REVIEW

CURRENT
OPINION Addressing psychological resilience during the
coronavirus disease 2019 pandemic: a rapid review
Judite Blanc a, Anthony Q. Briggs a, Azizi A. Seixas a, Marvin Reid b,
Girardin Jean-Louis a, and Seithikurippu R. Pandi-Perumal c
Downloaded from http://journals.lww.com/co-psychiatry by 7L315EwVd8EgaWam5GiEXKoQQHkzVfX7mbNE8Cywuvd2TebUQkjGAH+mE/zC9MzjGNzUkGoqjjYJEW+PvgAojXtVnyL/PJSyK8nShGJh+yALGKdHXLI6GrkITPTkMueKtnszqsxGw1E= on 11/30/2020

Purpose of review
The mental health toll on populations exposed to COVID-19 is alarming, and there is a need to address
this with urgency. This current review provides insights on how individuals, communities, and specific
populations, such as healthcare workers and patients are leveraging pre-COVID-19 and peri-COVID-19
factors to reinforce their psychological resilience during the global public health crisis.
Recent findings
Examination of the extant literature indicated that populations around the world rely often on support from
their loved-ones, closed significant others, outdoor and physical activities, and spirituality to cope with the
COVID-19-related distress. Increased sense of meaning/purpose since the COVID-19 pandemic was also
reported.
Summary
A portion of publications provided intervention models to reinforce resilience among specific populations
during the COVID-19 pandemic. Nevertheless, it is not convincing that some of these models can be
applied universally. Additionally, it is important to note that in this category, translational data was scarce.
Keywords
coronavirus disease 2019, infectious disease, mental health, outbreak, pandemic, resilience

INTRODUCTION Individuals with preexisting psychiatric conditions

reported a deterioration of psychiatric symptoms:
Mental health consequences of coronavirus 37.5% with an eating disorder and 56.2% reported
disease 2019 &&
additional anxiety symptoms [3 ]. In the general
On 11 March, the WHO declared the novel corona- population, the situation was no different, as studies
virus [coronavirus disease 2019 (COVID-19)] out- found that individuals without a mental health
break as a global pandemic. According to early history exhibited lower psychological well-being
October 2020 WHO’s updates, a new surge of and greater levels of anxiety and depression in com-
COVID-19 that has now spread to over 235 areas, parison to the period that preceded the COVID-19
&& &

countries, and territories, with over 35 million indi- pandemic [3 ,4 ]. The burden of mental health was
viduals contracting the virus. This has resulted in quite stark in the United States, as the prevalence of
over 1 million deaths across the globe [1] and many depression symptoms in the United States was more
more suffering from the economic, physical, and than three-fold higher during COVID-19 compared
mental health consequences of its aftermath [1]. It
is important to note that this COVID-19 translates to
a
a broad range of somatic conditions ranging from Department of Population Health, NYU Grossman School of Medicine,
Center for Healthful Behavior Change, bTropical Metabolism Research
fever or chills, cough, shortness of breath or difficulty
Unit, Tropical Medicine Research Institute, the University of the West
breathing, fatigue, muscle or body aches, headache, Indies, Kingston, Jamaica and cSomnogen Canada Inc., College Street,
the loss of taste or smell, sore throat, congestion or Toronto, Ontario, Canada
&& &&
runny nose, nausea or vomiting, diarrhea [2 ,3 ,6]. Correspondence to Seithikurippu R. Pandi-Perumal, Somnogen M1H
Studies reviewed by Vindegaard and Benros in 1C5 Canada Inc., College Street, Toronto 10016, ON, Canada. E-mail:
2020 revealed that the vast majority of participants [email protected]
infected with COVID-19 are at high risk for post- Curr Opin Psychiatry 2021, 34:29–35
traumatic stress (96.2%) and depressive symptoms. DOI:10.1097/YCO.0000000000000665

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Mood and anxiety disorders

main objective was to mitigate the devastating

KEY POINTS impacts of populations around the globe that were
 Psychological resilience has emerged as a fundamental struggling to cope with: neighborhood quarantines,
variable in reducing and preventing the negative social distancing, nighttime curfews, and states of
psychological effects of the pandemic. emergency that have been imposed worldwide
&& &
[10 ,11 ]. The global economy receded to a precari-
 Populations around the world rely often on support from
ous state with high levels of unemployment in
their loved ones, closed significant others, outdoor and
physical activities, and spirituality to cope with the major industries, and sectors coming to a screeching
COVID-19-related distress. halt, geographic borders and markets closed for
business, trade and agricultural production faltered,
 Overall, resilience promoting factors related to the altogether creating a cascade of financial losses
ongoing COVID-19 pandemic could be regrouped in a
and psychological stress above and beyond the
chronological perspective: pre-COVID-19 factors, peri-
COVID-19 lockdown factors, post-COVID-19 fear-provoking consequences of the virus itself
& & &&

lockdown factors. [7 ,12 ,13 ,14]. Most importantly, not all countries,
societies, and communities were impacted equally.
Many countries have no increased unemployment
percentages.
This is not the first time the world has witnessed
with the period before the COVID-19 pandemic a global pandemic and catastrophe of epic propor-
& & &&
[5,6,7 ,8 ,9 ]. One group that appeared to be most tions. The death toll of the influenza pandemic of
affected was healthcare workers. According to Vin- 1918–1919 surpassed that of World War I (WWI).
degaard and Benros (2020), frontline healthcare An estimate of 20–40 million people lost their lives.
workers who treated COVID-19 patients were at Also known as the Spanish Flu, it has been cited as
increased risk of suffering from depression/depres- the most devastating epidemic in recorded world
sive symptoms, anxiety, psychological distress, and history [15].
poor sleep quality. During the peak of the pandemic Less than one decade ago, another deadly epi-
in April 2020, 57% of New York healthcare workers demic emerged in Western Africa with Ebola virus
surveyed suffered from acute stress, 48% and 33% disease (EVD) in 2013. It was the most widespread
endorsed depressive, and anxiety symptomatology, outbreak of Ebola virus disease (EVD) in history
respectively. The vast majority (61%) reported an [16 ].
&

increased sense of meaning/purpose since the Exposure to global epidemics, such as the 2014–
&
COVID-19 pandemic [4 ]. Furthermore, physical 2015 Ebola and the 2003 SARS outbreaks has been
activity or exercise was the most frequent coping associated with a high rate of common mental dis-
strategy (59%) in addition to access to an individual orders among survivors in the short to long-term. The
therapist with online self-guided counseling (33%) prevalence of any psychiatric disorder at 30 months
&&
(Shechter et al. [9 ]). Moreover, US participants with post-SARS was 33.3%. One-fourth of the patients had
lower socioeconomic status (SES), and greater expo- posttraumatic stress disorder (PTSD), and 15.6% had
sure to stressors (e.g. loss of income) were more depressive disorders. Additionally, there is growing
&&
affected by depression symptoms [9 ]. evidence on the adverse psychological outcomes
Our main goal in this review on ‘psychological including PTSD symptoms, confusion, and anger
resilience during COVID-19’ is to summarize the that are associated with the isolation or quarantine
main findings on the following aspects: mental experience imposed on suspected cases during those
health consequences of the current pandemic, fac- & & &
outbreaks [11 ,17 ,18 ,19 ,20 ,21 ].
& & &

tors that facilitate the relationship between COVID As of Mid October 2020, the devastation caused
and mental health, resilience during infectious dis- by COVID-19 goes beyond that caused by the SARS
eases outbreak. Lastly, we describe lessons learned epidemic and Ebola. Preliminary studies published
that can be used in other conditions. on the mental health consequences of the current
COVID-19 reveal an alarming rate of stress-related
disorders among populations exposed to the pan-
Factors that facilitate the relationship demic. Symptoms of anxiety and depression (16–
between coronavirus disease 2019 and 28%) and self-reported stress (8%) are common
mental health psychological reactions to the COVID-19 pandemic,
The COVID-19 pandemic is associated with mortal- and may be associated with disturbed sleep and may
ity, contamination rate, and strict biosecurity vary by level of exposure [22 ].
&

restrictions that are affecting many segments of a In a nationwide survey of 52 730 individuals
functional society. At the peak of the pandemic, the from 36 provinces, autonomous regions, and

30 www.co-psychiatry.com Volume 34  Number 1  January 2021

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 Psychological resilience during the COVID-19 pandemic Blanc et al.

municipalities, from Hong Kong, Macau, and Key psychological resilience promoting
Taiwan between January 31 and February 20, factors during coronavirus disease 2019
2020, about 35% of the sample experienced psycho- lockdown
logical distress. Among this sample, in line with At present, there is preliminary data on important
previous findings, the COVID-19 Peri-traumatic Dis- key behaviors and other factors that may contribute
tress Index (CPDI) score was linked to sex, age, to psychological resilience during the pandemic
education, occupation, and region [23]. that originated from China in December 2019. For
instance, among Chinese adolescents, a study
explored the emotional resilience of middle school
Psychological resilience and infectious students learning at home between February and
diseases outbreak March 2020 as well as its effect on students’ learning
Over the past decade, the human’s ability to adapt management ability. The results of that study indi-
in the face of tragedy, trauma, adversity, hardship, cated that emotional resilience, measured by the
and ongoing significant life stressors has been stud- Chinese version of the ‘adolescent emotional resil-
ied under the rubric of ‘Psychological Resilience’. ience scale’ (AERS), was lower among eighth graders,
Psychological resilience has garnered tremendous compared with seventh graders. Furthermore, neg-
interest in mental health and has seized the atten- ative emotional recovery worsened during that
tion of public health practitioners. As such, psycho- period, and emotional resilience was positively
logical resilience has emerged as a fundamental related to learning management skills; positive emo-
variable in reducing and preventing the negative tional ability was a predictor of learning manage-
psychological effects of the pandemic. Currently, ment skills.
PubMed contains more than 50,000 entries related In an online Turkish survey conducted among
to COVID-19; among them, more than 150 scien- social media users using the ‘Short Psychological
tific publications focus on ‘Psychological resilience’ Resilience Scale’ and the ‘Beck Depression Scale’
and ‘COVID-19’. Overall, publications studying (BDI), men, educators, university graduates, and
psychological resilience during COVID-19 could those without mental health problems presented
be summarized in two categories psychiatric epide- stronger psychological resilience. Conversely,
miological research Report papers presenting mod- women, university students, high school and lower
els of interventions to reinforce psychological graduates, and individuals with mental health issues
resilience. &
were at higher risk for depression [25 ,37 ,38 ].
&& &&

One American study that focused on resilience

Psychiatric epidemiological research on (defined as the self-perceived trait-like ability to face
resilience and mental health during threatening situations according to the Connor-
coronavirus disease 2019 Davidson Risk Scale-CD-RISC; Connor and David-
Typically, those studies provide evidence on psycho- son [5]) among 18–35 years old Americans in early
logical resilience factors, such as protective factors April 2020 found that greater resilience was pre-
for anxiety, depression, posttraumatic stress, and dicted by a set of multiple modifiable factors includ-
other mental health disorders are included in this ing the number of days per week spent outdoor in
category. For instance, during the peak of the pan- the sunshine, daily exercise, perceived support from
&
demic in China, Ran et al. [12 ] in 2020 found that closed and loved-ones, sleep quality, perceived care
psychological resilience (CD-RISC scores) was nega- and support from a significant close ones, and fre-
tively associated with symptoms of depression, anx- quency of prayer. In summary, those who obtained
iety, and somatization. The authors concluded that higher scores on this combination of variables were
participants with greater psychological resilience more likely to exhibit stronger psychological resil-
& & & &
were less likely to exhibit emotional problems, ience during the lockdown [26 ,27 ,28 ,29 ].
whereas those with lower resilience factors were Bueanas et al. in 2020 explored coping strategies
more likely to report negative emotional symptoms. using the ‘Temperament and character inventory-
&
A similar finding was observed in Germany in an revised’ (TCI-R) [24 ] associated with symptomatic
online survey, which found that strategies, such as deterioration among people with eating disorders.
maintaining a healthy lifestyle and social contacts, Accordingly, a worsening in eating disorder symp-
acceptance of anxiety and negative emotions, fos- tomatology and other psychiatric symptoms (anxi-
tering self-efficacy, and information on where to get ety and depression) during the COVID-19 lockdown
medical treatment when necessary was helpful. Nev- were linked to low self-directedness. Greater eating
ertheless, the psychological burden was mostly disorder symptoms during confinement were asso-
linked to substance abuse and suppression of anxi- ciated with less adaptive coping strategies to adjust
&
ety and negative emotions [11 ]. to recommended confinement leading to weight

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Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Mood and anxiety disorders

gain. This aligns well with other work in confine- Individual level
&
ment as reported by Moccia et al. [8 ]. Additional As shown in Fig. 1, modifiable peri-COVID-19 fac-
variables, such as age and eating disorder severity tors were leveraged frequently by individuals in
were also associated with COVID-19 concerns. their effort to cope with the pandemic. Accordingly,
Overall, resilience-promoting factors related researchers have made many recommendations
to the ongoing COVID-19 pandemic could be from the conceptual and methodological gap of
regrouped in a chronological perspective: pre- psychological resilience perspective and program-
COVID-19 factors, peri-COVID-19 and lockdown ming standpoint, such as learning stress manage-
factors, and post-COVID-19 lockdown factors ment, social awareness and minimizing media
(Fig. 1). consumption, increased knowledge on mental
health education, continue to build support and
bonding, finding ways to increase self-preservation
Lessons learned that can be used in other through – physical fitness, reading, yoga, proper
conditions nutrition, laughter – finding creative outlets to
These publications provide interventions models to social and interpersonal communication with indi-
reinforce resilience among specific populations dur- viduals through small groups and online communi-
ing the COVID-19 pandemic. However, it is impor- && &
cation [3 ,5,30,31 ]. Virtual reality therapy to
tant to note that in this category, translational data acclimatize individuals pretravel or the growing
was scarce. interest in mental well-being health applications

PRE-COVID-19 (Built
environment, SES, Age, Sex,
Racial/Ethnic disparies,
etc.)

COVID-19
PERI-COVID-19 PSYCHOLOGICAL
(Sero-status, overall approach to lockdown or
quaranne such as self-efficacy, emoonal
RESILIENCE
regulaon, cognive appraisal, sleep quality, daily
acvity, physical acvies, outdoor acvies, (lower distress,
spiritual coping, level of COVID-19 related news anxiety, depressive
exposure, access to reliable source of informaon,
and social support available) and somac
complaints)

POST-COVID-19
LOCKDOWN
(SES, Age, Sex, Racial/Ethnic
disparies, Built
environment, etc.)

FIGURE 1. Summary of key psychological resilience promoting factors during coronavirus disease 2019 lockdown.

32 www.co-psychiatry.com Volume 34  Number 1  January 2021

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 Psychological resilience during the COVID-19 pandemic Blanc et al.

to be used as an informative tool for persons (i.e. streamline messaging and direct the workforce situ-
healthcare workers) dealing with PTSD – whether it ated within multiple hospitals and numerous prac-
is working long hours in high-intensity environ- tice sites, to a single regularly updated resource;
&
ments [12 ,23,30] or individuals recovering from developing psychosocial and mental health sup-
& &
COVID-19- [25 ,32 ]. It could also be the invention portive options – includes several options – self-care
of technologically innovative solutions (i.e. mental resource (i.e. mindfulness activities) to virtual sup-
well-being apps) as a mechanism to promote psy- port groups facilitated by social workers and psy-
chological resilience to foster a digitized community chologist and to one-on-one counseling sessions
and reduce fear, stress, anxiety, and depression and 24/7 immediate crisis management, training
& & & & && & &&
[20 ,21 ,22 ,29 ,33 ,34 ,35 ]. mental health staff with exercising the flexibility
to shift their responsibilities whenever needed, and
Institutional and community levels creating new initiatives [13 ].
&&

Leveraging social and economic resources available

from their individuals’ immediate environment,
emerged often in our rapid literature review on
CONCLUSION
resilience-promoting factors during COVID-19. The mental health toll on populations exposed to
Blanc et al. in 2020 in a qualitative study about COVID-19 is alarming. The current review provides
coping lessons that high-income countries could insights on how individuals, communities, and spe-
learn from the Haitian resilience, revealed three cific populations, such as healthcare workers and
main psychological resilient characteristics that patients are leveraging pre-COVID-19 and peri-
may have helped Haitians to cope with the alarming COVID-19 factors to reinforce their psychological
predictions from international and national health resilience during the ongoing global public health
authorities. These are: hardiness, the ability to cope, crisis. Throughout the review, we noted that pop-
move forward through traumatic events and large- ulations around the world rely often on support
scale disasters; with also the ability to make, imag- from their loved-ones, closed significant others,
ine, and hope for new future possibilities through outdoor and physical activities, and spirituality to
creative art. Finally, traditional, natural, and cultur- cope with the COVID-19-related distress. Increased
ally specific interventions (alignment with spiritual sense of meaning/purpose since the COVID-19 pan-
beliefs and complementary healing practices) as a demic was also reported. Concerning interventions,
mechanism to restore harmony and balance many scholars have recommended community and
&& &
[36 ,39 ]. These characteristics do not exist in social individual evidence-based models that could poten-
isolation but are reinforced through community tially reinforce psychological resilience during
and togetherness; these are acts that other western COVID-19. Nevertheless, we are skeptical about
countries could leverage in their efforts to buster the universal character of such models and what
community resilience during this pandemic. is deemed legitimate hard evidence with the proper
In the United States, at the institutional level, use of methods. Despite the weakness in their health
for instance, Mount Sinai Health System (MSHS) has infrastructures, some low-income countries seem to
created an Employee, Faculty, and Trainee Crisis have been successful in coping with the pandemic,
Support Taskforce (in Early March 2020) in New whereas in high-income countries, historically dis-
York City. The task force implemented a rapid needs advantaged populations bear the greatest toll of the
assessment model guided by three priority areas that pandemic. Consequently, there is an emergency to
focus on addressing many challenges of the work- fill the gap of scientifically sounded and culturally
force and maintaining the well-being of the entire responsive data supporting the effectiveness of the
MSHS workforce concerning the COVID-19 pan- aforementioned interventions, programs, or policies
&
demic [12 ]. The priority areas are meeting the basic on psychological resilience during the pandemic.
needs of the workforce throughout the crisis – this is
executed through the Office of well-being and Resil- Acknowledgements
ience (OBWR) human resources, recreation office, Ethical approval: not applicable.
housing office, infection prevention, nursing – Compliance with ethical standards: this article does not
entails serving five categories – food (discounted contain any studies with human participants or animals
or free), housing (onsite call room, on-campus performed by any of the authors. No primary data have
option, local hotel at discounted rates), transporta- been reported.
tion (free parking, discounted or free car rentals); Author’s contributions: All authors met the ICMJE criteria
enhancing communications – consolidating sys- for authorship. All authors contributed equally in the
tem-wide messaging into a daily communication subsequent preparation of the manuscript. Conceived
with links to a comprehensive website has helped and designed the manuscript: G.J.L., S.R.P., J.B.; wrote

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Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Mood and anxiety disorders

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34 www.co-psychiatry.com Volume 34  Number 1  January 2021

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