Mental health research during the COVID-19 pandemic

In epidemics of potentially fatal infectious diseases, an increased risk of mental disorders, especially anxiety, depression and post-traumatic stress disorders, has been observed in those infected, their families and the health personnel caring for them.¹ However, the current COVID-19 pandemic has certain peculiarities that are unprecedented. Among these particularities are: the risk of infection by asymptomatic people; the wide variability in the severity of the symptoms of those infected; and the social distancing measures implemented in almost all the countries of the world that have had a long duration and that have led both to economic problems and to changes in our way of working, receiving education, living together as a family and interacting with others. All this means that the real consequences for mental health are not predictable and that there is a very great need to investigate the subject from various perspectives.² In fact, priority topics in mental health have already been raised that should be investigated in an interdisciplinary manner.³

Research in mental health during the pandemic is very important in Latin America, where mortality from COVID-19 is among the highest in the world and the frequency of conditions of vulnerability, such as poverty, overcrowding and difficulties in accessing health services, can make the effect very different from that observed in other regions. One of the priority issues is the impact of the pandemic, the confinement measures and the way information is handled on the frequency of mental health problems in the general population and in vulnerable groups such as health personnel, the elderly, children and ethnic minorities, among others. Since the beginning of the pandemic, there have been a large number of publications on the frequency of mental health symptoms in the community and in these groups,^4,5 but it is not clear whether these are caused by the pandemic, what the longitudinal course is, if there is any real increase in the incidence of psychiatric disorders associated with the pandemic, or what the long-term consequences will be at the population level.

The consequences of the pandemic in patients with mental health disorders are also the source of multiple research questions. These patients are known to be a vulnerable group and their treatment under the current conditions has become more difficult. In addition, the care of a large proportion of psychiatric patients has had to shift rapidly to telehealth,⁶ despite the fact that previously there were prejudices about it, such as doubts about it being possible to establish a good therapeutic relationship, patients being uncomfortable due to a lack of familiarity with technology and of privacy, technical problems (e.g. video and audio quality), legal regulations, and difficulties in prescribing drugs.⁷ Previous research had shown a relationship between face-to-face care and diagnostic reliability and user satisfaction, but it is a field in which there is much to be investigated, such as its effectiveness, the conditions for the care of patients with cognitive impairment, visual or hearing difficulties, as well as the management of emergency conditions, among others.⁸ In addition, there is the potential to use novel mental telehealth strategies for prevention, diagnosis, treatment and rehabilitation that could contribute to improving morbidity from mental problems even in places where there is an insufficient number of psychiatrists.⁹

Another topic that has been considered a research priority is that of the consequences of COVID-19 infection on the mental health of those who have been infected ­– both in terms of the psychological consequences of contagion and the short and long-term neurological disorders that can occur as a result of the disease.^10,11 It has been thought that the prognosis of mental disorders may be affected and that suicide rates may increase.¹² Additionally, the need to monitor children whose mothers were infected during pregnancy has been proposed for possible long-term effects such as those that have been described for other viral diseases.³

The above are just some examples of the issues that have been raised within the research agendas for the pandemic. Undoubtedly, many have been left out and it is an opportunity to create knowledge that can be used in the future for similar situations and to evaluate new forms of care that could continue to be used even when this contingency is over.