The epidemic of the 2019 novel coronavirus SARS-CoV-2 leads to a global public health emergency with multifaceted severe consequences for people’s lives and their mental health (3). Especially, psychological factors play an important role in adherence to public health measures and in how people cope with the threat of infection and consequent losses (1). We should also recognize that, even in the normal course of events, people with established mental illness have a lower life expectancy and poorer physical health outcomes than the general population (3). So, coping with this new and threatening stress is very important. But before we look at the different coping strategies, we should consider how we develop mental illnesses. Therefore, we need to know what stress is.
“Stress” often represents the effects of anything that seriously threatens our homeostasis. In reaction to a stressor, our stress systems then have evolved to respond in highly adaptive ways, thereby enabling humans to deal with these challenges (3). On the one hand, you can deal with the stressor which means that your stress system can challenge the stressor and so generate in long-term more resources to deal with other, more challenging stresses, in the future. This principle is called eustress (3). Distress on the other hand means exactly the opposite, that your stress system does not successfully deal with the stress (3). This can lead then to exhaustion and burnout. You will see an overview of the difference between eustress and distress in Figure 1.
Figure 1 Eustress and Distress (Source: https://media.springernature.com/original/springer-static/image/chp%3A10.1007%2F978-3-319-24187-6_1/MediaObjects/322065_1_En_1_Fig3_HTML.gif, Retrieved from 26.04.2021)
So, now we know what the reasons for mental stress are. It is also very important to consider, that the impact of stress like the current pandemic will be highly heterogeneous. This means, that everybody of us deals differently with stress (3). But what are now the reasons why we generate mental illnesses during a pandemic? Recent studies show that the impact of the pandemic is different among the different countries and people. A Survey by the Indian Psychiatric Society shows for example a 20% increase in mental illnesses since the coronavirus outbreak in India (2). Another study of 1210 respondent from 194 cities in China in January and February 2020 found that 54% of respondents rated the psychological impact of the Covid-19 outbreak as moderate or severe; 29% reported moderate to severe anxiety symptoms, and 17% reported moderate to severe depressive symptoms (1). So, we see that mental consequences due to the coronavirus are there and widely spread under the population, which leads to the question what are the health risk factors.
One big reason is the pervasive uncertainty which makes it difficult to plan and thus generates additional psychosocial stress (3). In addition, the stressor is new, and there is also an absence of warning precluded preparation and pre-adaptation, and unknown long-term health and society-related implications of the virus (3). Further factors which can influence mental risks are living conditions, poverty, poor access to healthcare, illiteracy, uncertainty about the future, genetic background, previous life experiences, and social support (3). Furthermore, people are getting overloaded with rumors and misinformation which are not authentic and verified (2). And at least, there is currently a lack of mental health professionals, practitioners, counselors, and health facilities (2). These listed risk factors can now lead to many mental illnesses.
Anxiety and distress (1, 3)
Possible stress-related reactions in response to the coronavirus pandemic may include changes in concentration, irritability, anxiety, insomnia, reduced productivity, and interpersonal conflicts (3)
Chances of developing neurotic disorders such as generalized anxiety disorder and obsessive-compulsive disorders (2)
Increase in cases of depression, suicide, and self-harm, apart from other symptoms reported globally due to COVID 2019 (2)
Psychological reactions to pandemics include maladaptive behaviors, emotional distress, and defensive responses (1)
Health and social care professionals will be mainly affected by these risks (1, 3). But what are now the strategies to compensate for these mental risks. One Strategy can be social connectedness as good as possible (3). Also planning a routine for day-to-day activities and promoting self-care can be a good choice (3). In addition, it is known that exercise and nutrition promote resilience (3). Furthermore, try to improve your controllability about stressful situations. So, feel always in control and be able to exert control of the situation as much as possible (3). Finally, meditation and breathing exercises can have a health effect on us. You will see in Figure 2 an example of different coping strategies forms the Beth Israel Lahey Health Centre.
Figure 2 Coping Strategies (Source: https://www.bidmc.org/-/media/rich-text-images/beth-israel-org/about-bidmc/wellness-insights/covid-19-health-and-wellness/bidmc-covid-19-anxiety-infographic-1000px.jpg?h=525&w=1000, Retrieved from 26.04.2021)
Summarized, we see that different coping strategies are very important to deal with this new and threatening stress because of the heterogeneity of the risk factors and due to the different stress resources, each individual has to cope with stresses. So, there is an urgent need of augmenting our focus on resilience and on strategies to enhance it as resilience is pivotal to cope with the stress imposed by the virus outbreak at the individual and societal level (3). But it does not mean that every one of us will be affected by this situation. As I already said, the reactions are individually and heterogeneous. Also, many facts in this article are mostly speculations because of the newness of this situation. But these strategies are not only helpful for this specific situation. It can help you in your daily life. Therefore, you will get instruction for a simple stress-reducing technique on Friday.
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(1) Cullen, W., Gulati, G., & Kelly, B. D. (2020). Mental health in the Covid-19 pandemic. QJM: An International Journal of Medicine, 113(5), 311-312.
(2) Kumar, A., & Nayar, K. R. (2020). COVID 19 and its mental health consequences. Journal of Mental Health, 180(6), 817-8.
(3) Vinkers, C. H., van Amelsvoort, T., Bisson, J. I., Branchi, I., Cryan, J. F., Domschke, K., ... & van der Wee, N. J. (2020). Stress resilience during the coronavirus pandemic. European Neuropsychopharmacology, 35, 12-16.
Fatke, B., Hölzle, P., Frank, A., & Förstl, H. (2020). Psychische Probleme in der Pandemie–Beobachtungen während der COVID-19-Krise. DMW-Deutsche Medizinische Wochenschrift, 145(10), 675-681.
Pfefferbaum, B., & North, C. S. (2020). Mental health and the Covid-19 pandemic. New England Journal of Medicine, 383(6), 510-512.
World Health Organization. (2020). Mental health and psychosocial considerations during the COVID-19 outbreak, 18 March 2020 (No. WHO/2019-nCoV/MentalHealth/2020.1). World Health Organization.