Psychiatry and Neurosciences in the COVID-19 Era: Current Status and Future Perspectives

Dear Colleagues,

While it is true that the pandemic is a global event that has affected us all, it can trigger very different psychopathological trajectories secondary to various personal and environmental aspects. It is, in fact, the interaction between trauma and individual vulnerability, and not just the extent or severity of trauma exposure, that produces different psychopathological outcomes. Given this premise, it is crucial to consider that there are different categories of exposed individuals at risk of developing mental disorders in the context of the present pandemic.

First, we must consider the individuals who were already suffering from a mental disorder. Like anyone in the community, this category had to, in the medium to long term, deal with isolation and fear of contagion. In these cases, the distance implemented in social relationships, already fragile to begin with, and the vulnerability associated with the disease itself, exacerbated feelings of loneliness and stress over time. Studies of the Chinese population during the first phase of the pandemic showed that subjects with pre-existing mental disorders developed more severe forms of anxiety, depression and post-traumatic stress disorder than the general population. In these individuals, stressful conditions may have exacerbated disease symptoms or led to their recrudescence, made worse by the reduced access to treatment during the lockdown. It is precisely for this reason that the greater use of telemedicine strategies is desirable as a possible tool capable of facilitating access to care and at the same time enabling social distancing.

Rescuers and healthcare workers engaged in the COVID-19 emergency also have a high risk of experiencing psychological symptoms. For these individuals, the fear of becoming infected and infecting their loved ones was coupled with having been exposed to tight work rhythms, the need to isolate themselves and not return home so as not to be a vehicle of infection for relatives, as well as a very dangerous forced alteration of sleep–wake rhythms. The first scenario that indicated the psychosocial risks of this occupational category was the terrorist attack on the World Trade Center in 2001. After this event, many rescue workers presented a chronic deterioration in physical and mental health and social functioning. Moreover, healthcare workers are stably exposed to high levels of stress-related pathology, as shown by studies which have found rates of post-traumatic stress disorder between 10 and 20 percent, with the highest values in women and those with less professional training, and a correlation between the severity of the clinical picture and the extent of socio-occupational impairment. Individuals who have suffered the loss of a loved one represent another category at high risk of developing pathological reactions. The altered processing of grief (complicated grief), in addition to post-traumatic symptomatology, were also likely driven by certain aspects contingent to the pandemic, such as the inability to say goodbye to loved ones due to the severe restrictions imposed on relatives' access to the hospital, or the media emphasis on the military's involvement in the handling of remains.

Being infected and confronting the fear of death firsthand, or believing that one is on the verge of losing a loved one, represent major traumatic events that carry a risk of developing psychopathological symptoms. According to various epidemiological studies conducted on populations exposed to SARS or MERS outbreaks, these individuals are those most at risk of developing symptoms of post-traumatic stress disorder because of the possible long-term medical sequelae of the infection. Then, there are those individuals with critical family backgrounds, for whom being locked in the home may have been an additional stressor; unfortunately, great increases in domestic violence were reported throughout this period.

Finally, even among individuals who lived in less exposed regions and had the opportunity to remain in their homes in a good family environment, a good portion suffered large economic losses as a result of the lockdown; many lost their jobs or were forced to close their businesses, not knowing if they would be able to continue to provide for themselves and their children. Indeed, several researchers have shown how economic issues can strongly contribute to the development of psychopathological disorders following mass trauma. Many of the suicides reported in recent months are those of entrepreneurs affected by the economic crisis associated with the pandemic. What the pandemic scenario may have invoked in the categories of people described above is not simply excessive anxiety, but real specific and insidious clinical pictures that may develop as pathological reactions to particularly negative, stressful or traumatic life events: post-traumatic stress disorder and complicated grief.

In conclusion, the COVID-19 pandemic represented, and still represents, a global and collective traumatic experience that put each of us at risk of developing pathological reactions, regardless of the objectifiable extent of what we experienced in terms of exposure to the virus. The various and multifaceted constellations of individual microtraumas, such as sudden and emotionally charged bereavements, concern for our loved ones, apprehension about the economic crisis, stress load in particular areas of work, social separation, and so on, that we have endured throughout this period are no small matter, and many of those who have been intensely exposed or particularly susceptible to the terrible events of these months are at risk of chronic psychopathological sequelae that, if underestimated, can result in reduced psychosocial functioning and an increased likelihood of developing different disorders (psychiatric and otherwise) and maladaptive behaviors of various kinds, up to and including suicidal acts.

The aim of this Special Issue is to receive worldwide contributions in order to better evaluate and elucidate the current facts and views on mental health in relation to COVID-19.

Dr. Domenico De Berardis
Dr. Giovanni Martinotti
Dr. Mauro Pettorruso
Prof. Dr. Drozdstoi Stoyanov
Guest Editors

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• COVID-19
• mental disorder
• anxiety
• depression
• post-traumatic stress disorder