Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: practical considerations for the COVID-19 pandemic

Abstract

INTRODUCTIONEmerging infectious disease outbreaks, such as the present coronavirus disease 2019 pandemic, often have a psychological impact on the well-being of the general population, including survivors and caregivers. Our study aimed to synthesise extant literature regarding the combined psychological responses and coping methods used by the general population in past outbreaks. METHODSWe conducted a narrative synthesis of the published literature over the last two decades with a quality appraisal of included articles that reported both psychological responses and coping strategies within infectious disease outbreaks. RESULTSA total of 144 papers were identified from the search, 24 of which were included in the review. Overall, 18 studies examined the psychosocial responses of the general population towards the severe acute respiratory syndrome epidemic, four studies focused on the Ebola epidemic and two studies covered the H1N1 outbreak. Common themes in psychological responses included anxiety/fears, depression, anger, guilt, grief and loss, post-traumatic stress and stigmatisation, but also a greater sense of empowerment and compassion towards others. Coping strategies adopted included problem-focused coping (seeking alternatives, self-and other-preservation), seeking social support, avoidance, and positive appraisal of the situation.CONCLUSION Amid the range of psychosocial responses seen in past infectious disease outbreaks, practical considerations for the current COVID-19 pandemic need to focus on the individual in the context of the larger social environment, with an emphasis on raising awareness of the range of possible psychosocial responses, access to psychological help, selfcare, empowering self-support groups and sustained engagement with updated, reliable information about the outbreak.

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“…Infectious disease outbreaks significantly impact the physical and psychological wellbeing of communities, patients, and medical providers [21]. Studies from prior pandemics including the severe acute respiratory syndrome (SARS) outbreak in 2002-3, H1N1 influenza pandemic in 2009, and Middle East respiratory syndrome (MERS) in 2012 reveal marked anxiety; this has been confirmed among medical providers during the COVID-19 pandemic.…”

“…Increased anxiety levels and fear are attributed to a sense of personal vulnerability, uncertainty regarding risk and available personal protective equipment, rapidly changing prevention guidelines, the health of family members, economic instability, separation from friends and loved ones resulting from social distancing, and disruption in work and life routines [21,22]. A perceived lack of control with possible redeployment into less familiar, high acuity clinical care environments further facilitates a sense of fear and anxiety, and post-traumatic stress symptoms may arise, manifesting in intrusive thoughts, nightmares, and hypervigilance.…”

“…Working from home while balancing parental responsibilities, clinical and research activities can be overwhelming [23]. Depressive symptoms may arise secondary to disruption in daily routines, isolation, impaired sleep patterns, loss of control, and potential negative effects on future job prospects [21]. Feelings of anger and irritability may ensue as well as a sense of grief and loss.…”

“…Feelings of anger and irritability may ensue as well as a sense of grief and loss. Potential areas of loss include loss of one's prior way of life, financial loss, and loss of control [21]. Stigmatization and xenophobia toward Asian-Americans is being reported during COVID-19, creating feelings of abandonment and isolation [21].…”

“…Potential areas of loss include loss of one's prior way of life, financial loss, and loss of control [21]. Stigmatization and xenophobia toward Asian-Americans is being reported during COVID-19, creating feelings of abandonment and isolation [21]. In China, more than 70% of healthcare workers during this pandemic report insomnia, anxiety, and depression [23].…”