Mental health and brain research must be a higher priority in the response to the coronavirus pandemic, scientists have said, warning that the crisis could have a “profound” and “pervasive impact” on global mental health now and in the future.

In a paper published Wednesday in the Lancet Psychiatry journal, researchers called for better monitoring of mental health as part of the global response to the pandemic. The outbreak has infected more than 2 million people and killed over 128,000 worldwide, according to figures from Johns Hopkins University.

The paper, which draws on the work of 24 mental health experts, including neuroscientists, psychiatrists, psychologists and public health experts, also noted that little is known about the impact of Covid-19 itself on the human nervous system.

Other coronaviruses, the paper said, have passed into the central nervous system. Experts warn that more research -- as well as a database to monitor the psychological or brain effects of Covid-19 -- is urgently needed to understand the potential impacts of Covid-19 on the human brain and nervous system.

Researchers noted that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) -- the virus that causes Covid-19 -- may infect the brain or trigger immune responses that are detrimental to brain function and mental health in patients.

The paper -- which cited a poll of more than 2,000 people with lived experience of mental health problems, their supporters, healthcare professionals, researchers and the general public with an interest in the topic, and a survey of more than 1,000 of the UK’s general population -- found that the public were already concerned about coronavirus and mental health, and were worried about the effect of social isolation or social distancing on well-being, including increased anxiety, stress and depression.

Many survey respondents said that they worried about becoming mentally unwell and being unable to access mental health services during the pandemic, as did people who worried about loneliness as a result of being trapped and isolated.

The negative effects of social disruption

Respondents to the surveys, which were carried out in late March -- the week UK lockdown measures were announced -- were also concerned by other difficulties raised by the pandemic, including financial struggles.

“We talked to the general population, a sample of them, and they reported high levels of anxiety, depression, stress -- actually, those rated higher than the fear of contracting the physical illness,” Ed Bullmore, head of the department of psychiatry at the University of Cambridge, said in a press briefing on Wednesday.

The researchers said that frontline medical staff and vulnerable groups such as elderly people and those with preexisting mental health conditions should be prioritized for support.

The paper also calls for the rollout of evidence-based programs and treatments to address mental health conditions and increase the population’s resilience, including initiatives that can be accessed remotely, by phone or computers.

Researchers also warned that a rise of anxiety and “coping responses” are expected during the pandemic, but that there was also the risk that the numbers of people with anxiety, depression, or those engaging in harmful behaviors like suicide or self-harm could increase -- though they could be mitigated if the proper safeguards were put in place.

Experts pointed to statistics from the 2003 SARS epidemic, which was associated with a 30% increase in suicides in people over the age of 65. The outbreak was also associated with 29% of health workers experiencing “probable emotional distress,” and 50% of recovered patients remained anxious, researchers said.

Researchers warned that research and funding into the mental health effects of the pandemic should be started now, given the likelihood that the outbreak will continue to affect people’s lives for an extended period of time.

“To use a sporting analogy, there’s not just one match now -- we know that there’s a high risk for a repeat later on,” Emily Holmes, a professor from the department of psychology at Sweden’s Uppsala University said, adding that research is necessary now in order to care for populations in the longer term.

“if we were playing football and we’d just played one match well, we would be getting prepared and getting our game better for the future,” she said.

Experts warned that the pandemic has the potential to have a broad impact on society if proper research and funding are not allocated to mental health.

“Increased social isolation, loneliness, health anxiety, stress and an economic downturn are a perfect storm to harm people’s mental health and wellbeing,” Rory O’Connor, a professor of health psychology at the University of Glasgow and one of the paper authors, said in a statement.

“If we do nothing we risk seeing an increase in mental health conditions such as anxiety and depression, and a rise in problem behaviors such as alcohol and drug addiction, gambling, cyberbullying or social consequences such as homelessness and relationship[s] breakdown. The scale of this problem is too serious to ignore, both in terms of every human life that may be affected, and in terms of the wider impact on society,” he said.

“Despite this situation making some of us feel trapped, it shouldn’t make us feel powerless,” he added. “We can make a difference if we act now.”

“All aspects of life are affected” by the pandemic, said Arash Javanbakht, a trauma specialist and assistant professor of psychiatry at Wayne State University. “It was like one day, everything changed.”

And many are concerned that the painful changes brought about by the coronavirus pandemic will cause a spike in mental health problems that could persist long after the most immediate threat of the virus is over. That’s been the case with other major disasters, like Hurricane Katrina, said Lisa Meredith, a senior behavioral scientist at the Rand Corporation think tank who has studied disaster preparedness. “It’s not just during the event,” she said. “People will be stressed afterward.”

Among people who contract Covid-19 and need to be hospitalized, experts expect to see high levels of post-traumatic stress disorder and depression. Experts are also concerned about health care workers who are on the front lines battling the virus, sometimes without the appropriate equipment to keep them safe. A recent study of health care workers treating Covid-19 patients in China has already confirmed some of these concerns, finding considerable rates of anxiety, insomnia, and depressive symptoms. As Laura Hawryluck, an associate professor of critical care medicine at the University of Toronto, told Vox, “health care workers are people too.”

And while the current crisis is stressful for everyone, people who already have conditions like anxiety or depression may be especially at risk, psychologists say. For people with anxiety disorders, for example, “any new stressor can make it worse,” Javanbakht said.

It’s possible to mitigate some of these effects now if those affected have access to treatment, mental health experts say. But that will require an expansion of telemedicine to make sure people can get therapy safely while socially distancing. And it will require policymakers and society as a whole to take the psychological impact of the pandemic, not just its threats to physical health, seriously.

It’s safe to say that billions of people around the world are in a stressful situation right now. For many, life changed nearly overnight, with little time to prepare, Javanbakht noted. Some are now trying to work from home while caring for children. Others have been laid off or furloughed and may be worried about how they will pay their bills.

Meanwhile, people are getting a lot of contradictory information about the virus and the measures needed to combat it, Javanbakht said. While President Trump may say one thing, public health officials may say another. “It’s confusing and stressing,” Javanbakht said.

Feeling powerless in the face of such a widespread threat is common and real. “When we are dealing with a difficult situation, the more control we have, the less stressed we are,” Javanbakht said. But for many people right now, “the only control we have is to sit at home.”The fact that many people are unable to see their friends and loved ones in person only makes the situation worse. “Social distancing is really hard on people, and it’s especially taking its toll on people who are isolated at home alone,” Meredith said. “Loneliness can be a big source of stress.”

Even under more normal circumstances, prolonged loneliness can contribute to depression and anxiety, as well as to physical health problems. One 2016 study, for example, found that being lonely was associated with an increased risk of stroke and heart disease. Today, the ordinary risks of loneliness could be magnified by the stress of living during a pandemic. For people who are social distancing right now, “there is a high risk that they’re going to become more anxious, much more depressed, and it’s going to have longer-term effects,” Rima Styra, an associate professor of psychiatry at the University of Toronto, told Vox.

Overall, a lot of people around the world are experiencing a dip in mental well-being. Factors from “looming severe shortages of resources” to the “imposition of unfamiliar public health measures that infringe on personal freedoms” are likely to increase emotional distress during this time, psychiatry professors Betty Pfefferbaum and Carol S. North wrote in a paper published this week in the New England Journal of Medicine. (CNN, VOX)