Alarming levels of psychiatric symptoms and the role of loneliness during the COVID-19 epidemic: A case study of Hong Kong

Abstract

Public health strategies to curb the spread of the coronavirus involve sheltering at home and social distancing are effective in reducing the transmission rate, but the unintended consequences of prolonged social isolation on mental health have not been investigated. We focused on Hong Kong for its very rapid and comprehensive response to the pandemic and strictly enacted social distancing protocols. Thus, Hong Kong is a model case for the population-wide practice of effective social distancing and provides an opportunity to examine the impact of loneliness on mental health during the COVID-19. We conducted an anonymous online survey of 432 residents in Hong Kong to examine psychological distress in the community. The results indicate a dire situation with respect to mental health. An astonishing 65.6% (95% C.I. = [60.6%, 70.4%]) of the respondents reported clinical levels of depression, anxiety, and/or stress. Moreover, 22.5% (95% C.I. = [18.2%, 27.2%]) of the respondents were showing signs of psychosis risk. Subjective feelings of loneliness, but not social network size, were associated with increased psychiatric symptoms. To mitigate the potential epidemic of mental illness in the near future, there is an urgent need to prepare clinicians, caregivers and stakeholders to focus on loneliness.

Keywords: Anxiety; COVID-19; Depression; Global mental health; Loneliness; Psychosis.

Fig. 1

Impact of the 2003 SARS outbreak and level of concern about COVID-19.

Fig. 2

Number of days (over the past 30 days) in which health problems occurred. A) Physical health was not good: mean = 4.8 days (SD = 6.9). B) Mental health was not good: mean = 11.6 days (SD = 10.0); C) Usual activities were affected due to health problems: mean = 3.9 days (SD = 7.2); D) Usual activities were affected due to pain: mean = 1.9 (SD = 4.5); and E) Feeling worried, anxious, or tense: mean = 14.1 days (SD = 10.8).

Fig. 3

Levels of depression, anxiety, and stress among 381 respondents. A) Percentages of respondents scoring at different severity levels of Depression, Anxiety, and Stress on the DASS-21. B) Percentages of respondents scoring moderate to extremely severe on each and any of the three areas on the DASS-21.