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      COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health

      , PhD a , c , * , , PhD d , , PhD e , i , , PhD j , , PhD k , l , , MSc af , , PhD n , , PhD o , p , , MBBS q , , MSc m , r , , PhD s , , MPhil t , , PhD j , u , , MA v , w , , FMCPsych a , b , , PhD g , , PhD e , h , , PhD x , y , , MBBS z , aa , , PhD ab , ac , , DSc a , , PhD ad , , MD ae , , PhD e , f , , PhD j , m
      The Lancet. Psychiatry
      Elsevier Ltd.

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          Most of the global population live in low-income and middle-income countries (LMICs), which have historically received a small fraction of global resources for mental health. The COVID-19 pandemic has spread rapidly in many of these countries. This Review examines the mental health implications of the COVID-19 pandemic in LMICs in four parts. First, we review the emerging literature on the impact of the pandemic on mental health, which shows high rates of psychological distress and early warning signs of an increase in mental health disorders. Second, we assess the responses in different countries, noting the swift and diverse responses to address mental health in some countries, particularly through the development of national COVID-19 response plans for mental health services, implementation of WHO guidance, and deployment of digital platforms, signifying a welcome recognition of the salience of mental health. Third, we consider the opportunity that the pandemic presents to reimagine global mental health, especially through shifting the balance of power from high-income countries to LMICs and from narrow biomedical approaches to community-oriented psychosocial perspectives, in setting priorities for interventions and research. Finally, we present a vision for the concept of building back better the mental health systems in LMICs with a focus on key strategies; notably, fully integrating mental health in plans for universal health coverage, enhancing access to psychosocial interventions through task sharing, leveraging digital technologies for various mental health tasks, eliminating coercion in mental health care, and addressing the needs of neglected populations, such as children and people with substance use disorders. Our recommendations are relevant for the mental health of populations and functioning of health systems in not only LMICs but also high-income countries impacted by the COVID-19 pandemic, with wide disparities in quality of and access to mental health care.

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          Most cited references133

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          The psychological impact of quarantine and how to reduce it: rapid review of the evidence

          Summary The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.
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            Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science

            Summary The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.
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              COVID-19 and mental health: A review of the existing literature

              Highlights • Subsyndromal mental health concerns are a common response to the COVID-19 outbreak. • These responses affect both the general public and healthcare workers. • Depressive and anxiety symptoms have been reported in 16–28% of subjects screened. • Novel methods of consultation, such as online services, can be helpful for these patients. • There is a need for further long-term research in this area, especially from other countries

                Author and article information

                Lancet Psychiatry
                Lancet Psychiatry
                The Lancet. Psychiatry
                Elsevier Ltd.
                24 February 2021
                June 2021
                24 February 2021
                : 8
                : 6
                : 535-550
                [a ]WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
                [b ]Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
                [c ]BRiTE Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
                [d ]Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC, USA
                [e ]Centre for Global Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
                [f ]Centre for Implementation Science, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
                [g ]Centre for Society and Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
                [h ]WHO Collaborating Centre for Research and Training in Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
                [i ]Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
                [j ]Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
                [k ]Global Health Department, Health Services Academy, Islamabad, Pakistan
                [l ]Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
                [m ]Wellcome–DBT India Alliance, Sangath, New Delhi, India
                [n ]Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
                [o ]The Reference Centre for Psychosocial Support, International Federation of the Red Cross and Red Crescent, Hong Kong Special Administrative Region, China
                [p ]The Red Cross of the Hong Kong Special Administrative Region of China, Hong Kong Special Administrative Region, China
                [q ]CBM Global and Centre for Global Mental Health, London, UK
                [r ]School of Psychology, University of Sussex, Brighton, UK
                [s ]Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
                [t ]Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
                [u ]Centre for Data and Knowledge Integration for Health, CIDACS–FIOCRUZ, Bahia, Brazil
                [v ]Mental Health Service Users Association Ethiopia, Addis Ababa, Ethiopia
                [w ]Global Mental Health Peer Network, Pretoria, South Africa
                [x ]Pravara Institute of Medical Sciences, Loni, India
                [y ]Global Mental Health Peer Network, Johannesburg, South Africa
                [z ]Mentally Aware Nigeria Initiative, Lagos, Nigeria
                [aa ]United for Global Mental Health, London, UK
                [ab ]Centre for Rural Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
                [ac ]Centre for Health Systems Research and Development, Faculty of Humanities, University of the Free State, Bloemfontein, South Africa
                [ad ]Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
                [ae ]Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
                [af ]Sangath, India
                Author notes
                [* ]Correspondence to: Dr Lola Kola, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan PMB 5116, Nigeria
                © 2021 Elsevier Ltd. All rights reserved.

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