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      Years of life lost due to the psychosocial consequences of COVID-19 mitigation strategies based on Swiss data

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          Abstract

          Background.

          The pandemic caused by coronavirus disease 2019 (COVID-19) has forced governments to implement strict social mitigation strategies to reduce the morbidity and mortality from acute infections. These strategies, however, carry a significant risk for mental health, which can lead to increased short-term and long-term mortality and is currently not included in modeling the impact of the pandemic.

          Methods.

          We used years of life lost (YLL) as the main outcome measure, applied to Switzerland as an example. We focused on suicide, depression, alcohol use disorder, childhood trauma due to domestic violence, changes in marital status, and social isolation, as these are known to increase YLL in the context of imposed restriction in social contact and freedom of movement. We stipulated a minimum duration of mitigation of 3 months based on current public health plans.

          Results.

          The study projects that the average person would suffer 0.205 YLL due to psychosocial consequence of COVID-19 mitigation measures. However, this loss would be entirely borne by 2.1% of the population, who will suffer an average of 9.79 YLL.

          Conclusions.

          The results presented here are likely to underestimate the true impact of the mitigation strategies on YLL. However, they highlight the need for public health models to expand their scope in order to provide better estimates of the risks and benefits of mitigation.

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          Most cited references26

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          An interactive web-based dashboard to track COVID-19 in real time

          In December, 2019, a local outbreak of pneumonia of initially unknown cause was detected in Wuhan (Hubei, China), and was quickly determined to be caused by a novel coronavirus, 1 namely severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The outbreak has since spread to every province of mainland China as well as 27 other countries and regions, with more than 70 000 confirmed cases as of Feb 17, 2020. 2 In response to this ongoing public health emergency, we developed an online interactive dashboard, hosted by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University, Baltimore, MD, USA, to visualise and track reported cases of coronavirus disease 2019 (COVID-19) in real time. The dashboard, first shared publicly on Jan 22, illustrates the location and number of confirmed COVID-19 cases, deaths, and recoveries for all affected countries. It was developed to provide researchers, public health authorities, and the general public with a user-friendly tool to track the outbreak as it unfolds. All data collected and displayed are made freely available, initially through Google Sheets and now through a GitHub repository, along with the feature layers of the dashboard, which are now included in the Esri Living Atlas. The dashboard reports cases at the province level in China; at the city level in the USA, Australia, and Canada; and at the country level otherwise. During Jan 22–31, all data collection and processing were done manually, and updates were typically done twice a day, morning and night (US Eastern Time). As the outbreak evolved, the manual reporting process became unsustainable; therefore, on Feb 1, we adopted a semi-automated living data stream strategy. Our primary data source is DXY, an online platform run by members of the Chinese medical community, which aggregates local media and government reports to provide cumulative totals of COVID-19 cases in near real time at the province level in China and at the country level otherwise. Every 15 min, the cumulative case counts are updated from DXY for all provinces in China and for other affected countries and regions. For countries and regions outside mainland China (including Hong Kong, Macau, and Taiwan), we found DXY cumulative case counts to frequently lag behind other sources; we therefore manually update these case numbers throughout the day when new cases are identified. To identify new cases, we monitor various Twitter feeds, online news services, and direct communication sent through the dashboard. Before manually updating the dashboard, we confirm the case numbers with regional and local health departments, including the respective centres for disease control and prevention (CDC) of China, Taiwan, and Europe, the Hong Kong Department of Health, the Macau Government, and WHO, as well as city-level and state-level health authorities. For city-level case reports in the USA, Australia, and Canada, which we began reporting on Feb 1, we rely on the US CDC, the government of Canada, the Australian Government Department of Health, and various state or territory health authorities. All manual updates (for countries and regions outside mainland China) are coordinated by a team at Johns Hopkins University. The case data reported on the dashboard aligns with the daily Chinese CDC 3 and WHO situation reports 2 for within and outside of mainland China, respectively (figure ). Furthermore, the dashboard is particularly effective at capturing the timing of the first reported case of COVID-19 in new countries or regions (appendix). With the exception of Australia, Hong Kong, and Italy, the CSSE at Johns Hopkins University has reported newly infected countries ahead of WHO, with Hong Kong and Italy reported within hours of the corresponding WHO situation report. Figure Comparison of COVID-19 case reporting from different sources Daily cumulative case numbers (starting Jan 22, 2020) reported by the Johns Hopkins University Center for Systems Science and Engineering (CSSE), WHO situation reports, and the Chinese Center for Disease Control and Prevention (Chinese CDC) for within (A) and outside (B) mainland China. Given the popularity and impact of the dashboard to date, we plan to continue hosting and managing the tool throughout the entirety of the COVID-19 outbreak and to build out its capabilities to establish a standing tool to monitor and report on future outbreaks. We believe our efforts are crucial to help inform modelling efforts and control measures during the earliest stages of the outbreak.
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            Epidemic of COVID-19 in China and associated Psychological Problems

            Highlights • There are higher rate of anxiety, depression, alcohol use disorder, and lower mental wellbeing during the COVID-19 epidemic. • Depression and alcohol use disorder were higher among people from Hubei than other provinces. • Non-significant gender differences in anxiety, depression, and mental wellbeing. • Young people, aged 21–40 years old, were psychologically more vulnerable position during the COVID-19 epidemic.
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              The consequences of the COVID-19 pandemic on mental health and implications for clinical practice

              There is a wide consensus that the COVID-19 pandemic not only affects physical health, but also mental health and well-being [1,2]. The current pandemic is changing priorities for the general population, but it is also challenging the agenda of health professionals, including that of psychiatrists and other mental health professionals [3]. Everywhere in the world, psychiatric clinics are modifying their practice in order to guarantee care and support to persons with mental health problems, but also to those who are not mentally ill and are suffering from the psychosocial consequences of the pandemic. The number of those who will need psychiatric help is going to increase in the next weeks or months, requiring a reconsideration of our current practices. From a psychopathological viewpoint, the current pandemic is a relatively new form of stressor or trauma for mental health professionals [4]. It has been compared with natural disasters, such as earthquakes or tsunamis [5]. But in those cases, the emergencies are usually localized, limited to a specific area and to a given time; people know that they can escape, if they want to or if they have the possibility to do so [6]. It has also been compared with wars and international mass conflicts. But in those circumstances, the enemy is easily recognizable, while in pandemic the “threat” can be everywhere and it can be carried by the person next to us [7]. We consider that the mental health and psychosocial consequences of the COVID-19 pandemic may be particularly serious for at least four groups of people: (a) those who have been directly or indirectly in contact with the virus; (b) those who are already vulnerable to biological or psychosocial stressors (including people affected by mental health problems); (c) health professionals (because of higher level of exposure); and (d) even people who are following the news through numerous media channels. The pandemic and the related containment measures—namely quarantine, social distancing, and self-isolation—can have a detrimental impact on mental health. In particular, the increased loneliness and reduced social interactions are well-known risk factors for several mental disorders, including schizophrenia and major depression. Concerns about one’s own health and that of their beloved ones (particularly elderly or suffering from any physical illness), as well as uncertainty about the future, can generate or exacerbate fear, depression, and anxiety. If these concerns are prolonged, they may increase the risk of serious and disabling mental health conditions among adult males and females, including anxious disorders including panic, obsessive–compulsive, stress, and trauma-related disorders. A group at a particularly high risk is represented by infected people, physicians, and nurses working in emergency units and resuscitation departments. It is likely that in the next months—when the pandemic is over—we may have a shortage of health professionals due to burnout and mental exhaustion [8]. Another aspect which should be considered is related to stigma and discrimination toward infected people and their family members. Fighting social stigma toward those treating and caring for people with COVID-19 should be another priority for mental health professionals in the next months. Finally, Internet is spreading very rapidly a large amount of uncontrolled news. This information overload has been defined “infodemic,” with the risk of fake news running faster than the virus itself, and creating uncertainties and worries. This should be regulated by a continuous interaction with media and also by national regulations. Another consequence of the pandemic on mental health practice may be that psychiatric problems will be considered less important than physical ones. We should continue to advocate for our patients and their caregivers; our patients often need long-term treatment, continuous support and advices, personal meetings with their physicians or therapists. Their rights to be treated, also in a period of social distancing, should be preserved even though mental health services may be overloaded by a considerable number of requests for psychiatric consultations. Many of these psychosocial and mental health consequences of the pandemic will have to be addressed by psychiatrists and mental health professionals in the months to come. Most probably we will face an increase of mental health problems, behavioral disturbances, and substance-use disorders, as extreme stressors may exacerbate or induce psychiatric problems. In order to reduce the risk of developing mental health problems, simple advices may be provided to the general population: 1. Limit the sources of stress: to rely on a limited amount of official information sources only and to limit the time of the day devoted to this activity, disregarding those which come from unofficial channels and uncontrolled sources. 2. Break the isolation: to increase the communication with friends, family members, and loved ones, even if at a distance. Video-chat or group calls with family members may help to reduce loneliness and precariousness. In case of insufficient social network, professional helplines are particularly useful, if managed by qualified trained professionals. 3. Maintain your usual rhythm: keep a regular routine, by having regular sleep–wake rhythms and diet patterns. Addictive behaviors might be particularly at risk of rebound or relapses, therefore intellectual, physical, and social (even if virtual) activities will be useful. 4. Focus on the benefit of the isolation: we should indeed be conscious that this is a transient period and that this isolated time is needed as we are not only saving our health, but also protecting all others by stopping the epidemic, and therefore shaping our own future. 5. Ask for professional help: getting a psychiatric help or consultation, if the effects of stress is becoming too invasive, is always possible, even if with different modalities. Almost all psychiatric clinics are now equipped for providing support, emotional defusing, problem-solving strategies, and psychiatric consultations—also at a distance. The pandemic will be over, but its effects on mental health and well-being of the general population, health professionals, and vulnerable people will remain for a long time. We hope that all of the mental health community will have very quickly the opportunity to take care of patients in more conventional and personalized ways. Crises also reveal resilience skills and quality of links, the solidarity observed between European countries for severe cases (exchanging patients, material, and competencies) is a nice example to follow.
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                Author and article information

                Journal
                Eur Psychiatry
                Eur. Psychiatry
                EPA
                European Psychiatry : the journal of the Association of European Psychiatrists
                Cambridge University Press (Cambridge, UK )
                0924-9338
                1778-3585
                2020
                29 May 2020
                : 63
                : 1
                : e58
                Affiliations
                [ 1 ] Institute of Psychology, University of Bern , Bern, Switzerland
                [ 2 ] Department of Psychiatry, Child and Adolescent Psychiatry Service, Lausanne University Hospital , Lausanne, Switzerland
                [ 3 ] Djavad Mowafaghian Center for Brain Health, University of British Columbia , Vancouver, British Columbia, Canada
                [ 4 ] Department of Psychiatry, University of British Columbia , Vancouver, British Columbia, Canada
                [ 5 ] Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York, USA
                [ 6 ] Department of Psychiatry, Faculty of Medicine, University of Geneva , Geneva, Switzerland
                [ 7 ] Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine , New York, New York USA
                Author notes
                Dominik A. Moser, E-mail: domamoser@ 123456gmail.com
                Author information
                https://orcid.org/0000-0001-7119-1033
                https://orcid.org/0000-0001-8883-9473
                https://orcid.org/0000-0003-1663-6305
                Article
                S0924933820000565
                10.1192/j.eurpsy.2020.56
                7303469
                32466820
                8f7d7d62-4d92-4a87-8736-938ad771eb81
                © The Author(s) 2020

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 21 April 2020
                : 15 May 2020
                : 19 May 2020
                Page count
                Tables: 2, References: 60, Pages: 7
                Categories
                Research Article

                Clinical Psychology & Psychiatry
                alcohol use disorder,covid-19,depression,longevity,psychosocial stress,suicide

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