Mental Health During and After the COVID-19 Emergency in Italy

 Mental Health During and After the COVID-19 Emergency in Italy

Mental health during and after the COVID-19 emergency in Italy

Gabriele  Sani1,2  MD,  Delfina  Janiri3,4  MD,  Marco  Di  Nicola2 MD,  Luigi  Janiri1,2MD, Simonetta  Ferretti5MPH,Daniela Chieffo5PhD.1Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy.

Italy is the first European Country to face the Covid-19 emergency in all its dramatic appearance. As we write this letter, the total number of positive cases is 97689 and the deaths are 107791 and the situation is rapidly evolving. As mental health professionals,  we have to deal with both actual and future mental health concerns.   In  Italy,  about  the  25%  of  the  overall  burden  of  disease  is  attributed  to  neuropsychiatric  disorders2.  The community-based  Italian  psychiatric  assistance  is  integrated  in  the  National  Health  System,  includes  183  Mental  Health  Departments  and  takes  care  almost  780000  patients. Currently,  patients  are  continuously  followed-up,  mainly  with  the  use  of  internet  connections.  However,  the  actual stressful  period  and  social  isolation may increase the risk of recurrence and new episodes. In fact, people are forced now to live isolated because  social  distancing  is  the  most  effective  strategy  to  limit  the  spread  of  the  virus.  However,  social isolation, especially if protracted, may increase the risk of mental disorders such as anxiety, mood, addictive and  thought  disorders.  Additionally,  objective  social  isolation  and  subjective  feelings    of  loneliness  are associated with a higher risk of suicide3,4. Furthermore, people who will “lose loved ones before their time” will not be comforted by the large number of  deaths  due  to  the  pandemic  crisis.  On  the  contrary,  they  will  be  more  prone  to  develop  a  so-called complicated grief that is associated with unexpected death or social isolation or loss of a support system, like what we are experiencing now. Moreover, it is hard to predict the effect on the mental and social development of the hundreds of thousands of children and adolescents who, abruptly, had a dramatic change of their normal life. What we know is that early life stressful events are associated with disrupted neurodevelopment, social, emotional, and cognitive impairment, adult medical and psychiatric disorders, disability, and even earlier death

In the meantime,  healthcare  professionals  are  experiencing  an  extraordinary  burden  of  stress,  facing daily with severe illness or death. Liu and collaborators recently found 73.4 per cent of stress-related symptoms, 50.7 per cent of depression, 44.7 per cent of anxiety and 36.1 per cent of insomnia among the 1563 medical staff in China6. In Italian situation, the risk of acute stress disorder, burn-out syndrome, and full psychiatric disorders is very high.In the light of the above, it is evident that it is important to provide the necessary mental health support. So far, a few mental health professionals are directly involved in the direct management of the crisis. Anyway, many independent mainly on-line initiatives, such as the “NON SEI SOLO” (“YOU ARE NOT ALONE”) and the “Resilienza COVID-19” (“Resilience COVID-19”) projects of the Fondazione Policlinico Universitario Agostino Gemelli of Roma, are born in order to give psychological and psychiatric support to health professionals and laypeople.Therefore, we claim for an active participation of mental health professionals to the task forces activities inthis critical period as well as in the next future.  We strongly believe that our competence could help to better describe the current mental health situation, provide a nationwide, centrally coordinated and more efficient support  group,  increase  the  trust  between  workers  and  organizations7  and prevent  future  dramatic  development of full psychiatric disorders, which would be an additional social and economic burden to the oncoming post-epidemic crisis.

********References1.Italian                                       Civil                                       Protection                                       Department:http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.html#/b0c68bce2cce478eaac82fe38d4138b1 (accessed March 30th, 2020).2.Disease Control Priorities Project. Global Burden of Disease and Risk Factors. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. (Ed.). Oxford University Press and The World Bank; 2006. Available from: http://www.dcp2.org/main/Home.html3.Calati R, Ferrari C, Brittner M, Oasi O, Olié E, Carvalho AF, Courtet P. Suicidal thoughts and behaviors and social isolation: A narrative review of the literature. J Affect Disord. 2019 Feb 15;245:653-667.4.Sani G, Tondo L, Koukopoulos A, Reginaldi D, Kotzalidis GD, Koukopoulos AE, Manfredi G, Mazzarini L,  Pacchiarotti  I,  Simonetti  A,  Ambrosi  E,  Angeletti  G,  Girardi  P,  Tatarelli  R.  Suicide  in  a  large  population of former psychiatric inpatients. Psychiatry Clin Neurosci. 2011;65:286-95.5.Targum  SD,  Nemeroff  CB.  The  Effect  of  Early  Life  Stress  on  Adult  Psychiatric  Disorders.  Innov  Clin  Neurosci. 20191;16:35-37. 6.Liu S, Yang L, Zhang C, Xiang YT, Liu Z, Hu S, Zhang B. Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry. 2020 Feb 18.7.Imai H. Trust is a key factor in the willingness of health professionals to work during the COVID-19 outbreak: Experience from the H1N1 pandemic in Japan 2009. Psychiatry Clin Neurosci. 2020 Feb 27.