Mental health support interventions reduce levels of anxiety and depression in those exposed to mass outbreaks such as COVID-19, but not their levels of stress

Mass infectious disease outbreaks of unprecedented scale and impact was predicted decades before the outbreak of COVID-19, according to research from the ARC NWC MIDAS team.

Since 2000, there had been other infectious disease outbreaks: severe acute respiratory syndrome (SARS), Middle East Respiratory Syndrome (MERS), and Ebola. Therefore, the need for mental health support interventions for those exposed to such outbreaks was known.

Previous reviews have looked at the effectiveness of mental health support interventions during different types of mass adverse events.

However, these studies focused more on helping those affected by natural or man-made disasters (such as tsunamis or terrorism), rather than those exposed to mass infectious disease outbreaks.

To fill this gap, we reviewed the studies which explored the types and effectiveness of mental health support interventions used to support those exposed to mass infectious disease outbreaks (including SARS, MERS, Ebola and COVID-19).

Most of the studies we identified were published in the past 15 months. This suggests lessons have not been learnt from previous mass outbreaks and that relatively little attention was given to mental health support interventions to help those exposed to mass infectious disease outbreaks before the COVID-19 outbreak.

The studies we identified looked at interventions like online counselling, guided therapy, mobile phone apps, progressive muscle relaxation, guided imagery, Cognitive Behaviour Therapy, Eye Movement Desensitization and Reprocessing, and behaviour change interventions. Many of these were delivered either online via a computer or by a mobile phone app rather than face-to-face.

Our analysis found interventions were effective in terms of managing levels of depression and anxiety in individuals affected, but not their levels of stress.

Most studies involved participants who were patients with COVID-19, or with pre-existing chronic diseases exposed to COVID-19 and / or with a diagnosis of COVID-19. We found a lack of research exploring the effectiveness of mental health support interventions for health and social care staff, and for children and young people.

One of key messages from our review is that relying only on individual-level interventions is insufficient. To minimise the stressors associated with a mass infectious disease outbreak, a whole systems approach is needed to produce changes at the individual, organisational, cultural and societal levels. Interventions to prevent and / or reduce mental health consequences in specific people are also needed. For example:

Health and social care workers require both preventative and organisational-level interventions to reduce workplace stress caused by constantly caring for patients with COVID-19. They also require personalised interventions to reduce their levels of anxiety, depression and / or Post Traumatic Syndrome Disorder.

Children and young people who lost freedom and independence during lockdowns need targeted interventions to tackle anxiety and depression.

Targeted and tailored interventions are also needed for people experiencing domestic abuse as a consequence of lockdowns, and for people with disabilities who had to self-isolate or shield during the pandemic.

We acknowledge that the evidence base is evolving. Some interventions have not been formally evaluated e.g. NHS England’s commissioned resilience hubs for healthcare staff introduced in 2020.

However, the lack of available evidence means that uncertainty remains.

We support the call for greater global action and for wider public health measures to be included in national plans to minimise the negative impacts of mass infectious disease outbreaks.

Further research is needed to inform the development of a range of targeted and tailored mental health support interventions for all those exposed to, or more vulnerable to, mass infectious disease outbreaks such as COVID-19

Contact for further information: Dr. Alison Doherty, ARCNWC-MIDAS@uclan.ac.uk

Reference: Doherty, A., Benedetto, V., Harris, C. et al. The effectiveness of psychological support interventions for those exposed to mass infectious disease outbreaks: a systematic review. BMC Psychiatry 21, 592 (2021). https://doi.org/10.1186/s12888-021-03602-7