Mental health and a novel coronavirus (2019-nCoV) in China.

The novel coronavirus (2019-nCoV) outbreak that began in Wuhan, China, can cause severe respiratory illnesses, such as severe acute respiratory syndrome (SARS-CoV) (Lancet, 2020), and it has become a global public health emergency. The World Health Organization (WHO) has declared the 2019-nCoV outbreak to be a Public Health Emergency of International Concern (PHEIC). As of to 6 Feb 2020, a total of 28,129 cases of 2019-nCoV were confirmed in China, with 564 deaths and 1354 recovered patients. The latest mortality rate was approximately 2.0%, with 24,702 cases still suspected. Although no vaccine or antiviral treatment for human and animal coronavirus has been confirmed by clinical experiments (Lu, 2020), psychotherapy and pharmacotherapy interventions for the stressful impact of the 2019-nCoV outbreak should be given more attention in infected patients suspected persons, observed persons, and health care workers in close contact with the infected patients.

The outbreak of SARS-CoV in 2002 and 2003 in Guangdong Province, China, was regarded as a “mental health catastrophe” (Mak et al., 2009). Mak et al. found that the cumulative incidence of psychiatric disorders was up to 58.9% (53/90) after the SARS-CoV outbreak (Mak et al., 2009). Among these 53 survivors, 42 (44%) and 43 (47.8%) survivors suffered from depressive disorders and posttraumatic stress disorder (PTSD) at some time point after their infection, respectively (Mak et al., 2009). The outbreak of SARS-CoV was associated with depression, anxiety, fatigue, pain, weakness and sleep disturbance (Moldofsky and Patcai, 2011). Thus, it is of great significance to carry out regular screening for mental health issues and implement effective interventions in fighting against 2019-nCoV.

The number of deaths related to 2019-nCoV is quickly increasing (Huang et al., 2020), leading to feelings of helplessness, social isolation, anxiety, depression, sleep disturbances, aggression, and suicidal behavior among the confirmed patients and suspected persons. The infection symptoms, such as fever, hypoxia and cough, can also precipitate or aggravate the above mental health problems. In SARS-CoV survivors, being a women and having a low education level were positively associated with avoidance symptoms (Wu et al., 2005). Observed persons who have been quarantined are likely to fear not only for their own safety but also for the safety of their family members. Similarly, Grace et al found that health care workers who provided direct care to patients infected with SARS-CoV reported greater stigmatization and psychological distress than those who did not provide such care (Grace et al., 2005). Although the above mental health problems are common in 2019-nCoV patients, suspected persons, observed persons, and health care workers, most of the health care workers in the isolation ward have not received formal training in mental health psychiatry and psychology.

The stressful impact of the 2019-nCoV may be qualitatively distinct from the stress of other disasters, especially for health care workers in close contact 2019-nCoV patients. In particular, the stressful impact of an emerging infectious disease may attributed to the following two aspects: (1) exposure to infectious disease requires interpersonal isolation resulting from the nature of the efforts of health care workers to contain the threat (such as isolation precautions) and the threat itself (such as stigma and avoidance of contact) (Maunder, 2004); (2) health care workers are concerned about infecting their friends and family. Thus, exposure to contagion reduces the availability of social and family support, which is involved in buffering the impact of stress. When health care workers become infected with 2019-nCoV, the sudden role reversal from a care provider to a patient can lead to substantial adjustment challenges, including feeling frustrated and helpless. Fear of discrimination and stigmatization potentially hampers health care workers from seeking psychotherapy and pharmacotherapy interventions.

Given the high prevalence of psychiatric disorders among SARS-CoV survivors (Mak et al., 2009), the management of 2019-nCoV patients and 2019-nCoV survivors should not only focus on infectious disease treatments. Possible long-term psychiatric sequelae, such as depression and PTSD, should be alerted by health care workers who are responsible for following up with 2019-nCoV survivors. This study emphasizes the importance of screening, preventing and treating psychiatric comorbidities, which may exert a profound influence on recovery from psychiatric diseases.

Declaration of Competing Interest

The authors declare no conflicts of interest.