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| LETTER TO EDITOR |
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| Year : 2020 | Volume
: 2
| Issue : 2 | Page : 169-170 |
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The Need for Social Psychiatry Research on the Current COVID-19 Crisis
Alexander Kaltenboeck
Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| Date of Submission | 17-May-2020 |
| Date of Acceptance | 29-May-2020 |
| Date of Web Publication | 14-Aug-2020 |
Correspondence Address:
Dr. Alexander Kaltenboeck
Clinical Division of Social Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna
Austria
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/WSP.WSP_34_20
How to cite this article:
Kaltenboeck A. The Need for Social Psychiatry Research on the Current COVID-19 Crisis. World Soc Psychiatry 2020;2:169-70 |
The current coronavirus disease 2019 (COVID-19) pandemic, caused by the rapid spread of SARS-CoV-2, undeniably represents one of the biggest challenges that humanity had to face on a global scale in the last decades. In many countries, the pandemic has not only taken a huge toll in terms of morbidity and mortality,[1] but has also led to considerable changes of societal life, including changes in family and social interactions, employment, health care and medical services, communication in the (social) media, and welfare and social security. As Austrian psychiatric services were adapting to the COVID-19 pandemic in the last months, it has become increasingly clear that this crisis also has several important implications from the perspective of social psychiatry.
First, a subject of intense discussion – both from the medical and at least in Austria also from the welfare/social state's point of view – concerns the identification of people who are at increased risk of contracting a SARS-CoV-2 infection or of showing a more severe course of COVID-19. Surprisingly, little scientific attention has been given to date to the role of mental disorder in this context. However, there are good theoretical reasons to believe that patients suffering from certain neuropsychiatric conditions might be more vulnerable to SARS-CoV-2 – either due to specific psychopathological features of their disorder, the treatments they receive, or common comorbidities associated with their illness. For example, patients with schizophrenia might be more likely to contract a SARS-CoV-2 infection because of limited insight and/or cognitive capacity to follow recommended protective measures (e.g. frequent handwashing and social/physical isolation).[2],[3] Similarly, these patients might also be more prone to experiencing a less favorable outcome in case of infection, because of common mental and physical comorbidities (e.g. substance abuse, diabetes, and cardiovascular disease), side effects of antipsychotics that can worsen during an immune response (e.g. sedation, impaired swallowing, and hypersalivation), as well as difficulties in gaining timely access to medical services due to stigma and discrimination.[2] It is thus of critical importance that further research is dedicated to probe to what extent mental disorders might increase vulnerability in the current pandemic.
Second, in many countries, the COVID-19 crisis has led to the adoption of drastic outbreak control and prevention efforts, including societal lockdowns, enforced quarantine, suspension of work in offices, recommendation of extra hygiene measures, etc. These measures are targeted at the general public and some of their psychosocial (adverse) effects have been characterized in previous epidemics (e.g. SARS or Ebola).[4] However, little is known about the effects and sequelae of these public health interventions on people suffering from mental disorders.[5] Yet, the lived reality of many psychiatric patients differs significantly from that of the general public. For example, for many patients, social isolation, a lack of motivation or a fear to leave one's own house, or an uncontrollable compulsion to wash one's hands repeatedly have already been symptoms of their mental disorders long before the COVID-19 pandemic – and in the face of COVID-19 prevention recommendations might now become seriously aggravated. In a similar vein, in order to maintain good psychological functioning, many patients require regular psychiatric and laboratory checkups, prescription and/or administration of medication (especially relevant in the case of long-acting injectable antipsychotics), or in-person support from social workers – all of which have become drastically reduced due to disease prevention efforts. Taken together, this suggests that psychiatric patients might be differentially affected by the COVID-19 pandemic and its associated prevention efforts compared to the general public,[6] and it should be a key priority of social psychiatric research to interrogate this topic closer.
Third, the COVID-19 pandemic has already taken a gigantic toll on human life and health and has had major socioeconomic consequences, which are probably going to worsen in the near future. Some of the consequences of the current crisis, such as high numbers of unemployment, have previously been linked to adverse effects on population mental health. For example, a study performed during the economic crisis in 2008 showed that every 1% increase in unemployment was associated with a 0.79% rise in suicides at ages younger than 65 years.[7] It is thus to be expected that the socioeconomic consequences and the traumatic experience of the pandemic will have a considerable impact on the incidence and prevalence of mental health problems in the months to come – likely not just suicide, but also trauma-related disorders, affective disorders, and substance abuse.[5] In order to contribute its share in the global fight against SARS-CoV-2, it will therefore also be a major task for social psychiatry to monitor and quantify the adverse effects of the COVID-19 crisis on population mental health and to develop and propose suitable countermeasures.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | |
| 2. | Kozloff N, Mulsant BH, Stergiopoulos V, Voineskos AN. The COVID-19 global pandemic: Implications for people with schizophrenia and related disorders. Schizophrenia Bull 2020. pii: sbaa051.  |
| 3. | Brown E, Gray R, Lo Monaco S, O'Donoghue B, Nelson B, Thompson A, et al. The potential impact of COVID-19 on psychosis: A rapid review of contemporary epidemic and pandemic research. Schizophr Res 2020. pii: S0920996420302577. |
| 4. | Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020;395:912-20. |
| 5. | Holmes EA, O'Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, et al. Multidisciplinary research priorities for the COVID-19 pandemic: A call for action for mental health science. Lancet Psychiatry 2020;7:547-60. |
| 6. | Yao H, Chen JH, Xu YF. Patients with mental health disorders in the COVID-19 epidemic. Lancet Psychiatry 2020;7:e21. |
| 7. | Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. The public health effect of economic crises and alternative policy responses in Europe: An empirical analysis. Lancet 2009;374:315-23. |
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