Proposal to apply a "Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment (PERMA)" based approach to manage the COVID-19-related mental health problems in the era of long COVID

Abstract

At present, long COVID (LC)-related health problems are highly concerned since it has been a marked clinical problem in the routine clinical practice. Although the definition of LC remains in vague, it is commonly used to include the post-acute COVID-19-related sequelae (1). Ballering et al. estimated that approximately 65 million people worldwide are suffering from LC (2). Many patients seem to have "recovered" from an acute SARS-CoV-2 infection, however, they might experience various symptoms, almost involving all organs and systems of the whole body, certainly the neurological system is involved (1), of those, neuropsychiatric symptoms including depression, anxiety, and post-traumatic stress disorder (PTSD) are not rare (1). The causes of COVID-19-related mental health problems (CRMHPs) are quite complex. Overall, they can be classified into biological factors (brain injuries due to direct viral infection, related immunological/inflammatory reactions, and the systemic damage of the other organs, etc.) and social factors (worries due to illness per se, prophylactic measures like isolation or lockdown, unemployment, deterioration of the economic, etc.). Although the acute COVID-related respiratory/systemic symptoms were controlled, patents are commonly suffering from long-term mood disorders. Herrman et al. reported that patients infected with SARS-CoV-2 have double risk of development of mood disorders (3), about 30-40% of patients are estimated to have CRMHPs (4), vs. only 10-35% of those with non-COVID diseases (5,6).CRMHPs may influence the daily life of patients. Severe depression and/or anxiety state may markedly reduce the quality of life (QOL) of patients per se, family members, even the caregivers. If leave CRMHPs untreated, the situation might become worse, even induce the final tragic outcome, namely suicide. A study reported that the suicide rates were increased in 2021, which were (P1)