Patients with mental health disorders in the COVID-19 epidemic

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Abstract

More than 60 000 infections have been confirmed worldwide in the coronavirus disease 2019 (COVID-19) epidemic, with most of these cases in China. Global attention has largely been focused on the infected patients and the frontline responders, with some marginalised populations in society having been overlooked. Here, we write to express our concerns with regards to the effect of the epidemic on people with mental health disorders. Ignorance of the differential impact of the epidemic on these patients will not only hinder any aims to prevent further spread of COVID-19, but will also augment already existing health inequalities. In China, 173 million people are living with mental health disorders, 1 and neglect and stigma regarding these conditions still prevail in society. 2 When epidemics arise, people with mental health disorders are generally more susceptible to infections for several reasons. First, mental health disorders can increase the risk of infections, including pneumonia. 3 One report released on Feb 9, 2020, discussing a cluster of 50 cases of COVID-19 among inpatients in one psychiatric hospital in Wuhan, China, has raised concerns over the role of mental disorders in coronavirus transmission. 4 Possible explanations include cognitive impairment, little awareness of risk, and diminished efforts regarding personal protection in patients, as well as confined conditions in psychiatric wards. Second, once infected with severe acute respiratory syndrome coronavirus 2—which results in COVID-19—people with mental disorders can be exposed to more barriers in accessing timely health services, because of discrimination associated with mental ill-health in health-care settings. Additionally, mental health disorder comorbidities to COVID-19 will make the treatment more challenging and potentially less effective. 5 Third, the COVID-19 epidemic has caused a parallel epidemic of fear, anxiety, and depression. People with mental health conditions could be more substantially influenced by the emotional responses brought on by the COVID-19 epidemic, resulting in relapses or worsening of an already existing mental health condition because of high susceptibility to stress compared with the general population. Finally, many people with mental health disorders attend regular outpatient visits for evaluations and prescriptions. However, nationwide regulations on travel and quarantine have resulted in these regular visits becoming more difficult and impractical to attend. Few voices of this large but vulnerable population of people with mental health disorders have been heard during this epidemic. Epidemics never affect all populations equally and inequalities can always drive the spread of infections. As mental health and public health professionals, we call for adequate and necessary attention to people with mental health disorders in the COVID-19 epidemic.

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Mental health in China: challenges and progress.

Helen F K Chiu, Norman Sartorius, Gabor Ungvari … (2012)

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Comorbidity of mental and physical diseases: a main challenge for medicine of the 21st century

Norman Sartorious (2013)

Over the past two decades the prevalence of comorbid mental and physical diseases has increased dramatically, reaching epidemic proportions in many countries. In persons over the age of sixty the simultaneous presence of two or more diseases has become the rule rather than an exception. Comorbidity is also increasing rapidly at younger ages where the negative consequences of comorbid conditions are as numerous and as troublesome as those that occur at a higher age. There is every reason to believe that this increasing trend in the proportion of individuals who have comorbid conditions will continue in the years to come. This prediction is based on several facts: first, the successes of medicine in prolonging life without curing disease makes it easier to simultaneously contract two or more illnesses; second, demographic changes (with an increased proportion of the population reaching a higher age) increase the time individuals are at risk for a number of late-onset diseases; third, the epidemic spread of unhealthy life styles increases the likelihood of occurrence of several diseases which tend to appear together–such as cardiovascular diseases and diabetes; and fourth, it is possible that deterioration of the environment will lead to a higher intake of pollutants and abnormalities in the immunological system of humans and, thus, facilitate the occurrence of allergic and other diseases. Comorbidity does not mean the simple addition of two diseases that independently follow their usual trajectories. The simultaneous presence of two or more diseases will worsen the prognosis of all the diseases that are present, lead to an increasing number (and severity) of complications, and make the treatment of all of them more difficult and, possibly, less efficacious. A series of reviews published in recent years provides ample confirmation of these findings.[1]–[7] What is worse is that one of the comorbid diseases is often overlooked. This is particularly true for mental illnesses which are frequently comorbid with physical illnesses. Non-psychiatric specialists and general practitioners are usually focused on the illness about which they know a great deal and which they wish to treat, often missing or underestimating the importance of mental disorders that might also be present. For them the distinction of the distress that often accompanies serious physical illness (e.g. cancer) and a mental disorder (such as depression) is rarely clear, so they proceed with single-disease treatments in the belief that the psychological symptoms associated with the physical illness will disappear once the physical illness is treated. Specialists in disciplines other than psychiatry and general practitioners avoid making a diagnosis of mental illness – partly because of their uncertainty about the diagnosis and treatment of psychiatric disorders and partly because they would like to avoid the perceived stigmatization of their patients that occurs when they are labeled as 'mentally ill'. Psychiatrists are no better than other specialists at identifying comorbid conditions. They often deal with the mental illness they have extensive experience with and miss or undertreat a comorbid physical illness – often skipping a medical examination which might tell them about the presence of another illness. The admission of psychiatrists' reluctance to deal with physical illnesses in patients whom they treat for a mental illness is most clearly demonstrated in the creation of a special subdiscipline–liaison psychiatry. No other medical discipline has a similar subspecialty; there is no liaison orthopedics or liaison cardiology because it is expected that anyone specialized in orthopedics will care for their patients' cardiac problems and that anyone specialized in cardiology will deal with their patients' orthopedic problems. One can hope that in the future all psychiatrists will acquire sufficient knowledge to diagnose and treat (or refer) non-psychiatric diseases and that the discipline of liaison psychiatry will, therefore, become unnecessary. But we are far from this goal. For the time being we can admire psychiatrists who are able to provide care to people who have a physical as well as a mental disorder and regret that many cannot or do not wish to do so. Another discipline that deserves a comment is that of psychosomatics. Many years ago an expert committee convened by the World Health Organization recommended that the words psychosomatic medicine and psychosomatic illness should be avoided because when these terms are used they imply most diseases (i.e., those that are not psychosomatic) are either purely physical or purely psychological. This recommendation was not widely followed so there are now many specialists in psychosomatic medicine and several professional organizations that promote the discipline of psychosomatic medicine focusing on diseases with physical symptoms in which the role of psychological factors is particularly prominent. Now that the term is firmly established it is important that specialists in psychosomatic medicine, psychiatrists and enlightened clinicians in other fields take it as their goal to promote the notion that all diseases have psychological as well as somatic components and that the treatment of all diseases requires that equal attention be given to both of these components. Appropriate management of comorbidity – at the individual and at the public health level – will require a significant reorientation of medical education and a reorganization of health services. General practitioners can be trained to identify and treat patients with comorbid conditions, but specialists in all disciplines must also assume some of the responsibility for dealing with the issue of comorbidity in the patients whom they treat. Health services will have to be adjusted to the fact that most of the people who come to seek help are likely to suffer from more than one illness. Researchers will have to give more attention to the commonalities in the pathogenesis of mental and physical disorders and to the development and assessment of strategies for the treatment of comorbid conditions. As a first step, all of us will have to accept the fact that comorbidity of various diseases and in particular the simultaneous occurrence of mental and physical disorders is the rule rather than an exception and that we have to approach all our patients with this in mind. We must also make efforts to convince decision makers, educators, clinicians, and community members that comorbidity is one of the most urgent challenges to the quality of health care in the early decades of the twenty first century that must be recognized and dealt with without delay.

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Evaluation of attitudes and knowledge toward mental disorders in a sample of the Chinese population using a web-based approach

Juan Li, Meng-meng Zhang, Lin Zhao … (2018)

Background People with mental disorders often encounter stigmatizing attitudes related to their conditions. Stigma often represents one of the critical obstacles that stand in the way of delivering mental health care. The main aim of the study was to assess the knowledge and attitudes toward mental disorders in a sample of the Chinese population; furthermore, we also aimed to identify and explore the socio-demographic characteristics associated with specific knowledge and attitudes towards psychiatric disorders. Methods A cross-sectional survey was created and delivered through an Internet chat application over the period June–December 2017. The Mental Health Knowledge Questionnaire and the Perceived Devaluation and Discrimination Scale were used to evaluate the participants’ mental health knowledge and attitudes toward mental disorders. Results A total of 1087 participants were recruited in for our survey. The mean score of the MHKQ and PDD were (15.89 ± 2.69) and (33.77 ± 6.66), respectively. Univariate analyses showed that young people and rural residents tended to show more positive attitudes toward mental disorders with respect to older people and urban residents (P < 0.05). People with higher education levels, those who had contact with people with mental disorders, and those who learned about mental disorders by personal encounter resulted to have had higher MHKQ scores (P < 0.05). Conclusions In our sample of the Chinese population, negative attitudes toward mental disorders were often reported. General education programs may not be an effective way to decrease stigma, while anti-stigma campaigns targeted for specific groups, such as urban residents and the older people, should be carried out in the future in China.

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Author and article information

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Yi-Feng Xu

Journal

Journal ID (nlm-ta): Lancet Psychiatry

Journal ID (iso-abbrev): Lancet Psychiatry

Title: The Lancet. Psychiatry

Publisher: Elsevier Ltd.

ISSN (Print): 2215-0366

ISSN (Electronic): 2215-0374

Publication date PMC-release: 19 March 2020

Publication date (Print): April 2020

Publication date (Electronic): 19 March 2020

Volume: 7

Issue: 4

Page: e21

Affiliations

[a ]Harvard TH Chan School of Public Health, Boston, MA, USA

[b ]Shanghai Clinical Research Center for Mental Health, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China

[c ]Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK

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[†]

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[‡]

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Publisher ID: S2215-0366(20)30090-0

DOI: 10.1016/S2215-0366(20)30090-0

PMC ID: 7269717

PubMed ID: 32199510

SO-VID: c064a33f-52af-4d40-94a4-88a852d083fb

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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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Patients with mental health disorders in the COVID-19 epidemic

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Most cited references 3

Mental health in China: challenges and progress.

Comorbidity of mental and physical diseases: a main challenge for medicine of the 21st century

Evaluation of attitudes and knowledge toward mental disorders in a sample of the Chinese population using a web-based approach

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