Abstract

The Need for Prevention and Early InterventionSince the first case of novel coronavirus disease 2019 (COVID-19) was diagnosed in December 2019, it has swept across the world and galvanized global action.This has brought unprecedented efforts to institute the practice of physical distancing (called in most cases "social distancing") in countries all over the world, resulting in changes in national behavioral patterns and shutdowns of usual day-to-day functioning.While these steps may be critical to mitigate the spread of this disease, they will undoubtedly have consequences for mental health and well-being in both the short and long term.These consequences are of sufficient importance that immediate efforts focused on prevention and direct intervention are needed to address the impact of the outbreak on individual and population level mental health.The sparse literature on the mental health consequences of epidemics relates more to the sequelae of the disease itself (eg, mothers of children with congenital Zika syndrome) than to social distancing.However, largescale disasters, whether traumatic (eg, the World Trade Center attacks or mass shootings), natural (eg, hurricanes), or environmental (eg, Deepwater Horizon oil spill), are almost always accompanied by increases in depression, posttraumatic stress disorder (PTSD), substance use disorder, a broad range of other mental and behavioral disorders, domestic violence, and child abuse. 1 For example, 5% of the population affected by Hurricane Ike in 2008 met the criteria for major depressive disorder in the month after the hurricane; 1 out of 10 adults in New York City showed signs of the disorder in the month following the 9/11 attacks. 2,3And almost 25% of New Yorkers reported increased alcohol use after the attacks. 4Communities affected by the Deepwater Horizon oil spill showed signs of clinically significant depression and anxiety. 5The SARS epidemic was also associated with increases in PTSD, stress, and psychological distress in patients and clinicians. 6For such events, the impact on mental health can occur in the immediate aftermath and then persist over long time periods.In the context of the COVID-19 pandemic, it appears likely that there will be substantial increases in anxiety and depression, substance use, loneliness, and domestic violence; and with schools closed, there is a very real possibility of an epidemic of child abuse.This concern is so significant that the UK has issued psychological first aid guidance from Mental Health UK. 7 While the literature is not clear about the science of population level prevention, it leads us to conclude that 3 steps, taken now, can help us proactively prepare for the inevitable increase in mental health conditions and associated sequelae that are the consequences of this pandemic.