Coronavirus Disease (COVID-19): Psychological, Behavioral, Interpersonal Effects, and Clinical Implications for Health Systems

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The novel coronavirus disease that emerged at the end of 2019 began threatening the health and lives of millions of people after a few weeks. Highly contagious with the possibility of causing severe respiratory disease, it has quickly impacted governments and public health systems. These have responded by declaring a public health emergency of national and international concern, as well as by adopting extraordinary measures to prevent the contagion and limit the outbreak. Millions of lives have been significantly altered, and a global, multi-level, and demanding stress-coping-adjustment process is ongoing.

The COVID-19 disease has now achieved pandemic status. The World Health Organization has issued guidelines for managing the problem from both biomedical and psychological points of view. While preventive and medical action is the most important at this stage, emergency psychological crisis interventions for people affected by COVID-19 are also critical. This includes direct interventions for patients, and indirect for relatives, caregivers, and health care professionals.

After the first experiences in China, clinical institutions and universities internationally have opened online platforms to provide psychological counseling services for affected people. Nevertheless, some research has underlined that the mental health of COVID-19 patients (including confirmed patients, patients with suspected infection, quarantined family members, and health care workers) has been poorly considered and handled. Moreover, in order to develop psychological interventions for all or specific (e.g., more vulnerable) groups, important issues to address include the adverse psychological impacts and psychopathological symptoms in the general population during the pandemic.

In times of stress and uncertainty, a number of strategies can be helpful for maintaining well-being and promoting resilience. The uncertainties and specific restrictions related to the COVID-19 outbreak present particular challenges. For example, recent research has strongly supported two strategies for preventing or mitigating depressive and anxiety-related symptoms: promoting social connectedness and physical activity. In the current environment, necessary restrictions such as social distancing, self-quarantining and other measures can make this challenging. As such, we may need to be intentional about finding ways to reduce social isolation (for example: through virtual meetings, text and other messaging, or phone calls) and to engage in regular physical activity.

The resources highlighted below emphasize several evidence-based self-care and coping strategies. In addition to staying connected to others and keeping up physical activity, these include maintaining pillars of well-being such as regular sleep patterns and healthy eating, as well as limiting excessive exposure to distressing media and practicing stress management techniques such as mindfulness and deep breathing. For those with symptoms of significant stress or impairing anxiety, it is helpful to recommend professional support as needed.

In this guide:
Expert Strategies
Further Reads

Resource: Managing Stress: Tips for Coping with the Stress of COVID-19 ★
Source: Harvard T.H. Chan School of Public Health

Key Points:

Stress-related reactions may include: changes in concentration/thinking/memory; feeling tense/irritable/anxious; changes in energy/appetite/sleep; social withdrawal, reduced productivity, interpersonal conflict. Some individuals may be more susceptible to stress during an outbreak, including those with prior mental health conditions.
Coping strategies include:
Staying connected with family/friends/community in creative ways
Managing challenging emotions with acceptance, mindfulness, relaxation, soothing and/or pleasurable activities
Avoiding unhelpful coping strategies like substance use, rumination/constant worrying, high-risk behavior
Engaging in positive lifestyle behaviors such as physical activity and eating healthy, using acceptance, re-framing, and problem-solving as needed
Practicing sleep hygiene
Resource: Coronavirus Disease 2019 (COVID-19): Manage Anxiety & Stress
Source: Centers for Disease Control & Prevention

Key Points:

Stress-related reactions to an outbreak may include: worry, changes in eating/sleeping, physical symptoms, substance use
Coping strategies include:
Taking media breaks
Maintaining healthy behaviors
Engaging in relaxing activities
Connecting with others
Tailored recommendations for:
Individuals with pre-existing mental health conditions (includes hotline numbers)
Parents and children
Health responders
Quarantined individuals
Resource: Mental Health and Psychosocial Considerations During COVID-19 Outbreak
Source: World Health Organization

Key Points:

Tailored guidance for specific groups, including general population; healthcare workers; health facility leaders; caregivers for children; older adults and individuals with underlying health conditions; and quarantined individuals
General recommendations:
Avoiding blame/stigma of others
Reducing excessive media exposure and consuming from reputable sources
Finding ways to help others and contribute to community during this time
Amplifying positive stories and messages
Recognizing service efforts of health care workers
Recommendations for older adults and other vulnerable individuals:
Accessing simple and clear information
Planning ahead where to get practical help like food delivery, transport, medicines
Performing simple physical exercises at home
Maintaining regular routines where possible
Quarantined individuals recommendations:
Staying connected to social networks virtually (e.g., phone, Internet)
Acknowledging needs and feelings and maintaining self-care practices during quarantine
Limiting excessive media exposure during this time
Illustrated coping recommendations: View here »
Resource: Coronavirus and Mental Health: Taking Care of Ourselves During Infectious Disease Outbreaks
Source: American Psychiatric Association

Key Points:

Stress-related reactions to an outbreak may include: sleep changes; decreased sense of safety; substance use; physical symptoms; fear and blame
Coping recommendations include:
Staying informed via reputable sources
Practicing preventive hygiene behaviors
Limiting media exposure and correcting misinformation
Anticipating and addressing stress reactions via self-care strategies such as daily routines, enjoyable activities, social support, physical activity
Resource: COVID-19 Mental Health Resource Hub
Source: PsychHub

Key Points:

Collection of COVID-19 resources across different organizations (e.g., American Foundation for Suicide Prevention, National Alliance for Mental Illness, American Psychological Association), oriented at individuals, employers, and health providers
Expert Strategies
Resource: Cognitive Behavioral Strategies to Manage Anxiety: Tools to Build Resilience ★
Source: Massachusetts General Hospital
Key Points:

Dr. Luana Marques of the Mass General Center for Anxiety & Traumatic Stress Disorders, and president of the Anxiety & Depression Association of America, delivered a Psychiatry Grand Rounds lecture on March 19, 2020