COVID -19 on children: special focus on the psychosocial aspect - Minerva Pediatrica 2020 June;72(3):226-35". www.minervamedica.it. Retrieved 21 April 2021.
  79. ^ Liu YE, Zhai ZC, Han YH, Liu YL, Liu FP, Hu DY (September 2020). "Experiences of front-line nurses combating coronavirus disease-2019 in China: A qualitative analysis". Public Health Nursing. 37 (5): 757–763. doi:10.1111/phn.12768. PMC 7405388. PMID 32677072.
  80. ^ Arnetz JE, Goetz CM, Arnetz BB, Arble E (November 2020). "Nurse Reports of Stressful Situations during the COVID-19 Pandemic: Qualitative Analysis of Survey Responses". International Journal of Environmental Research and Public Health. 17 (21): 8126. doi:10.3390/ijerph17218126. PMC 7663126. PMID 33153198.
  81. ^ Glasofer A, Townsend AB (October 2020). "Supporting nurses' mental health during the pandemic". Nursing. 50 (10): 60–63. doi:10.1097/01.NURSE.0000697156.46992.b2. PMID 32947374. S2CID 221799178.
  82. ^ a b c Di Mattei VE, Perego G, Milano F, Mazzetti M, Taranto P, Di Pierro R, et al. (May 2021). "The "Healthcare Workers' Wellbeing (Benessere Operatori)" Project: A Picture of the Mental Health Conditions of Italian Healthcare Workers during the First Wave of the COVID-19 Pandemic". International Journal of Environmental Research and Public Health. 18 (10): 5267. doi:10.3390/ijerph18105267. PMC 8156728. PMID 34063421.
  83. ^ Sasaki N, Kuroda R, Tsuno K, Kawakami N (November 2020). "The deterioration of mental health among healthcare workers during the COVID-19 outbreak: A population-based cohort study of workers in Japan". Scandinavian Journal of Work, Environment & Health. 46 (6): 639–644. doi:10.5271/sjweh.3922. PMC 7737801. PMID 32905601.
  84. ^ a b Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P (August 2020). "Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis". Brain, Behavior, and Immunity. 88: 901–907. doi:10.1016/j.bbi.2020.05.026. PMC 7206431. PMID 32437915.
  85. ^ a b Leng M, Wei L, Shi X, Cao G, Wei Y, Xu H, et al. (March 2021). "Mental distress and influencing factors in nurses caring for patients with COVID-19". Nursing in Critical Care. 26 (2): 94–101. doi:10.1111/nicc.12528. PMID 33448567. S2CID 225407069.
  86. ^ Kader N, Elhusein B, Chandrappa NS, Nashwan AJ, Chandra P, Khan AW, Alabdulla M (August 2021). "Perceived stress and post-traumatic stress disorder symptoms among intensive care unit staff caring for severely ill coronavirus disease 2019 patients during the pandemic: a national study". Annals of General Psychiatry. 20 (1): 38. doi:10.1186/s12991-021-00363-1. PMC 8379565. PMID 34419094.
  87. ^ "Hate Crimes". CQ Researcher by CQ Press. Retrieved 13 March 2022.
  88. ^ Lui PP, Parikh K, Katedia S, Jouriles EN (September 2021). "Anti-Asian Discrimination and Antiracist Bystander Behaviors amid the COVID-19 Outbreak". Asian American Journal of Psychology. doi:10.31234/osf.io/eaz3k. S2CID 236658795.
  89. ^ Cai W, Burch AD, Patel JK (4 April 2021). "Swelling Anti-Asian Violence: Who Is Being Attacked Where". The New York Times. ISSN 0362-4331. Retrieved 13 March 2022.
  90. ^ "President Trump calls coronavirus 'kung flu'". BBC News. Retrieved 13 March 2022.
  91. ^ a b "COVID-19 and Asian Americans | McKinsey". www.mckinsey.com. Retrieved 14 March 2022.
  92. ^ Gunnell D, Appleby L, Arensman E, Hawton K, John A, Kapur N, et al. (June 2020). "Suicide risk and prevention during the COVID-19 pandemic". The Lancet. Psychiatry. 7 (6): 468–471. doi:10.1016/S2215-0366(20)30171-1. PMC 7173821. PMID 32330430.
  93. ^ Baker N (22 April 2020). "Warning Covid-19 could lead to spike in suicide rates". Irish Examiner. Retrieved 27 April 2020.
  94. ^ a b c d John A, Pirkis J, Gunnell D, Appleby L, Morrissey J (November 2020). "Trends in suicide during the covid-19 pandemic". BMJ. 371: m4352. doi:10.1136/bmj.m4352. PMID 33184048. S2CID 226300218.
  95. ^ Hilliard M (27 April 2020). "'Cocooning' and mental health: Over 16,000 calls to Alone support line". The Irish Times. Retrieved 27 April 2020.
  96. ^ Piovesan A (9 June 2021). "Attempted suicide rates among Victorian teenagers soar by 184 per cent in past six months, Kids Helpline reveals". News.com.au — Australia's Leading News Site. Retrieved 9 August 2021. Disturbing new data from the Kids Helpline revealed the shocking statistic after Victoria was plunged into its fourth major Covid-19 lockdown in the past 12 months.
  97. ^ "The Martin Gallier Project". The Martin Gallier Project. Retrieved 25 January 2022.
  98. ^ "COVID-19: Is the pandemic costing us our mental health?". Sky News. Retrieved 6 April 2021.
  99. ^ Rogers JP, Chesney E, Oliver D, Begum N, Saini A, Wang S, et al. (April 2021). "Suicide, self-harm and thoughts of suicide or self-harm in infectious disease epidemics: a systematic review and meta-analysis". Epidemiology and Psychiatric Sciences. 30: e32. doi:10.1017/S2045796021000214. PMC 7610720. PMID 33902775.
  100. ^ a b c d Pirkis J, John A, Shin S, DelPozo-Banos M, Arya V, Analuisa-Aguilar P, et al. (July 2021). "Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries". The Lancet. Psychiatry. 8 (7): 579–588. doi:10.1016/S2215-0366(21)00091-2. PMID 33862016. S2CID 233279069.
  101. ^ a b c d Banerjee D, Kosagisharaf JR, Sathyanarayana Rao TS (January 2021). "'The dual pandemic' of suicide and COVID-19: A biopsychosocial narrative of risks and prevention". Psychiatry Research. 295: 113577. doi:10.1016/j.psychres.2020.113577. PMC 7672361. PMID 33229123.
  102. ^ "Validate User". jamanetwork.com. Retrieved 19 April 2021.
  103. ^ Mamun MA, Griffiths MD (June 2020). "First COVID-19 suicide case in Bangladesh due to fear of COVID-19 and xenophobia: Possible suicide prevention strategies". Asian Journal of Psychiatry. 51: 102073. doi:10.1016/j.ajp.2020.102073. PMC 7139250. PMID 32278889.
  104. ^ a b Zhou W, Goh G (11 June 2020). "In post-lockdown China, student mental health in focus amid reported jump in suicides". Reuters. Retrieved 2 December 2020.
  105. ^ Rovoi D (22 September 2021). "Call for some TLC to address mental health crisis in Fiji". RNZ. Retrieved 22 September 2021.
  106. ^ "Two tipplers in Kerala commit suicide upset at not getting liquor during COVID-19 lockdown". The New Indian Express. Archived from the original on 29 March 2020. Retrieved 29 March 2020.
  107. ^ Ueda M, Nordström R, Matsubayashi T (April 2021). "Suicide and mental health during the COVID-19 pandemic in Japan". Journal of Public Health. doi:10.1101/2020.10.06.20207530. PMC 8083330. PMID 33855451. S2CID 222307132.
  108. ^ "新型コロナウイルス感染症対策（こころのケア）｜こころの耳：働く人のメンタルヘルス・ポータルサイト". kokoro.mhlw.go.jp. Retrieved 3 May 2020.
  109. ^ Owatari M (20 September 2020). "〈独自〉女性の自殺急増 コロナ影響か 同様の韓国に異例の連絡". 産経ニュース (in Japanese). Archived from the original on 21 September 2020. Retrieved 23 September 2020.
  110. ^ Green E (24 January 2021). "Surge of Student Suicides Pushes Las Vegas Schools to Reopen". New York Times.
  111. ^ Jackson A (10 April 2020). "A crisis mental-health hotline has seen an 891% spike in calls". CNN. Retrieved 27 April 2020.
  112. ^ "Suicides Rise in Black Population During COVID-19 Pandemic". www.hopkinsmedicine.org.
  113. ^ Marazziti D, Stahl SM (June 2020). "The relevance of COVID-19 pandemic to psychiatry". World Psychiatry. 19 (2): 261. doi:10.1002/wps.20764. PMC 7215065. PMID 32394565.
  114. ^ Vijayaraghavan P, Singhal D (13 April 2020). "A Descriptive Study of Indian General Public's Psychological responses during COVID-19 Pandemic Lockdown Period in India". dx.doi.org. doi:10.31234/osf.io/jeksn. S2CID 225951123. Retrieved 7 December 2020.
  115. ^ Yamamoto T, Uchiumi C, Suzuki N, Yoshimoto J, Murillo-Rodriguez E (December 2020). "The Psychological Impact of 'Mild Lockdown' in Japan during the COVID-19 Pandemic: A Nationwide Survey under a Declared State of Emergency". International Journal of Environmental Research and Public Health. 17 (24): 2020.07.17.20156125. doi:10.3390/ijerph17249382. PMC 7765307. PMID 33333893. S2CID 220601718.
  116. ^ Sugaya N, Yamamoto T, Suzuki N, Uchiumi C (October 2020). "A real-time survey on the psychological impact of mild lockdown for COVID-19 in the Japanese population". Scientific Data. 7 (1): 372. Bibcode:2020NatSD...7..372S. doi:10.1038/s41597-020-00714-9. PMC 7596049. PMID 33122626.
  117. ^ Gualano MR, Lo Moro G, Voglino G, Bert F, Siliquini R (July 2020). "Effects of Covid-19 Lockdown on Mental Health and Sleep Disturbances in Italy". International Journal of Environmental Research and Public Health. 17 (13): 4779. doi:10.3390/ijerph17134779. PMC 7369943. PMID 32630821.
  118. ^ Costi S, Paltrinieri S, Bressi B, Fugazzaro S, Giorgi Rossi P, Mazzini E (January 2021). "Poor Sleep during the First Peak of the SARS-CoV-2 Pandemic: A Cross-Sectional Study". International Journal of Environmental Research and Public Health. 18 (1): 306. doi:10.3390/ijerph18010306. PMC 7795804. PMID 33406588.
  119. ^ Oliver N, Barber X, Roomp K, Roomp K (September 2020). "Assessing the Impact of the COVID-19 Pandemic in Spain: Large-Scale, Online, Self-Reported Population Survey". Journal of Medical Internet Research. 22 (9): e21319. doi:10.2196/21319. PMC 7485997. PMID 32870159.
  120. ^ "La Moncloa. 13/03/2020. Government will declare state of emergency due to coronavirus on Saturday [President/News]". www.lamoncloa.gob.es. Retrieved 28 March 2022.
  121. ^ Rodríguez-Rey R, Garrido-Hernansaiz H, Collado S (2020). "Psychological Impact and Associated Factors During the Initial Stage of the Coronavirus (COVID-19) Pandemic Among the General Population in Spain". Frontiers in Psychology. 11: 1540. doi:10.3389/fpsyg.2020.01540. PMC 7325630. PMID 32655463.
  122. ^ Small S, Blanc J (8 January 2021). "Mental Health During COVID-19: Tam Giao and Vietnam's Response". Frontiers in Psychiatry. 11: 589618. doi:10.3389/fpsyt.2020.589618. PMC 7820702. PMID 33488422.
  123. ^ Do Duy C, Nong VM, Ngo Van A, Doan Thu T, Do Thu N, Nguyen Quang T (October 2020). "COVID-19-related stigma and its association with mental health of health-care workers after quarantine in Vietnam". Psychiatry and Clinical Neurosciences. 74 (10): 566–568. doi:10.1111/pcn.13120. PMC 7404653. PMID 32779787.
  124. ^ Owens M, Townsend E, Hall E, Bhatia T, Fitzgibbon R, Miller-Lakin F (January 2022). "Mental Health and Wellbeing in Young People in the UK during Lockdown (COVID-19)". International Journal of Environmental Research and Public Health. 19 (3): 1132. doi:10.3390/ijerph19031132. PMC 8834421. PMID 35162165.
  125. ^ Greenberg N, Docherty M, Gnanapragasam S, Wessely S (March 2020). "Managing mental health challenges faced by healthcare workers during covid-19 pandemic". BMJ. 368: m1211. doi:10.1136/bmj.m1211. PMID 32217624.
  126. ^ Wind TR, Rijkeboer M, Andersson G, Riper H (April 2020). "The COVID-19 pandemic: The 'black swan' for mental health care and a turning point for e-health". Internet Interventions. 20: 100317. doi:10.1016/j.invent.2020.100317. PMC 7104190. PMID 32289019.
  127. ^ Topooco N, Riper H, Araya R, Berking M, Brunn M, Chevreul K, et al. (June 2017). "Attitudes towards digital treatment for depression: A European stakeholder survey". Internet Interventions. 8: 1–9. doi:10.1016/j.invent.2017.01.001. PMC 6096292. PMID 30135823.
  128. ^ "Supplemental Material for Systematic Review of Mindfulness-Based Cognitive Therapy and Mindfulness-Based Stress Reduction via Group Videoconferencing: Feasibility, Acceptability, Safety, and Efficacy". Journal of Psychotherapy Integration. 14 September 2020. doi:10.1037/int0000216.supp. ISSN 1053-0479. S2CID 242659723.
  129. ^ a b Koonin LM, Hoots B, Tsang CA, Leroy Z, Farris K, Jolly T, et al. (October 2020). "Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic - United States, January-March 2020". MMWR. Morbidity and Mortality Weekly Report. 69 (43): 1595–1599. doi:10.15585/mmwr.mm6943a3. PMC 7641006. PMID 33119561.
  130. ^ Monaghesh E, Hajizadeh A (August 2020). "The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence". BMC Public Health. 20 (1): 1193. doi:10.1186/s12889-020-09301-4. PMC 7395209. PMID 32738884.
  131. ^ a b c Blease C, Salmi L, Hägglund M, Wachenheim D, DesRoches C (June 2021). "COVID-19 and Open Notes: A New Method to Enhance Patient Safety and Trust". JMIR Mental Health. 8 (6): e29314. doi:10.2196/29314. PMID 34081603.
  132. ^ Schwarz J, Bärkås A, Blease C, Collins L, Hägglund M, Markham S, Hochwarter S (December 2021). "Sharing Clinical Notes and Electronic Health Records With People Affected by Mental Health Conditions: Scoping Review". JMIR Mental Health. 8 (12): e34170. doi:10.2196/34170. PMC 8715358. PMID 34904956.
  133. ^ Blease C, Dong Z, Torous J, Walker J, Hägglund M, DesRoches CM (March 2021). "Association of Patients Reading Clinical Notes With Perception of Medication Adherence Among Persons With Serious Mental Illness". JAMA Network Open. 4 (3): e212823. doi:10.1001/jamanetworkopen.2021.2823. PMC 7991965. PMID 33760088.
  134. ^ O'Neill S, Chimowitz H, Leveille S, Walker J (October 2019). "Embracing the new age of transparency: mental health patients reading their psychotherapy notes online". Journal of Mental Health. 28 (5): 527–535. doi:10.1080/09638237.2019.1644490. PMID 31364902.
  135. ^ Blease CR, O'Neill S, Walker J, Hägglund M, Torous J (November 2020). "Sharing notes with mental health patients: balancing risks with respect". The Lancet. Psychiatry. 7 (11): 924–925. doi:10.1016/S2215-0366(20)30032-8. PMID 32059796.
  136. ^ Blease CR, O'Neill SF, Torous J, DesRoches CM, Hagglund M (April 2021). "Patient Access to Mental Health Notes: Motivating Evidence-Informed Ethical Guidelines". The Journal of Nervous and Mental Disease. 209 (4): 265–269. doi:10.1097/NMD.0000000000001303. PMID 33764954.
  137. ^ Blease C, Salmi L, Rexhepi H, Hägglund M, DesRoches CM (May 2021). "Patients, clinicians and open notes: information blocking as a case of epistemic injustice". Journal of Medical Ethics: medethics–2021–107275. doi:10.1136/medethics-2021-107275. PMID 33990427.
  138. ^ Tyler W (8 May 2020). "The Bottomless Pit: Social Distancing, COVID-19 & The Bubonic Plague". Sandbox Watch. Retrieved 10 May 2020.
  139. ^ "Social Distancing: How To Keep Connected And Upbeat". SuperWellnessBlog. 29 April 2020. Retrieved 25 July 2020.
  140. ^ a b Eisenbeck N, Carreno DF, Pérez-Escobar JA (17 March 2021). "Meaning-Centered Coping in the Era of COVID-19: Direct and Moderating Effects on Depression, Anxiety, and Stress". Frontiers in Psychology. 12: 648383. doi:10.3389/fpsyg.2021.648383. PMC 8010126. PMID 33815231.
  141. ^ Gloster AT, Lamnisos D, Lubenko J, Presti G, Squatrito V, Constantinou M, et al. (31 December 2020). Francis JM (ed.). "Impact of COVID-19 pandemic on mental health: An international study". PLOS ONE. 15 (12): e0244809. Bibcode:2020PLoSO..1544809G. doi:10.1371/journal.pone.0244809. PMC 7774914. PMID 33382859.
  142. ^ "COVID 'Long Haulers': Long-Term Effects of COVID-19". www.hopkinsmedicine.org. Retrieved 13 March 2022.
  143. ^ "Understanding Long Term Effects of COVID-19 – Brigham and Women's Hospital". www.brighamandwomens.org. Retrieved 13 March 2022.

Further reading[edit]

Retrieved from "https://en.wikipedia.org/w/index.php?title=Mental_health_during_the_COVID-19_pandemic&oldid=1081057889"