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      How mental health care should change as a consequence of the COVID-19 pandemic

      review-article
      , PhD a , * , , Prof, PhD b , c , , Prof, MD d , , Prof, DrMedSc e , , PhD f , , PhD g , , Prof, PhD h , , Prof, MD i , j , k , , PhD l , m , o , , PhD p , , Prof, MD q , , Prof, MD r , s , , Prof, DM t , , BSc u , , Prof, MD n , v , , MMed w , x , , Prof, MD y , , Prof, MD z , , MSS aa , , Prof, MD ab , , MD ac , , Prof, PhD ad , , Prof, PhD ae , af ,   , Prof, PhD a
      The Lancet. Psychiatry
      Elsevier Ltd.

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          Summary

          The unpredictability and uncertainty of the COVID-19 pandemic; the associated lockdowns, physical distancing, and other containment strategies; and the resulting economic breakdown could increase the risk of mental health problems and exacerbate health inequalities. Preliminary findings suggest adverse mental health effects in previously healthy people and especially in people with pre-existing mental health disorders. Despite the heterogeneity of worldwide health systems, efforts have been made to adapt the delivery of mental health care to the demands of COVID-19. Mental health concerns have been addressed via the public mental health response and by adapting mental health services, mostly focusing on infection control, modifying access to diagnosis and treatment, ensuring continuity of care for mental health service users, and paying attention to new cases of mental ill health and populations at high risk of mental health problems. Sustainable adaptations of delivery systems for mental health care should be developed by experts, clinicians, and service users, and should be specifically designed to mitigate disparities in health-care provision. Thorough and continuous assessment of health and service-use outcomes in mental health clinical practice will be crucial for defining which practices should be further developed and which discontinued. For this Position Paper, an international group of clinicians, mental health experts, and users of mental health services has come together to reflect on the challenges for mental health that COVID-19 poses. The interconnectedness of the world made society vulnerable to this infection, but it also provides the infrastructure to address previous system failings by disseminating good practices that can result in sustained, efficient, and equitable delivery of mental health-care delivery. Thus, the COVID-19 pandemic could be an opportunity to improve mental health services.

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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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            Is Open Access

            Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

            Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.
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              Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019

              Key Points Question What factors are associated with mental health outcomes among health care workers in China who are treating patients with coronavirus disease 2019 (COVID-19)? Findings In this cross-sectional study of 1257 health care workers in 34 hospitals equipped with fever clinics or wards for patients with COVID-19 in multiple regions of China, a considerable proportion of health care workers reported experiencing symptoms of depression, anxiety, insomnia, and distress, especially women, nurses, those in Wuhan, and front-line health care workers directly engaged in diagnosing, treating, or providing nursing care to patients with suspected or confirmed COVID-19. Meaning These findings suggest that, among Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions.
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                Author and article information

                Contributors
                Journal
                Lancet Psychiatry
                Lancet Psychiatry
                The Lancet. Psychiatry
                Elsevier Ltd.
                2215-0366
                2215-0374
                16 July 2020
                16 July 2020
                Affiliations
                [a ]Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
                [b ]Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London, London, UK
                [c ]South London and Maudsley NHS Foundation Trust, London, UK
                [d ]University of Campania “Luigi Vanvitelli”, Naples, Italy
                [e ]CORE-Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region, Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
                [f ]Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile
                [g ]Department of Psychiatry, University of South Florida, Tampa, FL, USA
                [h ]Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
                [i ]Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
                [j ]Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
                [k ]Department of Child and Adolescent Psychiatry, Charité—Universitätsmedizin Berlin, Berlin, Germany
                [l ]School of Management, College of Business, RMIT University, Melbourne, VIC, Australia
                [m ]Program for Recovery and Community Health, School of Medicine, Yale, New Haven, CT, USA
                [n ]Department of Psychiatry, School of Medicine, Yale, New Haven, CT, USA
                [o ]School of Medicine, Yale, New Haven, CT, USA
                [p ]School of Social Policy and Institute for Mental Health, University of Birmingham, Birmingham, UK
                [q ]Department of Psychiatry and State Key Laboratory on Cognitive and Brain Sciences, University of Hong Kong, Hong Kong Special Administrative Region, China
                [r ]Institute of Psychiatry and Neuroscience of Paris, University of Paris, INSERM U1266, Paris, France
                [s ]GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, Paris, France
                [t ]Division of Psychiatry (National Insitute for Health Research Mental Health Policy Research Unit), University College London, London, UK
                [u ]Global Alliance of Mental Illness Advocacy Networks-Europe, Brussels, Belgium
                [v ]Yale New Haven Hospital, New Haven, CT, USA
                [w ]North Region and Department of Psychosis, Institute of Mental Health, Singapore
                [x ]Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
                [y ]Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, NY, USA
                [z ]Department of Psychiatry, School of Medicine, University of Antioquia, Medellín, Colombia
                [aa ]EUFAMI, Leuven, Belgium
                [ab ]Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
                [ac ]Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
                [ad ]Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
                [ae ]Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
                [af ]Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy
                Author notes
                [* ]Correspondence to: Dr Carmen Moreno, Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain cmoreno@ 123456hggm.es
                Article
                S2215-0366(20)30307-2
                10.1016/S2215-0366(20)30307-2
                7365642
                32682460
                7f0b4ca8-dfa1-4f73-8ea4-eef3028e2ab7
                © 2020 Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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