COVID-19 has infected millions of people and upended the lives of most humans on the planet. Researchers from across the psychological sciences have sought to document and investigate the impact of COVID-19 in myriad ways, causing an explosion of research that is broad in scope, varied in methods, and challenging to consolidate. Because policy and practice aimed at helping people live healthier and happier lives requires insight from robust patterns of evidence, this article provides a rapid and thorough summary of high-quality studies available through early 2021 examining the mental-health consequences of living through the COVID-19 pandemic. Our review of the evidence indicates that anxiety, depression, and distress increased in the early months of the pandemic. Meanwhile, suicide rates, life satisfaction, and loneliness remained largely stable throughout the first year of the pandemic. In response to these insights, we present seven recommendations (one urgent, two short-term, and four ongoing) to support mental health during the pandemic and beyond.

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COVID-19 is a highly infectious viral disease caused by the novel coronavirus SARS-CoV-2. While it was initially regarded as a strictly respiratory illness, the impact of COVID-19 on multiple organs is increasingly recognized. The brain is among the targets of COVID-19, and it can be impacted in multiple ways, both directly and indirectly. Direct brain infection by SARS-CoV-2 may occur via axonal transport via the olfactory nerve, eventually infecting the olfactory cortex and other structures in the temporal lobe, and potentially the brain stem. A hematogenous route, which involves viral crossing of blood-brain barrier, is also possible. Secondary mechanisms involve hypoxia due to respiratory failure, as well as aberrant immune response leading to various forms of encephalopathy, white matter damage, and abnormal blood clotting resulting in stroke. Multiple neurological symptoms of COVID-19 have been described. These involve anosmia/ageusia, headaches, seizures, mental confusion and delirium, and coma. There is a growing concern that in a number of patients, long-term or perhaps even permanent cognitive impairment will persist well after the recovery from acute illness. Furthermore, COVID-19 survivors may be at increased risk for developing neurodegenerative diseases years or decades later. Since COVID-19 is a new disease, it will take months or even years to characterize the exact nature, scope, and temporal extent of its long-term neurocognitive sequelae. To that end, rigorous and systematic longitudinal follow-up will be required. For this effort to succeed, appropriate protocols and patient registries should be developed and put in place without delay now.

Performance of patients with quadrant lesions on the inherently ambiguous Cognitive Bias Task (CBT) suggests sexual dimorphism in the fundamental aspects of functional cortical geometry, by emphasizing different cerebral axes. In right-handed males, extreme context-dependent and context-independent response selection biases are reciprocally linked to left vs. right frontal systems. In right-handed females, these complementary biases appear to be reciprocally linked to posterior vs. frontal cortices. Frontal lobe functions are more lateralized in males than females due to sexual dimorphism of the left frontal systems. Both in males and females, patterns of CBT scores in non-right-handers with quadrant lesions are opposite to those found in right-handers. This suggests the existence of two functionally and neurally distinct cognitive selection mechanisms. Both mechanisms involve the frontal lobes, but their exact neuroanatomy depends on sex and handedness.

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Existing neuropsychological procedures assess veridical, but not adaptive, decision making, which are based on different mechanisms. This severely curtails the tests' ecological validity, because most real-life decision making situations are adaptive, rather than veridical. Veridical decision making entails finding the correct response intrinsic to external situations and is actor-independent. Adaptive decision making is actor-centered and priority-based. Prefrontal cortex is critical for adaptive decision making. Innovative actor-centered decision-making tasks are required to better understand frontal lobe functions. We have designed a prototype for such procedures, the Cognitive Bias Task (CBT). CBT elicited strong gender and hemispheric differences in the effects of focal frontal lesions, which are more robust than those elicited with veridical tasks, such as the Wisconsin Card Sorting Test.