REVIEW

published: 02 October 2020

doi: 10.3389/fpsyg.2020.566212

Emotional, Behavioral, and

Psychological Impact of the
COVID-19 Pandemic
Ana Luisa Pedrosa † , Letícia Bitencourt † , Ana Cláudia Fontoura Fróes,
Maria Luíza Barreto Cazumbá, Ramon Gustavo Bernardino Campos,
Stephanie Bruna Camilo Soares de Brito and Ana Cristina Simões e Silva*
Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo
Horizonte, Brazil

The emergence of SARS-CoV-2 in December 2019 prompted consternation in many

parts of the world. Due to its fast dissemination, the World Health Organization declared
a pandemic in March 2020. Aiming to contain the spread of the virus, leaders of many
countries restrained social movement, targeting to flatten the curve of contamination
Edited by:
with social distancing. This review aimed to analyze how human behavior has changed
Antonella Granieri, throughout this period. We also approached the key components of the emotional
University of Turin, Italy
reaction to the pandemic, how internal and external factors, such as personality
Reviewed by:
traits, gender, the media, the economy and the governmental response, influence the
Mohammed A. Mamun,
Undergraduate Research social perception of the pandemic and the psychological outcomes of the current
Organization Dhaka, Bangladesh scenario. Moreover, we explored in depth the groups at increased risk of suffering
Gabriele Sani,
Università Cattolica del Sacro Cuore,
mental health burden secondary to these circumstances. These include the healthcare
Italy professionals, elderly individuals, children, college students, black subjects, latin and
*Correspondence: LGBTQ+ communities, economically disadvantaged groups, the homeless, prisoners,
Ana Cristina Simões e Silva
the rural population and psychiatric patients. We also discussed several measures that
[email protected]
† These
might minimize the emotional impact derived from this scenario. It is crucial that the
authors have contributed
equally to this work health authorities, the government and the population articulate to assist the vulnerable
groups and promote emotional and psychological support strategies. Moreover, it is
Specialty section:
This article was submitted to
fundamental that the population is provided with accurate information concerning the
Health Psychology, COVID-19 pandemic.
a section of the journal
Frontiers in Psychology Keywords: SARS-CoV-2, COVID-19, behavior, psychological changes, social isolation, restricting measures,
mental health
Received: 27 May 2020
Accepted: 10 September 2020
Published: 02 October 2020
INTRODUCTION
Citation:
Pedrosa AL, Bitencourt L, In December 2019, a cluster of pneumonia cases was reported in the province of Hubei, China
Fróes ACF, Cazumbá MLB, (Lu et al., 2020). It was then discovered that the infection was caused by a virus, named SARS-
Campos RGB, de Brito SBCS and
CoV-2. Subsequently, the illness caused by this virus was termed Coronavirus disease 2019
Simões e Silva AC (2020) Emotional,
Behavioral, and Psychological Impact
(COVID-19). Data from the World Health Organization (WHO) Guidelines indicate that by
of the COVID-19 Pandemic. January 14th 2020, 1 day after the first recorded case outside of China, only 41 cases were
Front. Psychol. 11:566212. confirmed (World Health Organization [WHO], 2020b). At the present, statistics taken from the
doi: 10.3389/fpsyg.2020.566212 WHO Coronavirus Disease (COVID-19) Dashboard by September 5th announce 26.5 millions of

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Pedrosa et al. Psychological Impact in COVID-19 Pandemic

confirmed cases worldwide, with over 871 thousand deaths “informal settlements.” The search was conducted between
(World Health Organization [WHO], 2020c). May 14th and May 26th. This article was subsequently
Restricting measures have been implemented in several updated between May 26th and September 5th. The search
countries as an attempt to slow down the dissemination of the emphasized recent articles, published case series, consensus
SARS-CoV-2. China (Wang C. et al., 2020), Italy (Briscese et al., statements, guidelines, meta-analyses, systematic reviews and
2020), and the United Kingdom (UK) (Holmes et al., 2020), for prospective cohort studies, critically reviewed and selected by
example, carried out strict “lockdown” regulations, while other the authors. Research has also been made in informative official
countries, including the United States of America (US) (Imperial website public domains and in the references contained in the
College of London, 2020) and Brazil (Simões e Silva et al., 2020), previously data collected.
have delivered “stay home” recommendations. In many places,
means of transportation were shut down, public spaces were
closed and only essential services kept functioning; albeit with RESTRICTING MEASURES DUE TO THE
restrictions and preventive measures. PANDEMIC
However, as the world authorities seem to focus on the
infectious aspect of the pandemic, a rise has been observed Terminology on Quarantine, Social
in mental health disorders (Brooks et al., 2020; Holmes et al.,
2020). Indeed, during this ongoing health crisis, those affected
Isolation, and Social Distancing
by emotional, behavioral and psychiatric disorders tend to In the context of COVID-19 pandemic, the terms “social
be more numerous than those affected by COVID-19. As a distancing,” “social isolation,” and “quarantine” have been used
matter of fact, the fear of contracting COVID-19 seems not mostly as synonyms in the media, in communication with
to be as high as concerns about the psychological and social the public and even in scientific papers (Brooks et al., 2020).
impact of the pandemic, as reported in a United Kingdom However, there are great differences between these designations,
survey (Mental health Covid-19, 2020). Particular groups appear even though there is not always an agreement on the terminology.
to be at higher risk for this kind of mental health impact, “Quarantine” refers to extreme restrictions of movement of
including frontline healthcare workers, the elderly, children, those exposed or potentially contaminated by the virus, in
college students, the LGBTQ+ community, homeless individuals order to minimize the spread of the pathogen. Moreover, the
and those in economic vulnerability, rural community, foreigners term “quarantine” ought to be used in the context of groups
and psychiatric patients (Holmes et al., 2020; Khan et al., or at community level (Dsouza et al., 2020; Sánchez-Villena
2020; Salerno et al., 2020; Wood et al., 2020). Indeed, the and de La Fuente-Figuerola, 2020). “Social isolation” refers to
emotional stress linked to the current scenario may potentially the restriction of social movement of those infected with the
aggravate previous psychiatric conditions or may precipitate its disease (Dsouza et al., 2020; Sánchez-Villena and de La Fuente-
symptomatology (Yao et al., 2020). A critical aspect of this context Figuerola, 2020). Meanwhile, “social distancing” is a preventative
is that, due to physical distancing, many elective appointments measure recommended to the general population to flatten the
have been canceled and mental health support systems have been curve of the contagious disease. In this scenario, people are
suspended, even though remote assistance is rapidly increasing advised to stay at home and use services as little as possible,
(Holmes et al., 2020). as well as to avoid agglomerations, maintain the recommended
This review aims to discuss the impact of COVID-19 for the distance of one meter from each other and take precautionary
mental health of the overall world population, in addition to measures to avoid infection (Covid-19, 2020). Nevertheless, the
its causes and ramifications. The topics of greater relevance in use and the comprehension of these terms should not be so
the scientific literature so far have been included, most of which inflexible. In fact, the term “social isolation” has also been used
concern not only the healthcare professionals and authorities, to express the source of subjective feelings of solitude that may
but the entire population as well. Furthermore, some measures accompany the social distancing measures, especially for those
that ought to be taken to minimize the emotional burden of the who are already at enhanced risk of suffering from loneliness.
pandemic were debated. Notwithstanding, the term “social disconnection” is used in this
review to encompass this framework.

METHODS Source of Psychological Impact Related

to the Restricting Measures
Data were obtained independently by six authors, who It is undeniable that the restricting measures imposed to
carried out a comprehensive and non-systematic search in contain the COVID-19 pandemic have a severe impact on the
the PubMed, Cochrane, Scopus, SciELO, and Google Scholar mental health of the population. Nonetheless, it is yet unclear
databases. Search strategies included terms as: “COVID-19,” what promotes such negative effects. It is possible that these
“SARS-CoV-2,” “anxiety,” “depression,” “psychiatric disorders,” repercussions derive directly from the restrictive strategies and
“social isolation”, “behavior changes”, “psychiatric patients”, reduced social mobility (Bavel et al., 2020; Brooks et al., 2020;
“mental health”, “suicide”, “media”, “racism”, “healthcare Pfefferbaum and North, 2020; Wang G. et al., 2020). However, the
workers,” “elderly,” “domestic violence,” “sleep,” “LGBT emotional and psychological outcomes of the pandemic may also
community,” “homeless,” “foreigners,” “rural community,” be secondary to the intrinsic changes that the restricting measures

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Pedrosa et al. Psychological Impact in COVID-19 Pandemic

cause in lifestyle habits and socioeconomic scenario (Brooks et al., Finally, it must be observed that the adjustment to the new life
2020; Zhu et al., 2020). of social distancing may differ according to age groups, gender
and other variables surrounding the individuals. Therefore, given
the importance of fear in the pandemic context, scales addressing
KEY COMPONENTS OF THE this feeling have been developed and might be helpful to the
EMOTIONAL AND BEHAVIORAL comprehension and management of this emotional component
RESPONSE TO COVID-19 PANDEMIC (Ahorsu et al., 2020; Sakib et al., 2020).

The emotional and behavioral response to COVID-19 pandemic Stressors

is multifactorial. It relies not only on external components, but on In the pandemic background, stressors must also be considered in
personal and innate ones as well. Nonetheless, the reaction to the the assessment of the emotional and neuropsychological impact.
current circumstances seem to have predominant elements in the These mainly include COVID-19-related circumstances, such as
overall population. A significant increase in feelings of functional potential exposure to the virus and loss of loved ones, as well as
impairment, boredom, stigma, worry, phobia, frustration and secondary adversities due to economic difficulties, unavailability
anger has been observed (Ahmadi and Ramezani, 2020; Brooks of food, psychosocial effects, disruption of future plans and
et al., 2020; Pfefferbaum and North, 2020; Restubog et al., 2020; underlying physical and psychological conditions (Islam et al.,
Sher, 2020a; Teufel et al., 2020). In this topic, some selected 2020; Pfefferbaum and North, 2020).
factors must be discussed thoroughly due to its pivotal influence
on the mental health impact of the pandemic. Economic Factors
The ongoing pandemic caused by COVID-19 has set off a
Fear and Uncertainty distinguishable economic crisis in considerable domains of work
Unlike other virus outbreaks of the 21st century, such as SARS and business, including manufacturing, retail, travel and trade
and MERS, which were primarily disseminated in hospital (Restubog et al., 2020). Unemployment is in the rise and even
environments (Bai et al., 2004; Cauchemez et al., 2016), COVID- the most stable and former professionals are having their work
19 is unique in the way that it has spread far beyond health threatened. The International Labor Organization estimates that
centers’ borders. With the entire population at risk, the necessary there will be 25 million new unemployed individuals by the end
restricting measures have created an unparalleled scenario, of the second quarter of 2020 (Restubog et al., 2020). In addition,
dominated by fear and uncertainty. Even though fear is an surveys with US workers before and after previous economic
essential adaptive mechanism that humans and other species downturns state that unemployment is not the only possible
have developed to cope with threats in the environment, it detrimental outcome, since pay cuts, reduction in work hours,
can only be supportive for those who feel capable of dealing increased work demand and challenging working conditions are
with the menaces presented specifically to them. To those possibly part of a contingency plan for this pandemic (Restubog
who consider themselves as unable to handle such risks, fear et al., 2020). Financial loss has been profoundly linked to
can trigger defense responses (Bavel et al., 2020). And so, psychological distress and is considered a risk factor for mental
in a conjuncture where the fear is not only of death but health disorders, with long lasting effects. The disruption or
also of the repercussions in a myriad of different spheres, even bankruptcy of business, unpaid debts, stress of losing job,
including family organization, schools closure, social isolation poverty, inability to provide support to the family and food
and economic consequences, it is vital that close attention is insecurity are only a few examples that portray the extremely
paid to the mental health of the individuals (Ornell et al., harsh scenario regarding the financial impact secondary to
2020). In fact, previous studies showed that fear positively this pandemic (Bhuiyan et al., 2020; Dsouza et al., 2020;
associates with depression, anxiety, perceived infectability and Mamun and Ullah, 2020). Indeed, the lack of basic supplies,
germ aversion (Ahorsu et al., 2020). Furthermore, another including water, food, clothes and accommodation, seems to be
detrimental consequence of fear is the stigmatization and a particularly deleterious source of frustration, anxiety and anger
discrimination of those infected or exhibiting symptoms of (Brooks et al., 2020).
COVID-19 (Ahorsu et al., 2020). Additionally, a disturbing matter is that the economic impact
Although fear has several destructive outcomes, one represents one of the main risk factors for suicidal behavior
of the most maleficent one is suicide. In the COVID-19 (Conejero et al., 2020; Vandoros et al., 2019). During the
pandemic, there have been numerous reports of suicidal pandemic, cases of suicide due to financial downturns have been
behavior due to fear-related issues, for instance, fear of reported in several countries, particularly in those experiencing
being infected (Dsouza et al., 2020; Mamun and Ullah, more severe crises than developed countries, such as India
2020), fear of infecting others (Mamun and Griffiths, 2020), (Dsouza et al., 2020; Griffiths and Mamun, 2020), Bangladesh
fear of being quarantined (Dsouza et al., 2020) and fear (Bhuiyan et al., 2020; Griffiths and Mamun, 2020) and Pakistan
of the mental health impact (Sher, 2020b). A particular (Mamun and Ullah, 2020). Using the data available in the
illustration of this is a Bangladeshi 40-year old woman who International Labor Organization’s press release in March 2020,
took her own life in a hospital bathroom after being refused a study has estimated that, in the best-case scenario, the rise
medical care due to the staff ’s fear of SARS-CoV-2 infection in unemployment rates will provoke an increase of about
(Mamun et al., 2020a). 2,135 suicides in a year worldwide (Kawohl and Nordt, 2020).

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Pedrosa et al. Psychological Impact in COVID-19 Pandemic

Therefore, the number of individuals who might seek help from had increased appetite during this period, whereas 17.8% had
mental health services is expected to substantially increase in the less appetite. As a result, nearly half of the participants of the
context of the COVID-19 pandemic (Kawohl and Nordt, 2020). study perceived weight gain during the pandemic. Additionally, it
was observed that although there were no differences in physical
Domestic Violence activity in the group of individuals who did not play any sports
As a matter of fact, as the “stay home” recommendations remain, before the COVID-19 lockdown, the training frequency has
it is crucial to remember that home is not always a safe place increased amongst those who were physically active. Around 3%
for everyone. It can also be a residence for distortion of power of smokers have quit smoking in this period, probably due to
and abuse, which is supported by studies that suggest that the fear concerning increased risk of respiratory distress and
forced proximity, along with economic stress and disaster-related mortality from COVID-19 (Di Renzo et al., 2020).
instability, are risk factors for aggression and domestic violence
(Bavel et al., 2020; Usher et al., 2020). Furthermore, distancing Individualized Response to Stress
measures also represent, for those living in violent places, In times of psychological distress, emotional reactivity is
diminished access to community-based and familial support, deeply influenced by individual differences and stress-mediated
with fewer opportunities to ask for help (Usher et al., 2020). contexts. A study with the Italian general population aimed
Fear of COVID-19 and threats about contamination can even to observe the gender and personality traits that more
be used as a coercive mechanism to maintain the abuse. As a substantially associated with psychological impact during the
consequence, for example, those suffering from domestic violence COVID-19 pandemic (Moccia et al., 2020). The results showed
may be less inclined to go to the hospital on account of fear that individuals with anxious, cyclothymic and/or depressive
of infection. Ultimately, the social distancing, albeit essential to temperaments are predicted to suffer greater emotional impact
contain COVID-19, may exacerbate the violence and maintain it secondary to the current scenario. Meanwhile, male gender, as
less visible (Usher et al., 2020). well as secure and avoidant adult attachment style were protective
Indeed, in the United Kingdom, a domestic abuse organization for the risk of higher psychological burden (Moccia et al., 2020).
reported that calls to its domestic violence helpline increased Moreover, in a different line of research, a Chinese study
by 25% in the 7 days following the announcement of tighter proposed to understand the differential psychological distress
social distancing and lockdown measures by the government among distinct populations affected by the pandemic. It was
(Bradbury-Jones and Isham, 2020). In Australia, some police observed that individuals who had experienced SARS-CoV-2
departments reported a 5% increase in domestic violence-related infection had significantly increased prevalence of depressed
calls, while Google announced a 75% growth in internet searches mood, somatic symptoms and anxiety-like behavior (Zhang W.R.
for domestic abuse support (Usher et al., 2020). Additionally, et al., 2020). Post-traumatic stress disorder (PTSD) was found
there was a 32–36% increase in domestic violence complaints in to affect 96.2% of hospitalized patients with COVID-19, whereas
France and a 21–35% increase in the US after the implementation depression was also higher in COVID-19 patients (Vindegaard
of the social distancing measures (Usher et al., 2020). This pattern and Benros, 2020). Furthermore, having an infected friend or
is equivalent to what has already been observed in previous family member has been associated with higher anxiety levels
epidemics (Usher et al., 2020). (Duan L. et al., 2020).

Changes in Daily Habits

Analysis on sleep quality during the SARS-CoV-2 pandemic PSYCHOLOGICAL DISORDERS
also indicated that there has been a rise in sleep disturbances, SECONDARY TO THE COVID-19
a critical condition associated with anxiety, depression, and PANDEMIC
suicidal behavior (Sher, 2020a). Furthermore, diminished sleep
quality promotes short temperament and, as a consequence, The COVID-19 pandemic may intensify psychological disorders
complicates family cohabitation (Islam et al., 2020). or precipitate others, for instance, anxiety, depression, PTSD,
Another interesting inquiry was related to news monitoring: alcohol misuse, obsessive-compulsive behaviors, panic and
a study suggested that higher averages of time (≥ 3 h) spent paranoia (Dubey et al., 2020; Islam et al., 2020). A nationwide
focusing on the virus outbreak was positively correlated to the survey in China with over 52 thousand participants had almost
development of anxiety symptoms (Huang and Zhao, 2020), but 35% of the respondents experiencing psychological distress due
also with social responsibility values and compliance to social to the SARS-CoV-2 (Qiu et al., 2020). In this study, women
distancing recommendations among US adolescents (Oosterhoff appeared to be more vulnerable to stress than men, although
et al., 2020). Contrarily, less engagement in risk prevention this result is not consistent in literature (Huang and Zhao, 2020).
behaviors was observed in individuals who were apparently prone Therefore, some of the most cited psychological consequences of
to “optimism bias,” the belief that they are less likely to acquire the the pandemic will be further addressed.
disease than others. This principle is also seen in other diseases,
including lung cancer (Soofi et al., 2020). Anxiety and Depression
Moreover, an Italian survey performed in April 2020 assessed Anxiety, one of the main evaluated subjects, has been significantly
the changes in eating and lifestyle habits of 3,533 individuals, aged increasing in society during this pandemic (Huang and Zhao,
between 12 and 86 years. It was observed that 34.4% of responders 2020; Li et al., 2020; Qiu et al., 2020; Teufel et al., 2020). A research

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Pedrosa et al. Psychological Impact in COVID-19 Pandemic

group in China analyzed the online posts from about 18,000 that alcohol consumption is an important risk factor for the
Chinese social media users before and after the declaration of decompensation of psychiatric disorders and, ultimately, may
COVID-19 in China on January 20, 2020 and found an increase favor individuals to commit suicide, particularly the fragile and
in words that mirror negative emotions including anxiety, more vulnerable ones (Conejero et al., 2020).
depression, and anger (Li et al., 2020). One particular kind of Another complex consequence of such measures concerns
anxiety is worth mentioning: health anxiety. It is characterized those in recovery or wanting to recover from alcohol abuse.
mainly by catastrophic misinterpretations of bodily sensations, Since autonomy is crucial to sustain behavioral changes that
dysfunctional beliefs about health and illness and maladaptive result in the discontinuation of drinking, and since the patients
coping behaviors. Harmful consequences can derive from this have, during this period, restricted access to services such
condition, including excessive hand washing, social withdrawal, as Alcoholics Anonymous, prohibiting alcohol sales can be
panic purchasing and overspending in resources such as hand detrimental to recovery (Nadkarni et al., 2020). Additionally, the
sanitizers, medications and protective masks (Asmundson and social distancing, the anxiety and the negative thinking that have
Taylor, 2020b). In fact, especially for the suspected cases of been exacerbated in the pandemic situation may trigger relapse
COVID-19, the development of obsessive-compulsive symptoms (Nadkarni et al., 2020). In fact, in other countries where alcohol
may be a consequence of anxiety related to their health status sales were not prohibited, such as in the United Kingdom, the
(Dubey et al., 2020). The same rising tendency has been seen consumption of alcohol during lockdown significantly increased
for depressive symptoms (Bavel et al., 2020; Pfefferbaum and (Nadkarni et al., 2020). It is important, then, that countries
North, 2020; Restubog et al., 2020; Sher, 2020a). Interestingly, prohibiting alcohol sales carefully address its impact for those
groups with less education seem to be more susceptible to who suffer from addiction.
these manifestations in an epidemic context, especially due
to unreliable access to information and apprehension to its
academic formation (Pfefferbaum and North, 2020). MENTAL HEALTH VULNERABILITY
Post-traumatic Stress Disorder Several groups are more vulnerable to greater emotional,
Another alarming condition that can be expected to increase behavioral and psychological impact of the COVID-19 pandemic.
is post-traumatic stress disorder (PTSD) (Brooks et al., 2020; The most cited ones will be addressed in this discussion.
Dutheil et al., 2020; Gunnell et al., 2020), similar or worse to Nevertheless, other groups at increased risk for the mental health
what happened in previous epidemics, such as H1N1 Influenza repercussions of the pandemic include those with pre-existing
and Ebola (Xu et al., 2011; Cénat et al., 2020). The adverse health conditions, those living in care homes, domestic caregivers
effects of this illness are not manifested immediately and mental and COVID-19 patients and their family members (Dubey et al.,
health support must be prepared to deal with this issue in a few 2020; Khan et al., 2020).
months. PTSD is more likely to take place after longer periods
of social disconnection and it is associated with increased suicide Healthcare Professionals
risk by 2–5 times (Thibodeau et al., 2013; Brooks et al., 2020). One of the main groups in this category is the one with the
PTSD patients are also less prone to seek help from authorities, healthcare providers during the pandemic, specifically frontline
possibly due to few available information about this subject, workers. In the alarming context of this health emergency,
fear of stigmatization, beliefs that symptoms may disappear these professionals are put through different circumstances and
over time and concerns about the cost of mental healthcare afflictions, which include fear of being infected and infecting
(Dutheil et al., 2020). others, higher workload, significant pressure, pain of losing
patients and colleagues, the yet unpredictability nature of
Alcohol Addiction the virus, inadequate testing, limited treatment options and
During the lockdown, some countries also prohibited alcohol disruption of regular routine, along with insufficient personal
sales. The arguments to sustain the restricting conditions protective equipment and other medical supplies, especially in
included impaired ability of those under the influence of alcohol developing countries (Chew et al., 2020; Lancet, 2020; Mamun
to implement the preventive measures, the influence of drinking et al., 2020c; Pfefferbaum and North, 2020). Evidence reports
in domestic violence, its impact to the immune system and, that such conditions might make them more vulnerable not
finally, the high cost of acute drinking for the emergency only to physical symptoms, including headache and sore throat
services (Nadkarni et al., 2020). Nevertheless, higher numbers (Chew et al., 2020), but also to mental health burden, with
of abstinence syndrome appeared as a consequence within an increase in rates of anxiety, depression, stress, irritability,
patients who suffer from addiction (Narasimha et al., 2020). insomnia, anger, and frustration (Brooks et al., 2020; El-Hage
In a psychiatry emergency service in Bangalore, India, twice et al., 2020; Pfefferbaum and North, 2020; Zhang J. et al., 2020).
the number of severe abstinence syndrome (seizures, delirium Having an organic disease appeared as an independent risk factor
tremens, and hallucinations) occurred per day after lockdown for these outcomes in previous studies (Zhang J. et al., 2020).
(Narasimha et al., 2020). Furthermore, rise of the black marketing As an illustration, a study in China concluded that half of the
of alcohol, consumption of non-consumable alcohol and even frontline healthcare professionals had symptoms of depression
suicide in those suffering from addiction have been reported and anxiety, 70% had psychological distress and many also
in India (Nadkarni et al., 2020). In fact, it has been suggested reported insomnia (Mesa Vieira et al., 2020). Previous epidemics

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Pedrosa et al. Psychological Impact in COVID-19 Pandemic

had a similar pattern, as 29% of the healthcare workers may have disconnection may worsen neurodegenerative disorders, such as
had emotional distress after the SARS epidemic in 2003 (Holmes Alzheimer’s disease (Conejero et al., 2020; Plagg et al., 2020).
et al., 2020). This group is also at risk for the development of An additional topic of discussion that further elucidates
PTSD (Dutheil et al., 2020). the emotional impact of the pandemic among the elderly
Moreover, as the COVID-19 pandemic is currently at the is the phenomenon of “ageism”. In the early phases of the
center of the news broadcast, the public gains access to the COVID-19 outbreak, the disease had been predominantly
scientific data practically at the same time that it becomes portrayed as an illness that affects almost exclusively the older
available to the medical community. Therefore, in the midst adults (Ayalon, 2020). At present, this stereotype has been
of fear and anxiety, there is great pressure on healthcare proven erroneous, as age itself is not a reliable criterion to
professionals to be constantly updated on the release of new predict the health impact of SARS-CoV-2 infection (Ayalon,
studies, as well as to prescribe the experimental treatments 2020). Notwithstanding, albeit the scientific evidence of such
for their patients, in spite of insufficient high-quality evidence a statement, the social marginalization and segregation of
(González-Padilla and Tortolero-Blanco, 2020). the elderly persists throughout the population (Ayalon, 2020;
The extent of mental health vulnerability seems to vary Colenda et al., 2020). Indeed, in some countries, the gradual
amongst different populations within the healthcare staff. It has relaxation of the social distancing recommendations does not
been reported that young women are at higher risk for adverse seem to apply to the older adults, who are consistently
psychological repercussions than men (El-Hage et al., 2020; advised to self-isolate (Ayalon, 2020). Moreover, there is a
Lai et al., 2020). Moreover, nurses are also more likely to be general belief that the safety of this group should be sacrificed
affected than physicians (El-Hage et al., 2020; Lai et al., 2020; for the greater good of society, particularly in detriment to
Tsamakis et al., 2020). Interestingly, one study observed that non- the economy (Ayalon, 2020; Colenda et al., 2020). In this
frontline nurses were more prone to emotional impact than the scenario, the aggravation of the intergenerational tension can
frontline group, which seems to be due to their greater working be observed in social media content. As an illustration, the
experience and psychological preparation (Ghaffari et al., 2020). offensive hashtag #boomerremover appeared in over 4,000
Although results from other researches evidenced the opposite posts in Twitter in a 10-day period following the pandemic
(Lai et al., 2020), it brings attention to the importance of declaration of WHO in March (Jimenez-Sotomayor et al.,
providing psychological preparation and assistance to healthcare 2020). In this framework, there is a destructive increase in
professionals during the COVID-19 outbreak. the mental health burden of senior citizens, which must be
urgently addressed.
Elderly
As part of an important risk group for COVID-19, the elderly Children
are currently being instructed to remain at home and self- Children, especially the young ones, are also in a position of
isolate (Armitage and Nellums, 2020). Nonetheless, it has been vulnerability during the pandemic. This happens because, at
demonstrated that older adults are at higher risk for anxiety home, they suffer with limited social connection, crucial for
and depression when put in situations of social disconnection identity and well-being at young ages, reduced physical activity,
(Armitage and Nellums, 2020; Conejero et al., 2020). To those loneliness and boredom (Fegert et al., 2020; Jiao et al., 2020;
who do not have close family or friends and to those whose Loades et al., 2020), which may result in long-term effects.
only social contact is out of the home, these can be particularly Indeed, the mental and physical health, as well as productivity
dawning times. Many individuals within this group rely solely in adult life, is deeply rooted in the childhood years (Loades
on community centers, places of worship, voluntary work and et al., 2020; Wang G. et al., 2020). Data from previous epidemics
social care, activities which have been severely restrained by the demonstrate that children who experienced isolation measures
COVID-19 outbreak (Armitage and Nellums, 2020). In addition, were five times more prone to demand mental health services
many older individuals have smaller access and/or literacy to and more inclined to experience PTSD (Loades et al., 2020).
social networks, which prevents them from maintaining virtual It has also been demonstrated that children who are out of
connection with others (Mesa Vieira et al., 2020). Therefore, school (i.e., weekend and summer holidays) tend to have longer
the psychological and emotional impact is tremendous. The screen times, irregular sleep patterns and less favorable diets
social disconnection causes and aggravates loneliness, neglect, (Wang G. et al., 2020), which can be exceptionally harmful in
depression and anxiety, all of which can produce long- longer periods of time such as the yet unknown duration of this
term health consequences (Banerjee, 2020; Bavel et al., 2020). pandemic. Furthermore, the economic recession, the restricting
Moreover, the context of this pandemic might increase suicide measures and the overall family stress may be accompanied
behavior amongst older adults. As an example, after the SARS by an increase in domestic violence and child maltreatment,
epidemic in 2003, suicide rates among elderly individuals were situations that impact the mental health of children (Fegert et al.,
increased by 30% (Holmes et al., 2020). The solitude in the 2020). Adolescents with previous mental health disorders require
elderly has also been suggested to be accompanied by biological particular attention since disruption of school routine can decline
modifications that make this group more vulnerable to commit their mental health status (Khan et al., 2020). Moreover, the
suicide, which includes the elevation of inflammatory markers current events have further prompted the expansion of remote
and expansion of peripheral blood mononuclear cells (Conejero work, whereas schools and daycare centers had to interrupt their
et al., 2020). Furthermore, it has also been suggested that social activities. In this setting, family and work environment have

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Pedrosa et al. Psychological Impact in COVID-19 Pandemic

merged and decreased performance can be seen in both spheres, psychological outcomes (Fish et al., 2020; Phillips et al., 2020;
as stress intensifies (Mental health Covid-19, 2020). Salerno et al., 2020).
Following the distancing measures, social media has become For the LGBTQ+ youth, for instance, the social distancing
an important resource to maintain social interaction. Even measures might lead to confinement in unsupportive homes,
though its use might alleviate some of the mental health impact increasing their exposure to discrimination, violence and
of the isolation, it is essential to analyze its negative impact rejection from their family (Fish et al., 2020). Previous researches
in children and adolescents (Deslandes and Coutinho, 2020; Ni have demonstrated that one third of the LGBTQ+ youth undergo
et al., 2020). First, consuming indiscriminate information about family rejection and that these individuals are six times more
the pandemic may trigger stress, anxiety, panic and depression. prone to depression and eight times more prone to suicide
This effect is even more intense in younger individuals that (Salerno et al., 2020). Simultaneously, the LGBTQ+ youth,
do not have the discernment to filter information (Deslandes during the pandemic, experience less access to essential social
and Coutinho, 2020). Second, the excessive use of the Internet connections, identity-based alliances and school-based mental
might create an addiction, compromising the development of a health services (Fish et al., 2020; Salerno et al., 2020). As a result,
healthier routine during the pandemic, which is also composed this group is more vulnerable to anxiety, depression, suicide
by study, leisure, and exercise activities (Deslandes and Coutinho, behavior, PTSD, substance abuse and self-harm (Fish et al.,
2020). Third, digital social networks are extremely based in 2020; Salerno et al., 2020). For this reason, online communities
the virtual construction of a self-image and visibility, which, have emerged as important support resources for this group
especially for the youngest, might mediate self-esteem through (Fish et al., 2020).
the pursuit of social approval. Simultaneously, social media can Moreover, the LGBTQ+ elders are twice as likely to live
be a violent place. As a consequence, its excessive use may alone, four times less prone to have children and more inclined
contribute to self-harm actions through virtual challenges, in to be segregated from their family (Salerno et al., 2020).
which the participant has assignments related to self-mutilation Therefore, social distancing measures may exacerbate loneliness
and even suicide that should be filmed and posted. The online and previous mental health conditions (Salerno et al., 2020).
search for the term “challenges online” has increased since Finally, the levels of poverty, lack of health-insurance and
the implementation of the restricting measures (Deslandes and unemployment are higher amongst LGBTQ+ individuals, which
Coutinho, 2020). Ultimately, elevated Internet use is associated aggravate the impact of the pandemic in their mental health
with behavioral problems such as neglecting personal life, (Phillips et al., 2020; Salerno et al., 2020).
relationship disorders, mood dysfunction and sleep disturbances,
as well as increased anxiety and depression levels during the Black and Latin Communities
pandemic (Duan L. et al., 2020). Structural racism imposes unequal access to healthcare and
protective resources among different racial and ethnic
populations. For instance, many individuals of color do not
College Students
have adequate housing, a main social determinant of health.
Since universities have temporarily closed during this world
Additionally, nearly one third of the black Africans and one
health emergency, college students are also vulnerable to
fourth of Black Caribbean in the United Kingdom are workers
major changes in their routine and, as a consequence, to the
in essential services without the possibility of working from
psychological impact of the pandemic (Khan et al., 2020). As a
home (Farquharson and Thornton, 2020; Liu and Modir, 2020).
matter of fact, having the graduation affected by the pandemic has
Furthermore, there is an insufficient amount of well-resourced
already been significantly associated with increased depression
hospitals in many primarily black and latin communities (Liu
rates (Duan L. et al., 2020). Factors that may aggravate this
and Modir, 2020). As a result, the COVID-19 pandemic has an
situation include living away from family, instability of family
increased impact on the individuals of color, which may lead to
income and insufficient access to technology in order to attend
enhanced fear of infection and worse mental health outcomes
online classes (Cao et al., 2020; Khan et al., 2020). In fact, the
(Farquharson and Thornton, 2020; Liu and Modir, 2020). In
mental health impact of online classes is a topic that deserves
fact, black Americans have the highest COVID-19 mortality
further evaluation, since it might lead to overburden (Dubey
rate among the racial groups in the United States and early
et al., 2020). As an extreme example, a suicide pact related to
data reported that 33% of all deaths were of black people, even
online classes has been reported between a private university
though this group composes 13% of the United States population
student and his mother. Similarly, suicides due to depression
(Liu and Modir, 2020).
after an exam postponement and due to inability to access online
Furthermore, in the course of the pandemic, the
classes have also been announced (Mamun et al., 2020b).
stigmatization of racial minorities exacerbates, causing
rejection, social disconnection and physical violence
LGBTQ+ Community (Farquharson and Thornton, 2020). As an example, the
LGBTQ+ individuals, in general, have worse mental health early recommendation to wear face masks in public resulted,
and well-being compared to non-LGBTQ+ peers, especially for the black community, in increased racial profiling
for the persons of color (Fish et al., 2020; Salerno et al., and police violence (Liu and Modir, 2020). Therefore, the
2020). As a consequence, during the COVID-19 pandemic, narrative “we’re all in this together” regarding the COVID-19
they face particular stressors that can trigger deleterious outbreak has been proven inaccurate, and the communities

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Pedrosa et al. Psychological Impact in COVID-19 Pandemic

of color are a vulnerable group for the mental health Homeless Individuals
repercussions of the pandemic (Farquharson and Thornton, Homeless individuals compose another vulnerable group for
2020; Liu and Modir, 2020). contracting COVID-19 and for the psychological impact of the
pandemic (Hsu et al., 2020; Khan et al., 2020; Mesa Vieira et al.,
Foreigners 2020). First, this group faces difficulties in taking preventive
The continuous threat of SARS-CoV-2 has aggravated ethnic measures for COVID-19, such as hand washing and self-isolation.
prejudice and intolerance toward stigmatized groups, especially Conversely, they are more prone to risky behaviors such as
toward Chinese people (Asmundson and Taylor, 2020a; Bavel substance abuse and the sharing of needles (Wood et al.,
et al., 2020). This is not unprecedented in History: Jewish 2020). Second, many individuals have an increased prevalence
people were linked to the Black Death, HIV was believed to of comorbidities and chronic diseases compared with people
be disseminated by the LGBTQ+ community and the western of similar age, including mental health disorders like bipolar
African population was discriminated against during the Ebola disorder and schizophrenia (Khan et al., 2020; Mesa Vieira
outbreak (Coates, 2020). In this pandemic, it is likely that the et al., 2020; Wood et al., 2020). Third, they face enhanced
novelty of the virus and the uncertainty surrounding its potential obstacles to receive treatment for previous medical conditions,
outcomes in several spheres of society have triggered fear and especially considering their reduced accessibility to telehealth
anxiety that endorse the xenophobia behavior (Asmundson and services (Wood et al., 2020).
Taylor, 2020a). There have been reports of discrimination within
social and political contexts: Chinese restaurants having to shut
down due to reduced number of costumers (Asmundson and
Prisoners
Taylor, 2020a), Chinese individuals being barred from entering The vulnerability of the prison population in the COVID-19
certain establishments and even the United States President pandemic does not seem to be thoroughly explored by the
referring to COVID-19 as the “Chinese virus” (Devakumar scientific community (Hewson et al., 2020). Notwithstanding,
et al., 2020). Moreover, immigrants have decreased access to this group of individuals comprise numerous risk factors
healthcare services, adequate housing and clean water, especially for worse mental health outcomes secondary to the current
if undocumented (Liu and Modir, 2020; Mesa Vieira et al., 2020). circumstances. This magnified emotional impact is a result
To manage such reality, multidisciplinary measures are necessary of several aspects. The frequency of pre-existing psychological
to correctly inform the population on public health risks, to notify disorders, neurodevelopmental health, substance misuse, suicide
discriminatory acts and to support those affected by harmful and self-harm is already increased in this group compared to
misconceptions (Rzymski and Nowicki, 2020). the rest of the population (Hewson et al., 2020; Kothari et al.,
2020). Moreover, as consequences of the COVID-19 pandemic,
Individuals in Economic Vulnerability these individuals have been suffering with diminished social
As in natural hazards, the economically disadvantaged people interaction with other inmates and outside visitors, suspension
seem to be more susceptible to the threat and more likely of jury trials and delay of court hearings, and recreational
to be minced by it (Bavel et al., 2020). For instance, a study and occupational prison activities (Fovet et al., 2020; Hewson
has shown that groups with lower income may have been et al., 2020; Tozzo et al., 2020). This group is also more
performing less physical exercises during this period, due to vulnerable to the infection of SARS-CoV-2, as prisons tend to
less access to Internet and technological tools. This is evidence be overcrowded, have poorly ventilated environments and low
that, besides the economic impairment, these individuals are also compliance to hygiene rules (Tozzo et al., 2020). In light of
more vulnerable to physical and psychological repercussions of this scenario, prisoners are more likely to suffer from anger,
social isolation (Peçanha et al., 2020). Furthermore, there has depression, anxiety, irritability, frustration, paranoia, fear of
been correlation between socioeconomic deprivation and ability contamination, psychosis, exacerbation of underlying mental
to adopt preventive measures, enhancing the risk inequality illness and suicidal behavior (Fovet et al., 2020; Hewson et al.,
(Atchison et al., 2020). 2020; Tozzo et al., 2020).
Those living in informal settlements have particular stressors
that decline their mental health. For instance, space constraints, Rural Communities
violence and overcrowding implicates in decreased capability The individuals living in rural communities experience more
to adhere to the social distancing measures and, as a loneliness, lack of belonging and perceived burdensomeness than
consequence, in increased fear of contamination (Corburn those living in urban centers. They are, therefore, at elevated risk
et al., 2020). Furthermore, basic needs such as access to water, for unsatisfactory mental health and even suicide (Monteith et al.,
waste collection, sewers and adequate housing may not be 2020). During the COVID-19 pandemic, the social distancing
available. Moreover, most of the individuals living in slums measures, often not accompanied by virtual connections due
are informal workers and, therefore, are more vulnerable to to diminished access to the Internet, may exacerbate mental
the economical impact of the pandemic (Corburn et al., 2020). health symptoms and increase suicide behavior in this population
Finally, racism, xenophobia and stigmatization of the poor have (Monteith et al., 2020). Furthermore, intimate partner violence
raised during the pandemic, which implicates in even worse tends to be more intense in rural communities, whereas access to
outcomes regarding the mental health of these populations mental healthcare tends to be deficient. All of these circumstances
(Corburn et al., 2020). may exacerbate during the pandemic and might result in

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Pedrosa et al. Psychological Impact in COVID-19 Pandemic

poorer mental health outcomes and increased suicide rates change its manifestations (Fischer et al., 2020). For example, a
(Monteith et al., 2020). 43-year old German patient with schizophrenia had delusions
and hallucinations related to the pandemic (Fischer et al.,
Psychiatric Patients 2020). He believed he contracted the disease through a
In psychiatric patients, the COVID-19 pandemic might trigger WhatsApp video from COVID-19 patients in China and
an even worse outcome regarding mental health. As previously started having acoustic hallucinations, anxiety and depressing
discussed, the uncertainty, fear and social distancing may humor. Therefore, equilibrated communication, based on
exacerbate pre-existing psychiatric diseases and precipitate its scientific facts, is essential to minimize this possible damage
symptomatology (Holmes et al., 2020; Vindegaard and Benros, (Fischer et al., 2020).
2020; Yao et al., 2020). Added to their higher vulnerability Furthermore, schizophrenic patients were less likely to
to many stressors (Yao et al., 2020), they face worsen vaccinate, adhere to social distancing, wash their hands
medical follow-up due to the suspension of some elective and use masks during influenza pandemic (Maguire et al.,
appointments and redirection of health professionals to face 2019). This reality is also true for patients with other
the pandemic (Holmes et al., 2020). Furthermore, they tend to psychiatric conditions, such as addiction (Narasimha et al.,
have more severe forms of COVID-19 due to comorbidities, 2020). Therefore, they are a vulnerable group for contracting
immunosuppression (Fontenelle and Miguel, 2020; Yao et al., COVID-19, especially if their mental health is worse than usual
2020) and, possibly, worst access to medical care because of (Yao et al., 2020).
discrimination (Yao et al., 2020).
Hospitalized Patients
Depression and Anxiety Stress experienced during COVID-19 pandemic is probably
When performed several scales to assess the psychological even higher for psychiatric patients hospitalized for severe
impact of COVID-19 pandemic in China on 76 psychiatric illness. In China, these patients had to stay in closed wards
patients (with major depressive disorder, anxiety disorders without family visits or electronic equipment (Li and Zhang,
and mixed anxiety and depressive disorder patients) and 109 2020). These conditions exacerbated their distress and mental
healthy controls, the patients group had worst outcomes on symptomatology (Li and Zhang, 2020). Additionally, the patients
almost all variables addressing depression, anxiety, stress and in these facilities tend to make group activities, share dining and
insomnia (Hao et al., 2020). As for other psychiatric symptoms bathroom spaces, interact closely and practice less preventive
referred during the survey, the patients group had more worries measures because of their mental state (Bojdani et al., 2020;
about their physical health, more moderate to severe anger Xiang et al., 2020). Therefore, they are more vulnerable
and impulsivity and more suicidal ideation (Hao et al., 2020). to the transmission of SARS-CoV-2 (Bojdani et al., 2020;
However, it is important to mention that the control group was Xiang et al., 2020).
evaluated simultaneously to the patients group. Control group
was composed of individuals without psychiatric disorders that
were evaluated before COVID-19 pandemic. For this reason, EXTERNAL INFLUENCE
results of the study can be contestable.
Moreover, patients with generalized anxiety have increased Culture
health anxiety. As a result, they are more prone to confound As a multi-dimensional psychosocial construct that shapes the
normal feelings with COVID-19 symptoms, generating even perception of the world, culture has the ability to influence
more anxiety and distress (Dubey et al., 2020). several aspects of daily life. In the framework of the pandemic,
cultural components affect how the population will perceive, for
Obsessive-Compulsive Disorder instance, the implementation of hygienic greetings etiquette, the
Many patients with obsessive-compulsive disorder (OCD) recognition of health symptoms and the fear of stigmatization
already excessively worry about having a disease or (Bruns et al., 2020; Furlong and Finnie, 2020). For this reason,
contaminating others. During this world health emergency, it can be challenging to encourage individuals to comply
these feelings may intensify (Fontenelle and Miguel, 2020). Also, with some of the necessary precautions, such as avoidance of
some signs and symptoms of OCD are very similar to important cultural activities (i.e., worship meetings) and submission to the
preventive measures for COVID-19, such as compulsive hand restricting measures, particularly if these strategies are divergent
washing and avoiding physical contact (Fontenelle and Miguel, to the customary social norms (Bruns et al., 2020; Furlong
2020). Therefore, this overlap may cause difficulty for physicians and Finnie, 2020). For example, in Asia, where the COVID-19
to diagnose and treat new cases of OCD. Finally, the stressors outbreak started, discipline is highly valued in society, as well as
associated with the pandemic might increase the number of new punishments for deviance. Therefore, the sense of community
OCD patients, especially among those “at risk” for COVID-19 can be vital in motivating individuals to comply and respect
(Fontenelle and Miguel, 2020). the measures imposed. Contrarily, countries who value freedom
and individual expression, including the United States, Italy,
Schizophrenia and Brazil, may exhibit more difficulties in renouncing personal
In psychiatric patients, excessive attention to media or social desires in order to oblige to a common good (Bavel et al.,
networks might precipitate an acute phase of the disease or 2020). As a result, the mental health outcomes derived from

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Pedrosa et al. Psychological Impact in COVID-19 Pandemic

this pandemic rely deeply on the level of cultural impact in the and behaviors (Brooks et al., 2020; Gao et al., 2020). In
community (Furlong and Finnie, 2020). fact, particularly in the scenario of this unprecedented crisis,
social networks have been suggested to play a fundamental
Media and Access to Information role in social support, tension release and emotional catharsis
As a worldwide unprecedented health issue, COVID-19 (Liu and Liu, 2020).
pandemic has drawn massive attention from the media.
Nonetheless, the supply of information regarding the disease has Government
heavily surpassed the demand from the population (Liu and Liu, In the midst of the pandemic disarray, the government of each
2020). This phenomenon has two main repercussions in respect country is in the position to guide the population and to execute
to the mental health impact. the necessary interventions to minimize the propagation of
First, the manner by which media vehicles have been the virus. Some strategies consisted of school closures, limited
portraying the current situation to the community might be commercial activities, requests that individuals work from home
causing great harm in terms of psychological implications. and reduced freedom to use public spaces (Briscese et al., 2020).
This can be easily translated as an analogy with vicarious This kind of leadership has powerful repercussions, with surveys
traumatization, a process suffered by the health staff in command indicating that trust in the government increased from the day
when listening to the victims’ narration of traumatic events they the restrictive measures were implemented (Teufel et al., 2020)
experienced (Liu and Liu, 2020). Similarly, the negative exposure and that positive behavioral changes were made in response
of individuals to ruthless details concerning the COVID-19 to authorities’ guidance (Atchison et al., 2020). Indeed, it has
pandemic has the potential to promote great psychological been demonstrated that government’s interventions of disease
distress in the society. During these times, pessimistic reports prevention and control have significantly increased the likelihood
have prevailed in the correspondence with the public, including of adoption of protective measures (Duan T. et al., 2020).
daily updates on the number of those infected and number Moreover, a study showed that, in the United Kingdom, the
of deaths, economic impact and uncertainty about the future. inclusion of altruism in government’s health messages possibly
This consequently increases negative emotions throughout the had a positive effect on wellbeing compared with compulsory
community and makes people more susceptible to panic. An orders to stay at home (Holmes et al., 2020).
illustration of this matter is the display of images of empty shelves Nonetheless, in regard to the governments’ strategy to mitigate
and panicked shoppers during the first months of the pandemic. the emotional and behavioral impact of the pandemic, the
Even though this may have been used as a critic, it induced results may not be as optimistic. During health crises, there
viewers to look out after themselves and foster individuality and seems to be a special focus from authorities in epidemiological
competitiveness (Bavel et al., 2020). and biomedical data (Atlani-Duault et al., 2020). Indeed, a
Secondly, as information travels at an uncontrollable speed, it Chinese study investigated the government’s communication
is virtually impossible to control the accuracy and authenticity with the public through social media and observed an overall
of the majority of news in circulation. As expressed by the inadequate responsiveness to the public’s concerns. The majority
Director-General of the WHO, in addition to the fight to the of posts consisted of reports on the epidemic situation,
SARS-CoV-2 virus, the world is currently facing an “infodemic” disease-related questions, guidelines and prevention advice.
(Dubey et al., 2020; Zarocostas, 2020). It is characterized not only Although these are tremendously relevant topics, there seemed
by the massive frequency of fake and inaccurate news (Irwin, to be insufficient instrumental and emotional support for the
2020), but also conspiracy theories and misinformation, which community (Liao et al., 2020).
puts the public through the distress of having to distinguish Moreover, an interesting phenomenon is the “heroization”
between scientific evidence and unreliable information (Depoux process (Atlani-Duault et al., 2020; Liao et al., 2020). It can be
et al., 2020). The repercussions of this phenomenon are illustrated by the fact that, in any disaster, there seems to be a
numerous and deleterious, particularly to the mental health of social need for attribution of blame, in which certain groups or
the population, given it is a potential source of anxiety, phobia, individuals may be considered heroic figures (Liao et al., 2020).
panic, depression, obsession, irritability, and COVID-19-related Therefore, in order to balance the complex geographies of hope
paranoia (Dubey et al., 2020). and blame (Atlani-Duault et al., 2020), the government must be
aware of this phenomenon in order to modulate the community’s
Social Network emotional response to the pandemic, as well as to counteract fake
In this topic, social networks present twofold effects. On one news and misinformation (Atlani-Duault et al., 2020).
hand, it is one of the main vehicles of the misinformation Another key component to examine in the government’s
and inaccurate information reported. Moreover, people can be influence over the population is the establishment of deadlines
adversely influenced by what they see in social networks, which to the end or the loosening of restricting measures. While
may alter risk perceptions, encourage unhealthy behaviors and the lack of an end date to protective efforts may increase
reassure the non-compliance with preventative measures (Gao the perceived severity of the situation, which, in turn, may
et al., 2020). On the other hand, as the current situation demands build up compliance to such measures, it is also possible that
physical distancing, remote communication has become an the absence of a deadline might increase anxiety and other
indispensable resource to have social connection (Bergman psychological complications over the uncertainty of the future
et al., 2020), as well as to find inspiration on healthy habits (Briscese et al., 2020). The opposite may also apply: a deadline

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Pedrosa et al. Psychological Impact in COVID-19 Pandemic

may also create the impression that the emergency is limited in face-to-face CBT in health anxiety disorders, while resulting
time and not particularly serious. In addition to that, deadlines in lower treatment costs in previous studies (Axelsson et al.,
may develop expectations in the population that, if not met, 2020). Therefore, even though the evidence base is still limited,
might reduce people’s acceptance to the necessary procedures, these therapeutic modalities may have an important role for
trust in authorities and compliance to social distancing, a result facing mental health issues during COVID-19 pandemic (Bilder
which is called “social isolation fatigue” (Briscese et al., 2020). et al., 2020; Fegert et al., 2020). Nevertheless, telepsychology
uptake in more complex cases with severe symptomatology,
such as antisocial personality disorder, behavioral issues and
MEASURES ADOPTED TO MINIMIZE bipolar disorder, had a lower increase during the pandemic,
indicating difficulty to treat the conditions via the internet
BEHAVIORAL AND PSYCHOLOGICAL
or insufficient specialized training for psychologists. The same
CONDITIONS FACING COVID-19 pattern was observed with testing and evaluation, which could
PANDEMIC signal insufficient tests adapted for telepsychology (Pierce et al.,
2020). Furthermore, technology issues are among the main
In light of all the harmful ramifications that derive from barriers to the implementation of telehealth. For instance, the
the current COVID-19 pandemic, it is essential that the elderly may lack familiarity with the platforms, while those from
government, the health authorities and the population articulate a lower socioeconomic background or those living in rural areas
to endorse preventive and supportive measures, not only may deal with deficiency of technological devices or Internet
for the transmission of the disease, but also for emotional, connections (Bilder et al., 2020; Monteith et al., 2020).
behavioral and psychological impact. In this context, it is Finally, mental health professionals should be prepared
important to include mental health professionals managing the to address some particularities of minority groups, such as
pandemic more broadly (Sani et al., 2020). Their knowledge the LGBTQ+, black and latin communities, with cultural
and experience are crucial to monitor the situation and to responsiveness (Liu and Modir, 2020; Phillips et al., 2020). For
coordinate supportive measures in order to prevent an even the black community, psychologists can use racial socialization
higher increase in psychological disorders, including panic, OCD, in order to enhance awareness about the reality of racism and to
addiction and PTSD (Fiorillo and Gorwood, 2020; Sani et al., promote coping mechanisms (Liu and Modir, 2020).
2020). Finally, considering that poor mental health is associated
with lower adherence to preventive measures for SARS-CoV-2,
improving well-being might even decrease the rates of infection Hotlines
(Adhanom Ghebreyesus, 2020). It has been recommended that people under quarantine should
have access to hotlines with trained healthcare providers to
receive guidance regarding possible symptoms or doubts. Such
Telepsychology Services communication channels would reassure and comfort distressed
As mentioned, worse medical follow-up is one of the most people, providing a sensation that they have not been forgotten.
important features to understand the mental health impact Online support groups for people who are quarantined at home
of COVID-19 pandemic to mentally ill patients. Demand might also be helpful in reducing levels of fear and anxiety
for telepsychology services, therefore, has increased markedly (Brooks et al., 2020).
during the pandemic, and managers have accordingly tried People with suicidal tendencies or previous mental illnesses
to keep up with this abnormally high demand (Perrin et al., need special support. Some of them will search for help, and, in
2020). In fact, psychologists performed 7.07% of their work this case, it is necessary to increase the volunteer team and to
through telecommunication technologies before the COVID-19 prepare individuals to deal with the situation, including resources
pandemic, whereas, during the pandemic, this number increased through the Internet or phone call. For those who will not
to 85.53%, with 67.32% of the mental health professionals search for help, it is important to be attentive to their signs,
executing their work solely via telepsychology (Pierce et al., such as social disconnection and humor flows (Gunnell et al.,
2020). The United States government has pursued some actions 2020). Monitoring the mental status of the population is crucial
to enlarge the role of telepsychology, such as allowing the to guide new interventions and improve the overall wellbeing
possibility of some drugs to be prescribed in appointments (Holmes et al., 2020).
via the Internet, and the expansion of Medicare and Medicaid
to cover telepsychology and telemedicine consultations (Perrin
et al., 2020; Pierce et al., 2020). Furthermore, online training with Digital Technology Monitoring and
experienced trainers, along with tools and resources prepared by Assistance
psychology organizations, are available in order to instruct the The global issue of misinformation and social media panic is a
professionals for this new demand (Pierce et al., 2020). These crucial topic to be addressed during this pandemic. In order to
learning opportunities are remarkably important, since lack of avoid misleading media reports, the main news outlets should
self-efficacy is one of the main reasons that explain the small use assign professionals to moderate the information that is passed
of telepsychology preceding the pandemic (Pierce et al., 2020). on to the public, in the interest of verifying if it is in line
Concerning its efficacy, Internet-delivered therapy, such as with the current guidelines and scientific evidence (Gunnell
cognitive behavior therapy (CBT), was not less effective than et al., 2020). Furthermore, news broadcasts should use simple

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Pedrosa et al. Psychological Impact in COVID-19 Pandemic

language when communicating with the public, which means life satisfaction have been associated with higher levels of
avoiding complex and scientific terms. It is also recommended inflammation, which increases the odds of contracting the disease
that they offer practical and specific advice instead of vague (Mesa Vieira et al., 2020).
or complex guidance (Lakhani et al., 2020; Mesa Vieira et al., Moreover, a study with employed students observed that
2020). This facilitates the comprehension of the information and there are multiple emotion regulation strategies that might be
also promotes social inclusion of the more vulnerable groups helpful during this period. They include seeking and reaching
(Mesa Vieira et al., 2020). out to social connection, such as friends or family, or even
Moreover, there is a serious need for online platforms that volunteering, as reducing the feeling of loneliness and enhancing
clarify the available data concerning COVID-19, as well as belongingness is crucial to prevent suicide (Holmes et al., 2020).
demystify the fake and inaccurate news in circulation (Depoux Keeping oneself committed to other things (i.e., hobbies, music,
et al., 2020). An illustration of this strategy is the “Mythbusters” reading, film, and television and home improvements) and
dashboard in the WHO website, which carries this exact purpose engaging in enjoyable activities to improve one’s mood have
(World Health Organization [WHO], 2020a). Additionally, the also been suggested (Restubog et al., 2020). As complex and
use of social media must be conducted with responsibility. The multicomponent activities, arts and crafts have been highly
users should avoid the sharing of information that it is either not associated with diminished risk of developing mental health
followed by a reliable source or that may cause panic or anxiety. disorders (Conejero et al., 2020). It is suspected that they
Medical advice ought to be provided solely if it is backed by modulate several neurotransmitters, as well as cortisol levels, and
evidence (González-Padilla and Tortolero-Blanco, 2020). stimulate neuroplasticity. Therefore, they offer the possibility of
Moreover, as the Internet has become an indispensable tool emotional expression and regulation (Conejero et al., 2020).
to foster social connections and perform numerous activities, As the COVID-19 outbreak severely restricted people’s
online access, as well as reliable connection, is imperative and movement, outdoor activities have been limited, which does not
must be provided particularly for the vulnerable groups (Bavel mean, however, that physical activity needs to be limited as well.
et al., 2020). For instance, in order to nurture belonging, Physical exercises have been strongly associated with positive
webinars, meetings and virtual extracurricular activities can be effects regarding mental and physical health (Jiménez-Pavón
implemented for the black, latin and LGBTQ+ communities (Liu et al., 2020; Lyons et al., 2020). Therefore, exercising at home is an
and Modir, 2020; Salerno et al., 2020). Furthermore, those with accessible and easy alternative, which includes not only walking
limited literacy concerning the use of digital technologies ought and running, but also several online and free classes of different
to receive special consideration. sport modalities (Chen et al., 2020; Jiménez-Pavón et al., 2020;
Mental health Covid-19, 2020).
Financial Support Several other strategies can contribute to improve the
As for the financial stress experienced during the COVID-19 mental health status during the current situation. They include
pandemic, the government of each country should offer financial mediation, faith, prayers, playing and listening to music, cooking
support for the vulnerable population in this context, including and baking, caring for a pet or gardening (Lades et al.,
the self-employed and those with lower income. It is also crucial 2020; Lyons et al., 2020; Mental health Covid-19, 2020). The
to prepare an economical plan during and after the quarantine, importance of maintaining a routine or daily plan has also
in order to reduce stress about the uncertainty of the future been emphasized (Lyons et al., 2020; Mental health Covid-
(Gunnell et al., 2020). Moreover, aiming to alleviate the economic 19, 2020). The management of information intake, keeping
burden faced particularly by numerous groups throughout the news monitoring to a minimum in order to reduce levels
community, medical expenses of COVID-19 confirmed and of anxiety (Holmes et al., 2020; Mesa Vieira et al., 2020) or
suspected patients should be subsidized by the government. This simply following official guidelines to stay safe and to respect
strategy may also ensure that individuals seek medical care and, social distancing are also fundamental strategies to diminish the
therefore, promotes health equity and disease control amongst stress response (Mental health Covid-19, 2020). Furthermore,
the more vulnerable groups (Wang and Tang, 2020). sleep has a significant impact in mental health and stress
response and the population should be constantly informed of
its importance, particularly during the COVID-19 pandemic
Personal Strategies to Improve Mental (Holmes et al., 2020).
Health
In light of this difficult scenario, there are ways in which
individuals may personally attempt to improve their well- Specific Measures for Certain Vulnerable
being. Undoubtedly, maintaining interest and motivation is Groups
difficult for those suffering from mental health disorders or Healthcare Professionals
for those struggling financially (Mental health Covid-19, 2020). Considering the emotional and psychiatric risk that healthcare
Nonetheless, studies have suggested that nourishing adaptive workers are exposed to, actions must also be taken to protect
mindsets regarding stress may exert positive effects on how and support this group. Healthcare managers should offer
people deal with their emotions. It may also reduce adverse proactive steps to help their workers deal with this situation,
physical symptoms and boost physiological functioning under reinforcing teams as needed, being honest about the situation
acute stress (Bavel et al., 2020). In fact, stress and loss of and monitoring their staff more closely (Greenberg et al., 2020).

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Pedrosa et al. Psychological Impact in COVID-19 Pandemic

Support measures such as psychologists and psychiatrists’ contribution of the senior citizens to the society (Jimenez-
appointments, psychological assistance hotline, support groups Sotomayor et al., 2020). Furthermore, intergenerational contact
and reading materials illustrating coping mechanisms to deal with ought to be stimulated, as it promotes mental health benefits
stressors should also be provided without stigma (Santarone et al., for both the parties involved (Jimenez-Sotomayor et al., 2020;
2020; Zaka et al., 2020). Since many professionals are afraid of Office et al., 2020).
going home and infecting their families, it is important to inform
them about the safety measures that can minimize the chances of
Children
infection (Mamun et al., 2020c). Hospitals can also provide a place
It has been recommended that the children maintain a healthy
where the workers can rest and, if possible, record their hospital
routine with adequate sleep cycle and physical activity, and videos
routine in order to share with their family (Zaka et al., 2020).
can be used to encourage them to exercise and to play (Deslandes
Furthermore, the family members of the healthcare professionals
and Coutinho, 2020; Wang G. et al., 2020). In order to prevent
should receive special access to testing and treatment, if necessary
loneliness, families might seize the opportunity to establish better
(Dutheil et al., 2020; Mamun et al., 2020c).
bonds with their kids, providing them a sense of belonging in
Moreover, an adequate work environment is essential to
the family (Loades et al., 2020). Additionally, social networks
diminish the mental health impact of the pandemic in healthcare
should be used to allow interaction with their peers (Loades
professionals. In that matter, there should be sufficient PPE
et al., 2020). Nevertheless, it is suggested that the parents monitor
availability and detailed rules about its use, limited hours
and control the screen time and the content visualized in the
in each shift, dissemination of medical information through
Internet (Deslandes and Coutinho, 2020). Parents should always
multiple platforms and languages, education about skills to deal
talk to children about the current circumstances clearly and
with the patients psychological concerns, delaying of elective
directly, in order to minimize the negative feelings and to help
appointments and surgeries and, if possible, assembly of a
the kids better comprehend the pandemic and the information
backup force composed of capable retired workers and college
received from the Internet (Deslandes and Coutinho, 2020;
students about to graduate for the times of higher patient
Dubey et al., 2020; Wang C. et al., 2020). Interestingly, an effort
volume (Dutheil et al., 2020; Santarone et al., 2020; Zaka et al.,
that has already been made is the creation of the book My
2020). Special attention must be paid to preventive strategies of
Hero is You (Storybook for Children on Covid-19, 2020) by the
PTSD and its related risk of suicide in the upcoming months
United Nation in conjunction with other agencies. This book was
(Dutheil et al., 2020).
designed to help children aged 6 to 11 coping with the stress
Finally, it is important to acknowledge that targeting the
and anxiety generated by the pandemic. Furthermore, online
psychological impact of the pandemic in healthcare professionals
services provided by psychologists can be useful, especially due to
is also important to control the COVID-19 itself, since impaired
domestic conflicts, harassment, abuse and other types of violence
mental health affects their attention, understanding and decision-
(Wang C. et al., 2020).
making (Zaka et al., 2020).

Elderly Domestic Violence

Considering the particularly detrimental consequences of social Domestic violence is a complex issue with strong cultural
disconnection among the elderly, the benefits and damage of components (Gunnell et al., 2020). Therefore, it requires a
such restriction must be thoroughly and continuously weighed combination of multiple measures in order to protect the victims
(Plagg et al., 2020). In institutions and nursing homes, this group (Gulati and Kelly, 2020).
should be allowed the visit of healthy relatives and friends, as long To improve the reporting of domestic violence, it is important
as the hygienic measures are adequately taken. If possible, these to ensure constant availability of hotlines and digital reporting
relatives and friends might be tested for SARS-CoV-2 infection systems (Sacco et al., 2020; Sharma and Borah, 2020). However,
(Mesa Vieira et al., 2020; Plagg et al., 2020). since the victims may be isolated with their perpetrators, other
Moreover, the family should be encouraged to contact these alternatives must be adopted. For instance, family, friends and
individuals more frequently, as well as voluntary organizations neighbors have an essential role revealing domestic violence,
and community projects should provide similar support for this and advertising campaigns should encourage the community
group (Armitage and Nellums, 2020). Indeed, the phone call to report the cases (Marques et al., 2020; Sacco et al., 2020;
outreach program promoted by the Northwestern University Sharma and Borah, 2020; Usher et al., 2020). A positive message,
in Chicago, Seniors Overcoming Social Isolation, has been focusing on solutions, is more effective in these circumstances
developed with the purpose of minimizing social disconnection (Sharma and Borah, 2020). Furthermore, code-based systems to
among the elderly and providing significant engagement with report abuse situations could be implemented in pharmacies,
the community (Office et al., 2020). Older adults must also supermarkets or even with toll-free phone numbers (Sacco et al.,
be stimulated to leave their room or even perform outdoor 2020; Usher et al., 2020). Finally, healthcare workers should
activities when possible (Plagg et al., 2020). Online cognitive be aware of the signs of domestic violence and of the risk
behavioral exercises and therapy should also be provided factors involved, such as substance misuse by family members
(Armitage and Nellums, 2020). (Gulati and Kelly, 2020).
At last, the community should be encouraged to not comply After reporting, the speed of the response is critical,
with ageist content and to recognize the immense value and especially since the victims and their perpetrators are probably

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Pedrosa et al. Psychological Impact in COVID-19 Pandemic

sharing spaces during the pandemic (Sharma and Borah, physical exercise, even if it is inside the cell (Fovet et al., 2020;
2020). Accordingly, domestic violence must be included in the Hewson et al., 2020). Although access to hygiene measures can
policymaker’s response to the pandemic, guaranteeing financial be difficult, the prisoners should be constantly informed about
funding, human resources and protective measures for the the social distancing precautions and provided with accurate
victims (Marques et al., 2020; Sharma and Borah, 2020). information about the pandemic, in order to reduce anxiety and
Moreover, the population should be communicated about the improve adherence to the restricting measures (Hewson et al.,
speed of the arrest, since it increases the chances of the victim and 2020; Tozzo et al., 2020).
bystanders to report the crime (Sharma and Borah, 2020). Finally,
encouraging initiatives to provide social support, advocacy and
psychological and physical healthcare for the victims is crucial CONCLUDING REMARKS
(Gulati and Kelly, 2020; Marques et al., 2020).
Some victims will not report the domestic violence for several COVID-19 pandemic brings novel challenges to human beings.
reasons, such as fear, economic dependency and protection of Not only virus’ spread and disease mortality for risk groups,
the perpetrator. In these cases, friends and family assistance and but also emotional, behavioral and psychological impact to the
support groups are especially important to reduce the mental population. Measures to contain disease transmission, including
health impact of the abuse (Sharma and Borah, 2020). quarantine, social isolation and social distancing may affect the
population’s behavior and may lead to psychological disorders.
Informal Settlements and Homeless Individuals
Several emotional and psychological conditions including fear,
For those living in informal settlements and for the homeless, it
anxiety, depression, and suicide ideation are triggered by the
is essential that the police avoid top-down forced directives and
pandemic itself as well as by the adopted preventive measures.
that committees are created in order to improve communication
Special attention should be paid to vulnerable groups both
between the population and the government. Along with
in regard to prevent harmful emotional repercussions of the
financial support, food assistance and adequate water, sanitation
pandemic, but also to provide the necessary assistance. The
and hygiene should be provided for this population (Corburn
health authorities and the governments should strategize to
et al., 2020; Dubey et al., 2020). In this context, non-governmental
alleviate the mental burden of COVID-19 pandemic by providing
organizations such as community-based organizations and faith-
emotional support to the entire population, but particularly to the
based groups are also extremely important (Corburn et al.,
vulnerable individuals.
2020; Dubey et al., 2020). Furthermore, shelters can be created
in sports installations, closed universities and military lands to
shelter the homeless or to the de-densification of the settlements
(Corburn et al., 2020). It is also crucial that psychologists and AUTHOR CONTRIBUTIONS
psychiatrists are available for those demanding specific support
ALP and LB equally contributed to this article as first authors,
(Dubey et al., 2020). Ultimately, all individuals require their
both authors made the literature revision and selection of main
basic rights protected to diminish the mental health impact
articles for this review, defined the topics of this review, and wrote
of the pandemic.
the first draft. ACFF, MLBC, RGBC, and SBCSB helped in writing
Prisoners specific topics of the review and helped in search and analysis
In light of the increased risk for worse mental health of clinical trials included in this review. ACSS conceptualized
outcomes due to the pandemic, prisoners must receive special the study, made general supervision, revised the manuscript,
consideration and support. Prison management should explore and submitted the final version of the manuscript, which is
the development of strategies that promote the well-being approved by all authors.
among the incarcerated community. It has been recommended
that the inmates should receive telehealth support, substitute
recreational activities, for instance, puzzles, coloring and playing FUNDING
cards, as well as other communication methods, such as writing
letters and obtaining increased access to telephone landlines The authors acknowledge the Brazilian National Funding
and social networks (Fovet et al., 2020; Hewson et al., 2020; Agencies, CAPES and CNPq (Grant # 302153/2019-5) for
Kothari et al., 2020). They must also be encouraged to practice financial support.

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