The novel coronavirus outbreak has received a lot of attention worldwide as the number of confirmed cases and deaths continue to climb and isolated cases are being reported abroad. In the meantime, mental health care for those affected by the outbreak, including confirmed coronavirus patients, suspected patients, quarantined family members, and medical personnel, has been under-addressed. A study conducted by the research team of Prof Yutao XIANG from the University of Macau (UM) Faculty of Health Sciences draws attention to this issue and has been recognised by the authoritative international journal Lancet Psychiatry. Titled ‘Timely Mental Health Care for the 2019-nCoV Outbreak is Urgently Needed’, the paper draws experience from global epidemic outbreaks in the past and discusses the importance of initiating mental health assessment, treatment, and interventions as part of the anti-epidemic campaign against the novel coronavirus outbreak.
During the epidemic outbreak, confirmed patients and suspected patients may worry about the grave consequences of this potentially deadly virus and experience a range of negative emotions such as feelings of helplessness, loneliness, and anger. In extreme cases, patients may even refuse treatment or commit violence or suicide. The physical symptoms experienced by these patients, such as fever, dyspnea, and cough, can also aggravate the above mental health problems. In addition, those who have been quarantined, including family members of the patients and close contacts, may worry about being discriminated by others and experience feelings of guilt. For frontline medical personnel, they usually experience more psychological problems because they are at a greater risk of catching the virus. The worry about catching the virus themselves and spreading it to their family members, friends, and colleagues can lead to severe anxiety and insomnia. Although these mental health problems are common among patients and their family members affected by the outbreak, most medical personnel working in isolation wards have never received professional training in psychiatry or clinical psychology and thus do not know how to handle them.
According to the study, although the clinical features of the novel coronavirus is not identical to those of the severe acute respiratory syndrome (SARS), there are many similarities between the two in terms of the source of infection, epidemiological characteristics, the rapid form of transmission, and the inadequate preparations among health authorities for the outbreak. Part of the response plans adopted during the SARS outbreak in 2003 may help health officials head off some of the more serious consequences from this virus outbreak. Concrete suggestions include the following: First, local health authorities should form multidisciplinary (psychiatric and clinical psychological) teams comprised of psychiatrists, psychiatric nurses, and clinical psychologists, in order to provide appropriate psychological interventions and support for patients, quarantined family members and close contacts, as well as frontline healthcare providers. For patients who have already developed severe mental disorders, psychiatric treatment should be provided immediately. Second, in order to reduce the feelings of uncertainty and fear about the epidemic among patients and medical personnel, the government and the media should release accurate and real-time information on the development of the epidemic to the general public. Meanwhile, the teams should closely monitor the infected patients and their family members to build their confidence in treatment. Also, remote online psychological counseling service can be provided through WeChat and other media platforms to patients and quarantined people to reduce their sense of isolation. Third, the teams should conduct regular mental health screening for depression, anxiety and suicidal thoughts among infected patients, and provide timely intervention if necessary. Regarding the use of psychiatric drugs, the teams should prescribe based on the physical conditions of patients diagnosed with the 2019-nCoV pneumonia. They should also pay attention to the medication doses and the interactions between different drugs.
According to Prof Yutao XIANG, fear, a feeling of uncertainty, and suffering from the stigma of getting infected are common among people affected by epidemic outbreaks and these symptoms may seriously affect the outcomes of clinical treatment. Based on previous experience in the prevention and control of several worldwide acute infectious diseases, the implementation of comprehensive psychological tests and timely psychological treatment and intervention is of great significance in the fight against the 2019-nCoV pneumyutaonia.
Prof Xiang is a professor in the Faculty of Health Sciences and a registered psychiatrist. Since 2007, he has published more than 410 papers in leading SCI-indexed international journals, including Lancet, Lancet Psychiary, JAMA Psychiatry, World Psychiatry, and Am J Psychiatry. He has received more than ten international scientific research awards. His main research interests include psychiatry clinical medicine, clinical evidence-based medicine, and clinical epidemiology of psychiatry.
Prof Yutao XIANG
UM front-line service providers