The coronavirus infection has created new circumstances globally and has posed important questions some of which have to be faced urgently.
While the importance of measures to avoid the spread of the epidemic (that has regretfully developed into a pandemic) cannot be emphasised more, some of those imposed have created circumstances that can produce serious psychosocial problems. For example we know from research carried out during economic crises (for review see 1) that unemployment is closely associated with suicide. Now, the inevitable lockdown that sooner or later was implemented almost everywhere, created unemployment. It has to be seen whether this has contributed to the suicide rates but this possibility appears likely.
This pandemic has the proportions of a real Disaster. We have suggested that in addition to the two classical Disaster types, a third category should be added, namely Economic Disasters (2). We are now proposing a fourth category, Biological Disasters.
The situation in Greece
Greece is considered as a paradigmatic country in the way it has handled the epidemic. The government was quick in responding, the people collaborated well, the measures taken were supported by all sectors of the population, the lockdown imposed was not violated, and the campaign to advertise the imposed restrictions was very successful. Additionally, it was left to a health professionals' committee, headed by a low-key Associate Professor called Sotiris Tsiodras to make decisions and inform the public. As a result of this, Greece counted (30th May) only 175 deaths - most of them citizens of advanced age with concurrent health problems. The whole management is considered as extremely successful and we did not have to choose whose life we would save and whose life we would spare. These serious and very upsetting ethical questions were avoided. Yet, consideration and discussion of these important issues demands the attention of the international psychiatric and medical community.
Psychosocial problems and Management
The Psychiatric Community responded to the expected psychosocial problems produced by the coronavirus by establishing telephone and internet helplines. The Hellenic Psychiatric Association established an internet helpline with volunteer members of the Association, the 1st Department of Psychiatry of Athens University run a telephone helpline unit (supported and advertised on TV by the Government) and so did various other psychiatric facilities all over Greece. The Society of Preventive Psychiatry established a telephone helpline for athletes who were particularly frustrated by the fact that they could not carry out group athletic activities.
Additionally, many mental health facilities carried out research to see what the effect of the threat represented by the virus would result in and how the measures imposed, including the lockdown would influence the psychological health of the population. Many mental health agencies (e.g. the 2nd Psychiatric Department of the University of Thessaloniki) participated in international surveys that provide the opportunity for transcultural comparisons. The Society of Preventive Psychiatry has carried out a survey with a special Questionnaire and psychological instruments like the WHOQOL to measure quality of life, psychopathology, concerns about germs and contamination and body vigilance (supported by the Hellenic Psychiatric Association). Preliminary findings from many of the above investigations indicate that the sector of the population with pre-existing psychopathology shows increased vulnerability and consequently requires increased attention. The general impression is that anxiety and stress have increased during the epidemic (as expected) but these impressions have to be confirmed.
A special session entitled "The Biological Disaster of our Century: Impact noted, trauma caused, measures taken, lessons learned" has been scheduled for the WPA Intersectional Congress to be held in Athens, Greece on 11-13 December 2020. Many of the findings of the above investigations will be reported during this important event.
References
1. Christodoulou NG and Christodoulou GN. Financial crises: Impact on Mental Health and Suggested Responses. Psychotherapy and Psychosomatics 82, 279-284, 2013.
2. Christodoulou GN, Mezzich JE, Christodoulou NG, Lecic-Tosevski D (editors) Disasters: Mental Health Context and Responses, Cambridge Scholars Publishing, Newcastle, 2016.
Author: George N. Christodoulou