Joint International Collaboration to Combat Mental Health Challenges During the Coronavirus Disease 2019 Pandemic

In the past several months, the novel coronavirus disease 2019 (COVID-19) has received extensive attention globally. It was first reported in Wuhan, Hubei province, China, at the end of 2019 and was transmitted to multiple regions of China and subsequently to many countries in the East and the West. As of March 30, 2020, the number of patients infected with COVID-19 has rapidly reached 693 224 globally, especially across the North American, European, and Eastern Mediterranean regions, including in the US, Italy, Spain, and Iran.¹ The rapid transmission of COVID-19, high fatality rates in subpopulations, lack of effective treatments and vaccines, and mass quarantine measures have led to common mental health problems, such as fear, anxiety, depression, and sleep problems, in patients with COVID-19 infections, close contacts, the public, and even health care professionals.^2,3 Therefore, there is a pressing need to establish appropriate mental health services to address the risk of psychiatric morbidities. Mental health professionals are facing insurmountable challenges because of the lack of relevant guidelines, scant mental health resources, and inadequate training to provide mental health services in isolation infectious units and hospitals. Patients with serious psychiatric needs are considered a highly vulnerable population to contract COVID-19. For example, hundreds of patients with psychiatric disorders, as well as mental health professionals, were infected in China.⁴ As such, a joint effort to establish international collaboration is urgently needed to address the mental health challenges caused by the COVID-19 pandemic.

To reduce the risk of negative psychological outcomes associated with the COVID-19 pandemic, the Central Health Authority of China and different national academic societies have integrated mental health crisis interventions into the general deployment of disease prevention and treatment. More than 20 specific guidelines and expert consensus for mental health services for the COVID-19 outbreak were disseminated by the end of February 2020⁵ to provide timely guidance for frontline health care professionals. External mental health expert teams in other provinces were also established to provide emergency mental health services in Hubei province, China. In addition, widespread adoption of online public education, psychological counseling, and hotline services have been set up for those in need. Consequently, these measures may have reduced the negative mental health outcomes of the COVID-19 pandemic, as evidenced by 2 recent surveys. One was conducted in an early stage of the COVID-19 outbreak from the end of January to early February 2020, and it reported the prevalence of insomnia symptoms (34.0%) in frontline health care professionals.⁶ We conducted another survey at the end of February 2020, which found that the prevalence of poor sleep quality in frontline health care professionals was 18.4% (Y. Zhou, Y. Yang, T. Shi, Y. Song, Y. Zhou, Z. Zhang, Y. Guo, X. Li, Y. Liu, G. Xu, T. Cheung, Y. T. Xiang, and Y. Tang; written communication; February 19, 2020). While direct comparison of these different surveys should be cautious, the results suggest some benefits on sleep quality from a range of mental health measures adopted across China. The COVID-19 transmission has been effectively controlled in most areas of China, and 3 major key points should be considered in tackling the mental health challenges caused by the COVID-19 pandemic.

First, China should take a proactive lead to share its protocol of emergency mental health services with other countries affected by the COVID-19 pandemic. Second, international academic organizations, such as the World Psychiatric Association and the Pacific Rim College of Psychiatrists, should develop guidelines on crisis psychological interventions, organize expert teams to coordinate mental health resources, and provide timely advice to different countries affected by the COVID-19 pandemic. Large-scale epidemiological surveys should be conducted to examine the prevalence of mental health problems associated with the COVID-19 pandemic in different subpopulations (eg, elderly individuals, survivors of COVID-19 infections, and frontline health care professionals) to inform the development of appropriate mental health services. Third, leading academic organizations equipped with mental health expertise on crisis mental health interventions (eg, the American Psychiatric Association in the US) should readily share their experiences and guidelines with low- and middle-income countries that are also affected by the COVID-19 pandemic. With a timely and close collaboration with different nations and institutions, the mental health challenges caused by the COVID-19 pandemic can be adequately addressed.

Corresponding Author: Yu-Tao Xiang, MD, PhD, Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Avenida da Universidade, 3/F, Building E12, Taipa, Macao Special Administrative Region, China (xyutly@gmail.com).

Published Online: April 10, 2020. doi:10.1001/jamapsychiatry.2020.1057

Author Contributions: Drs Xiang and Jin contributed equally to this work.

Conflict of Interest Disclosures: The study was supported by the National Science and Technology Major Project for investigational new drugs (grant 2018ZX09201-014), the Beijing Municipal Science & Technology Commission (grant Z181100001518005), and the University of Macau (grant MYRG2019-00066-FHS). No other disclosures were reported.

Additional Contributions: The authors thank Chee H. Ng, MD, MBBS, Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, for his contribution to this article. He was not compensated.