Addressing the mental health impact of COVID-19 through population health

Abstract

The COVID-19 pandemic has and will continue to result in negative mental health outcomes such as depression, anxiety and traumatic stress in people and populations throughout the world. A population mental health perspective informed by clinical psychology, psychiatry and dissemination and implementation science is ideally suited to address the broad, multi-faceted and long-lasting mental health impact of the pandemic. Informed by a systematic review of the burgeoning empirical research on the COVID-19 pandemic and research on prior coronavirus pandemics, we link pandemic risk factors, negative mental health outcomes and appropriate intervention strategies. We describe how social risk factors and pandemic stressors will contribute to negative mental health outcomes, especially among vulnerable populations. We evaluate the scalability of primary, secondary and tertiary interventions according to mental health target, population, modality, intensity and provider type to provide a unified strategy for meeting population mental health needs. Traditional models, in which evidence-based therapies delivered are delivered in-person, by a trained expert, at a specialty care location have proved difficult to scale. The use of non-traditional models, tailoring preventive interventions to populations based on their needs, and ongoing coordinated evaluation of intervention implementation and effectiveness will be critical to refining our efforts to increase reach.

Keywords: COVID-19; Evidence-based psychotherapy; Intervention; Mental health; Population mental health; Risk factor.

Fig. 1

Targets of population health interventions: social determinants of health and social risk factors as they interact with pandemic stressors to increase risk of negative mental health outcomes. Social determinants of mental health and social risk factors (socio-demographic characteristics & clinical vulnerabilities) and pandemic stressors may increase risk of adverse mental health outcomes in isolation or together in synergistic ways. Pandemic stressors directly increase risk of mental health outcomes. Social determinants of mental health and social risk factors increase risk by increasing the likelihood or impact of pandemic stressors. As represented by grey the arrow, mental health outcomes may persist indefinitely.

Fig. 2

Characteristics of primary, secondary and tertiary prevention interventions suitable for addressing the mental health impact of COVID-19. Notes: CBT = Cognitive Behavioral Therapy; EBPs = Evidence-based psychotherapies; PFA = Psychological First Aid; SFA = Stress First Aid.