Psychotherapists' Reports regarding the Impact of the COVID-19 Pandemic on Their Patients: A Cross-National Descriptive Study Based on the Social-Ecological Model (SEM)

Abstract

The COVID-19 outbreak has raised questions about how vulnerable groups experience the pandemic. Research that focuses on the view of individuals with pre-existing mental health conditions is still limited, and so are cross-country comparative surveys. We gathered our sample of qualitative data during the first lockdown after governmental measures against the spread of the SARS-CoV-2 virus came into force in Austria, Czechia, Germany, and Slovakia. A total of n = 1690 psychotherapists from four middle European countries answered the question of how the COVID-19 pandemic was addressed in sessions by their patients during the early stage of unprecedented public health conditions. We employed a descriptive qualitative methodology to determine themes following levels of the social-ecological model (SEM) regarding how the COVID-19 pandemic affected patients. At the public policy level, stressful environmental conditions concerned the governmental mitigation efforts. At the level of community/society, reported key themes were employment, restricted access to educational and health facilities, socioeconomic consequences, and the pandemic itself. Key themes at the interpersonal level regarded forced proximity, the possibility of infection of loved ones, childcare, and homeschooling. Key themes at the individual level were the possibility of contracting COVID-19, having to stay at home/isolation, and a changing environment. Within the SEM framework, adaptive and maladaptive responses to these stressors were reported, with more similarities than differences between the countries. A quantification of word stems showed that the maladaptive reactions predominated.

Keywords: COVID-19; adaptive responses; maladaptive responses; mental health; pandemic; psychotherapy; social environment; stressors.

Figure 1

The weekly cases per million people in all four countries within the data gathering period. Source: Johns Hopkins University CSSE COVID-19 Data.

Figure 2

The strictness of the mitigation efforts in all four countries within the data gathering period. The composite measure is based on nine response indicators including school closures, workplace closures, and travel bans, rescaled to a value from 0 to 100 (100 = strictest). If policies vary at the subnational level, the index is shown as the response level of the strictest sub-region. Source: Hale, T.; Angrist, N.; Goldszmidt, R.; et al. A global panel database of pandemic policies (Oxford COVID-19 Government Response Tracker). Nat. Hum. Behav. 2021, 5, 529–538. https://doi.org/10.1038/s41562-021-01079-8.

Figure 3

Stressful environmental conditions are addressed in all four countries at the public policy, community/society, interpersonal, and individual level.

Figure 4

Maladaptive responses that could potentially deteriorate a patient’s health state were found in #4 and #3 countries, #2 countries, and #1 country.

Figure 5

Adaptive responses that could potentially positively contribute to a patient’s health state were found in #4 and #3 countries, #2 countries, and #1 country.