Experts speaking at the March 26 SPH coronavirus seminar Mental Health in a Time of Crisis: Sandro Galea, SPH dean (clockwise from top left), Patricia Watson, Dartmouth Geisel School of Medicine, Karestan Koenen, Harvard T. H. Chan School of Public Health, and Sarah Lowe, Yale School of Public Health. Photo courtesy of BU School of Public Health

Mental Health

How to Reduce the Psychological Harm of the COVID-19 Pandemic

SPH coronavirus seminar: mental health experts stress need for social support

To slow the spread of the novel coronavirus that has sickened half a million people and killed more than 25,000 globally, everyone now knows to wash their hands for at least 20 seconds, cough and sneeze into their elbows or tissues, avoid touching their face, stay at least six feet from others, and remain home and self-quarantine when feeling unwell.

“We need a similar five for mental health,” Karestan Koenen, a Harvard T. H. Chan School of Public Health professor of psychiatric epidemiology, suggested March 26 at the second event in the School of Public Health Coronavirus Seminar Series, Mental Health in a Time of Crisis, moderated by Sandro Galea, dean of SPH and Robert A. Knox Professor. The online seminar drew an audience of 3,200, maxing out the Zoom conference capacity and spilling over onto Facebook Live.

The COVID-19 pandemic is unprecedented, Koenen said, but its mental health consequences are becoming clear. She said that in China, where COVID-19 now appears to be under control and in decline, research published this week found depression and anxiety in about half of the population.

Recent epidemics also show the heavy mental health toll of such events, she said, noting that the majority of people in parts of Sierra Leone affected by Ebola had depression and/or anxiety symptoms a year after the outbreak.

The current pandemic has “multiple qualities that are toxic to mental health,” Koenen said, and there are constant visual reminders, from news showing overwhelmed hospitals in New York City and coffins in Italy to the empty shelves in local supermarkets. The newness of this coronavirus brings tremendous uncertainty, she noted, and population-wide isolation measures to prevent spread of the disease cuts people off from their friends and families or traps them in difficult, and even dangerous, home environments. Xenophobia has reached every level of society, from verbal and physical abuse of Asian Americans in public spaces to the president’s references to the “Chinese virus.” And losing loved ones, as well as opportunities and economic stability, is bringing widespread grief.

“We need a concerted public health effort to address mental health in the COVID-19 pandemic,” she said. “We know it’s going to be a problem, and it’s something we need to address proactively.”

Koenen’s five recommendations for taking on the mental health consequences of COVID-19 begin with identifying that there is a problem. Next is broadening the safety net, based on overwhelming evidence that “by buffering people from the economic consequences and the other social consequences of the pandemic, we are also protecting people’s mental health.”

Third, we have to support those most at risk for trauma, including people with existing mental health problems, families in conflict and/or with histories of domestic violence, families with children with special needs, people who were already isolated before the pandemic, and people working in health care. “There are a lot of at-risk populations, which again argues for a population mental health approach,” Koenen said.

She also recommended building up resilience strategies for individuals and communities. Her last point: we need “to be kind to ourselves and to each other, to our families, and to our neighbors, because we are all under so much stress.

“All of us, everyone is essential to victory over the virus, and over all of its consequences,” she said.

Another featured speaker, Sarah Lowe, a Yale School of Public Health assistant professor of social and behavioral sciences, described some of the ways that individuals and communities can reduce the pandemic’s mental health harms.

Lowe warned that reading and watching too much about this traumatic event is harmful, so it’s a good idea for individuals and families to limit news and social media consumption. Communities can also reduce exposure by protecting one another from COVID-19 and its social and economic harms through community organizing.

She also stressed the importance of how a person copes with the feelings arising from the pandemic. “Research has shown that people who have very intense fear, worry, anger, and grief during mass trauma tend to fare worse—but on the other hand, these are all normal reactions to an abnormal situation,” she said. “The strategies that we use to cope really shape responses, whether a person uses more adaptive strategies like mindfulness and acceptance, cognitive reappraisal, social support-seeking, and exercise, or less adaptive strategies” like dwelling on the problem, binge eating, or substance use.

Lowe’s answer to a question from the audience about how leaders can help model healthy responses to the pandemic stressed the importance of validation, while simultaneously instilling hope for the future. “Doing those things in parallel is really important—not telling people that they shouldn’t be afraid or that this isn’t something to be scared of, because it is scary and people are rightly worried, but at the same time we, as a community, are strong, and that we will get through this and support each other.”

In fact, she said, getting through this difficult time will make many people more resilient: “Most trauma survivors report at least some degree of what’s called post-traumatic growth, including perceived stronger relationships with others, a greater appreciation of one’s life, a sense that new things are possible, that people are stronger than they thought they were, and a stronger sense of faith.”

The third speaker was Patricia Watson, a Dartmouth Geisel School of Medicine assistant professor of psychiatry. She said that while resiliency and recovery is the norm, 10 to 30 percent of the population will likely need some form of mental health treatment for the longer-term mental health effects of the pandemic,  and that will mean unprecedented demand. Watson, who is also a Department of Veterans Affairs National Center for PTSD senior educational specialist, and her colleagues are already “scrambling,” she said, to develop strategies and resources to help individuals develop skills to better handle their own experiences of the pandemic, and support their families, friends, communities, and colleagues.

Some of these resources are already available from the National Center for PTSD, including tips for anyone to manage their own stress from the outbreak, for providers and community leaders to help others manage this stress, and for health care workers to manage their stress.

 She and National Center for PTSD colleagues are also working on creating what she called a “psychological first aid” fact sheet for the COVID-19 pandemic and similar situations, pulling from the Skills for Psychological Recovery Manual (a manual that should ideally be used by a mental health provider or with the help of one). Watson also noted that the manual’s section for helping children at different ages during and after traumatic events is a useful tool during this time.

The overwhelming theme of each speaker was the importance of social support, “which is of course particularly difficult in a time of physical distancing,” said moderator Galea, who is an expert in the mental health effects of mass traumatic events. “Separating physical distancing from social distancing is critical,” he said.

The other speakers agreed, emphasizing the importance of finding ways to stay connected with friends, loved ones, and colleagues—a sentiment that in a seminar conducted over Zoom with thousands of people hit home.

Watch the full recorded Health in a Time of Crisis seminar here. Sign up for next week’s event in the SPH Coronavirus Seminar Series, titled Politics, Health, and Coronavirus, here.