Biobehavioral Aspects of the COVID-19 Pandemic: A Review

Abstract

Objective: This review highlights the scope and significance of the coronavirus disease 2019 (COVID-19) pandemic with a focus on biobehavioral aspects and critical avenues for research.

Methods: A narrative review of the published research literature was undertaken, highlighting major empirical findings emerging during the first and second waves of the COVID-19 pandemic.

Results: Interactions among biological, behavioral, and societal processes were prominent across all regions of the globe during the first year of the COVID-19 emergency. Affective, cognitive, behavioral, socioeconomic, and technological factors all played a significant role in the spread of infection, response precautions, and outcomes of mitigation efforts. Affective symptoms, suicidality, and cognitive dysfunction have been widely described consequences of the infection, the economic fallout, and the necessary public health mitigation measures themselves. The impact of COVID-19 may be especially serious for those living with severe mental illness and/or chronic medical diseases, given the confluence of several adverse factors in a manner that appears to have syndemic potential.

Conclusions: The COVID-19 pandemic has made clear that biological and behavioral factors interact with societal processes in the infectious disease context. Empirical research examining mechanistic pathways from infection and recovery to immunological, behavioral, and emotional outcomes is critical. Examination of how emotional and behavioral factors relate to the pandemic-both as causes and as effects-can provide valuable insights that can improve management of the current pandemic and future pandemics to come.

FIGURE 1

Cumulative deaths per million in the first year of the COVID-19 pandemic. Data are in the public domain. Source: https://ourworldindata.org/coronavirus.

FIGURE 2

Cumulative cases by selected continent in the first year of the COVID-19 pandemic. Data are in the public domain. Source: https://ourworldindata.org/coronavirus.

FIGURE 3

Deaths by selected country in the first year of the COVID-19 pandemic, expressed in absolute numbers (A) and per capita (B). Data are in the public domain. Source: https://ourworldindata.org/coronavirus.

FIGURE 4

Mental health impacts of the COVID-19 pandemic as a function of age group. Data are from the Household Pulse Survey, Centers for Disease Control and Prevention. Bars represent average values collapsed across all panels of data collection between April 23, 2020, and February 1, 2021. For interpretive purposes, an all-ages reference value of 11% (anxiety or depressive symptoms; 6.5% for depression symptoms only; 8.2% for anxiety symptoms only) was found in the National Health Interview Survey conducted in the year before the pandemic. In the Household PULSE Survey, measurements were taken using a two-item version of the Patient Health Questionnaire and a two-item version of the Generalized Anxiety Disorder scale, both adapted to a 7-day recall time frame. Data are public domain. Source: Centers for Disease Control and Prevention, https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm.

FIGURE 5

Age and sex distribution of COVID-19 deaths in the first year of the COVID-19 pandemic. Data are in public domain. Source: Centers for Disease Control and Prevention, https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm.