COVID-related anxiety disorders

PTSD is a common consequence of major disasters, including epidemics. Epidemiological projections made by the World Health Organisation (WHO) show that post-disaster mental health problems range from mild to very severe distress, affecting between 20 and 50% of the population. A minority develop new and debilitating mental disorders, and those with pre-existing mental disorders need even more help than before. In the current pandemic, the WHO suggests that levels of loneliness, depression, harmful alcohol and drug use, and self-harm or suicidal behaviour are also expected to rise. Considering the breadth of the COVID-19 pandemic, and the widespread impact of quarantine, social isolation, loss of loved ones (and the inability to grieve socially), loss of income and financial worries, potentially extreme illnesses (which can themselves impact mental health), and frontline working, the current crisis is likely to trigger large numbers of people with long-lasting anxiety and PTSD or post-traumatic stress symptoms (PTSS). In fact, a recent paper suggested ‘PTSD as the second tsunami of the SARS-CoV-2 pandemic ’ .
A systematic review of the evidence on the psychosocial impact of quarantine measures during previous coronavirus outbreaks showed that quarantine measures were consistently associated with negative psychosocial outcomes, including depressive symptoms, anxiety, anger, stress, post-traumatic stress, social isolation, loneliness and stigmatisation . For example, the rates of mental health symptoms after the severe acute respiratory syndrome (SARS) outbreak were between 3.7 and 17.3%, and were worst for health care workers. Survey respondents who had been isolated, worked in high-risk workplaces, or had friends or close relatives who contracted SARS were two to three times more likely to develop high levels of PTSS .
In the current COVID-19 outbreak, an early study of residents in Wuhan and surrounding cities were asked about PTSS and sleep qualities. One month after the outbreak (data was collected in Jan 2020), the prevalence of PTSS was about 7% . A subsequent study (1210 respondents from 194 Chinese cities) found 54% of respondents rated the psychological impact of the outbreak as moderate or severe; 17% reported moderate to severe depressive symptoms; 29% reported moderate to severe anxiety symptoms; and 8% reported moderate to severe stress levels (Wang et al., 2020). Looking at the mental health effects of COVID-19 in younger people, a cross sectional survey suggests that nearly 15% of the sample had PTSD symptoms . In patients who contracted COVID-19, the degree of psychological distress may be related to the level of systemic inflammation .
A multinational, multicentre study on the psychological outcomes amongst healthcare workers during COVID-19 surveyed 906 healthcare workers . Using the depression, anxiety and stress scale (DASS-21) scoring system, the authors found anxiety in 16%, depression in 11% and stress in 5% of the study participants. 7% of the study cohort screened positive for clinical concern of PTSD. Another cross sectional survey of 1257 health care workers treating COVID-19 patients in China found significant reported symptoms of depression (50%), anxiety (45%), insomnia (34%), and distress (72%).
These studies highlight the upcoming prevalence of COVID-related anxiety and PTSD, especially amongst healthcare workers and those most directly affected by the pandemic. The pharmacological treatment strategies are likely to involve selective serotonin reuptake inhibitors (SSRIs), selective noradrenaline reuptake inhibitors (SNRIs), serotonin 1A (5HT1A) agonists and benzodiazepines, all of which have side effect profiles that are not always tolerable to patients including drug dependence and withdrawal syndromes. Moreover, these treatments can show limited efficacy in a significant number of patients and their therapeutic effects can have a delayed onset of action (in the case of SSRIs and SNRIs). Psychological treatments (e.g. exposure therapy) are also available but, again, they can have limited or temporary theraputic effects . Thus, novel agents are required to manage these symptoms.