The COVID-19 pandemic has affected many aspects of our lives, including mental health. Identifying risk factors and risk groups associated with anxiety, depression, and other emotional disorders for reasons related to the COVID-19 pandemic is highly relevant. This narrative review aims to summarize the evidence to date on risk factors for emotional disorders during the COVID-19 pandemic in order to identify the risk groups of people in need of early psychiatric and psychological assistance, point out the controversial data on the influence of risk factors on emotional disorders in COVID-19, and finally offer recommendations for alleviating symptoms of anxiety, depression, and other emotional disorders in such people. According to the current literature, being under the age of 40, being female, having contact with a COVID-infected person, and watching the news about COVID-19 for more than 3 h a day all increase the likelihood of anxiety, depression, and sleep disturbances. Healthcare workers, particularly nurses, working in the COVID-19 hot zone suffer more from sleep disorders, anxiety, and depression. It is also noted that people with a previous psychiatric history, in addition to increased risks of anxiety and depression, have an increased risk of relapse during the COVID-19 pandemic. The same is true for people who have had episodes of substance abuse in the past. Aside from socioeconomic factors, the mental wellbeing of those who have had COVID-19 is also impacted by biological factors (using anti-COVID-19 drugs, COVID-19-associated immunothrombosis and venous thromboembolism, interferon-gamma-related cytokine storm, etc.), resulting in a wide range of acute and long-term cognitive disorders. During the restricted resource time, the aforementioned risk groups should be prioritized for prevention, early identification, and proper treatment of potential emotional disorders. The risk factors that were found in this narrative review, as well as how they interact and change over time, will help understand why some studies of at-risk groups do not agree with each other, justify new preventive measures, and strengthen existing programs to keep people’s mental health in check during this pandemic and other emergencies.
On 11 March 2020, the World Health Organization (WHO) declared the start of a coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
[1]. The COVID-19 pandemic was marked by the implementation of unprecedented restrictive measures around the world, such as self-isolation
[2] and the use of personal protective equipment (PPE) in public places
[3]. This led to a forced change in people’s behavior and, against this background, changes in their emotional state. These measures and other risk factors associated with the pandemic can negatively impact mental health and cause emotional disorders
[4].
Research from years prior to the COVID-19 pandemic suggests that depression, anxiety disorders, substance abuse, behavioral addictions, self-harm, and post-traumatic stress disorder (PTSD) commonly follow major economic crises, new pandemics, or natural disasters
[5][6][7][8][5,6,7,8]. For example, the previous human immunodeficiency virus (HIV) pandemic and the emergence of new recombinant forms and strains of HIV
[9][10][9,10] have been proven to contribute to the deterioration of mental health in society
[11]. Another example is that the frequency of cigarette, alcohol, and psychoactive drug consumption in the US has significantly increased since the September 11 attacks
[12]. It was found that stress plays a crucial role in provoking substance abuse
[13].
The drastic changes in people’s lives and the many aspects of the global, public, and private economy associated with the current COVID-19 pandemic have become a source of great stress for many people
[14]. Financial instability and unemployment, death of loved ones and isolation, fear of infection, school and daycare closures, travel restrictions, the sudden shift to working from home, bans on social gatherings, and other changes in social life and everyday life have contributed to an increase in domestic violence
[15], increasing dependence on psychoactive substances and video games
[5][8][15][5,8,15], and the general deterioration in the mental health of citizens during the COVID-19 pandemic
[16][17][18][19][20][21][22][23][24][16,17,18,19,20,21,22,23,24]. When the immediate threat of the virus wanes, the long-term effects of the COVID-19 pandemic could make it difficult for many people to return to a normal emotional state.
One of the most studied and frequently observed effects of the COVID-19 pandemic is depression, which significantly increases the appearances of many somatic diseases, including Alzheimer’s disease (2.0 times), cardiovascular diseases (1.5–2.0 times), stroke (1.8 times), epilepsy (4.0–6.0 times), diabetes (1.6 times), and cancer (1.0–1.3 times)
[25], and increases the risk of suicide by 25 times
[26]. During the COVID-19 pandemic, there has been a sharp increase in the use of drugs for depression, i.e., antidepressants. Antidepressants have many side-effects, including weight gain, sexual dysfunction, hypotension, and dyspeptic symptoms. Noncompliance or discontinuation of medication can lead to relapse of depression and increase the risk of suicide
[25]. As a result, identifying risk groups for people who may be depressed is becoming more important. Adopting preventive measures against depression, anxiety, suicidal behavior, and other emotional disorders should become a public health priority to reduce the population’s economic and drug burden.
Some risk groups are more vulnerable and require more support and attention during the COVID-19 pandemic. Unfortunately, a greater need for psychological help does not mean a greater appeal for it. A study among medical staff found that people with three psychological problems received less care than people without any disorders
[27]. Thus, risk groups and risk factors for emotional disorders, especially anxiety and depression, during the COVID-19 pandemic/lockdown and beyond the post-COVID period have not yet been clearly defined. The identification of such risk factors and the identification of risk groups will allow the development of better recommendations for the prevention of emotional disorders and the improvement of mental health.
Therefore, this narrative review aims to summarize the evidence to date on risk factors for emotional disorders during the COVID-19 pandemic in order (1) to identify the risk groups of people in need of early psychiatric and psychological assistance, (2) to point out the controversial data on the influence of risk factors on emotional disorders in COVID-19, and finally (3) to offer recommendations for alleviating symptoms of anxiety, depression, and other emotional disorders in such people.
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