Characteristics of individuals receiving telemedicine mental health services using mindfulness: Cases in South Korea during the COVID-19 pandemic.

Coronavirus disease 2019 (COVID-19), an infectious disease known to have first occurred in Wuhan, China in December 2019 (World Health Organization, 2020), affects the global population and the World Health Organization (WHO) declared it a pandemic on March 11, 2020 (Cucinotta and Vanelli, 2020). COVID-19 usually causes physical symptoms such as fever, muscle pain, fatigue, and dyspnea, and can potentially induce serious conditions such as “cytokine storms” that can lead to death (Cascella et al., 2020). However, the negative psychological impacts of COVID-19 are much broader, not only on infected patients but the unaffected public (Rajkumar, 2020). According to an online survey assessing the harmful impacts of COVID-19 on mental health among 1210 individuals from the general population, 16.5 % had moderate-to-severe depression symptoms, 28.8 % complained of moderate-to-severe anxiety symptoms, and 8.1 % had moderate-to-severe stress (Wang et al., 2020).

In South Korea, the Association of Korean Medicine has established the COVID-19 telemedicine center of Korean medicine (KM) to provide telemedicine services to COVID-19 patients and the general public. By March 9th, 2020, more than 20 % of all patients with COVID-19 in South Korea have received medical services at this center. Notably, a mental health counseling manual including mindfulness-based interventions (MBIs) centered around mindfulness meditation was provided to those complaining of mental health problems (Supplementary material 1). Undoubtedly, human beings are currently in the tragedy and uncertainty of the COVID-19 pandemic, but this highlights the weaknesses of existing public health system and especially the importance of mental health, which may consequently be an opportunity for better preparedness (Tandon, 2020). In this letter, the characteristics of individuals who received mental health counseling at the center were analyzed, which would help develop optimal mental healthcare manuals for individuals who were either directly or indirectly affected by COVID-19.

An institutional review board approval for this study was exempted for full review at the Korea Institute of Oriental Medicine for the use of medicinal records (number I-2004/003-003). The basic demographics of individuals who were counseled by KM doctors using the mental health counseling manual (Kwon et al., 2020) from March 22 to April 26, 2020 at the center were analyzed. At the initial interviews, the numerical rating scale (NRS) was assessed that included the following psychological and physical symptoms: overstrain, fear, anxiety, lethargy/depression, insomnia, dyspepsia, pain, and anger/irritability. The evaluation involved a three-step approach, and the mind-body modalities applicable to individual symptoms were provided as text messages and a YouTube video (https://youtu.be/7XCZIgxkPeE) as previously described (Kwon et al., 2020).

A total of 190 individuals were analyzed. The majority were females (n = 147, 77.4 %), and in their 20 s (n = 59, 31.1 %) and 50 s (n = 46, 24.2 %). Most were free from hypertension, diabetes, hyperlipidemia, cancer, and chronic respiratory disease. The majority were released from isolation after the confirmation of COVID-19 and the symptoms were treated or managed (n = 176, 92.6 %). However, a small number of confirmed patients also received the telemedicine service while still in isolation (n = 13, 6.8 %). Most were staying at home (n = 179, 94.2 %) and few were hospitalized (n = 10, 5.3 %). More than 90 % were from the Daegu–Gyeongbuk region (n = 176, 92.6 %) (Supplementary material 2), where is the place where a large-scale outbreak of COVID-19 occurred in mid-February 2020 in relation to other regions in South Korea. Regarding psychological and physical symptoms, the NRS scores were 3.1 ± 3.22 for pain and 5.5 ± 3.27 for fear. In general, psychological symptoms including overstrain, fear, anxiety, and insomnia were more pronounced than physical symptoms. More than half of the participants had NRS scores of 5 or higher for overstrain (63.6 %), fear (64.1 %), anxiety (56.1 %), and insomnia (53.0 %). In addition, more than 20 % of the participants had NRS scores of 8 or higher for overstrain (21.7 %), fear (32.8 %), anxiety (24.7 %), and insomnia (27.3 %) (Fig. 1 ) (Supplementary material 3).

Fig. 1

The COVID-19 telemedicine center of Korean medicine.

Some clinical studies (Huang et al., 2020; Wei et al., 2020; Zheng et al., 2020) have reported the benefits of MBIs as a promising strategy for improving public mental health in the COVID-19 pandemic, and our findings can be used to optimize the strategies in pandemics like COVID-19. However, the following limitations should be considered. First, psychological and physical symptoms of individuals were evaluated using NRS rather than a validated mental health assessment tool. Due to the nature of telemedicine, it was difficult to use a validated tool in a non-face-to-face manner and therefore the content of the questionnaire was minimize. Second, the symptom evaluation was conducted only at initial counseling; therefore, the impact of mental health counseling at the COVID-19 telemedicine center of KM was not assessed. Third, this letter showed that overstrain, fear, anxiety, and insomnia are important symptoms of the adverse psychological impacts of COVID-19, and fear was the most prominent. However, the authors did not have enough data to assess the causes or potential mediators of these negative psychological symptoms. Since they are interrelated, mediator analysis can help determine the optimal target.

Author contributions

The study was conceptualized by CYK. The characteristics of individuals who received mental health counseling at the COVID-19 telemedicine center of KM were analyzed by CYK. All authors have read and approved the final version of the manuscript.

Funding

This research received no external funding.

Declaration of Competing Interest

The authors report no declarations of interest.