key: cord-0910074-tg3ffezj
authors: Demartini, Benedetta; Fortunato, Federico; Nisticò, Veronica; D'Agostino, Armando; Gambini, Orsola
title: COVID-19 and mental health: the other side of the coin
date: 2021-03-01
journal: J Affect Disord
DOI: 10.1016/j.jad.2020.12.189
sha: aa343e7e7a4df423022fca405af4d3407d651d14
doc_id: 910074
cord_uid: tg3ffezj

nan

After almost three months from the beginning of the worldwide coronavirus disease 2019 (COVID-19) pandemic, it is arguably evident that its psychological effects are pervasive and could affect mental health now and in the future. In the last few weeks, there has been a surge in the literature exploring the psychological impact not only due to the COVID-19 pandemic itself but also to the subsequent strict lockdown ordered by the government authorities in many countries of the world. Although still preliminary, results underlined how levels of stress, anxiety and depression have significantly raised in the general population since the beginning of the pandemic (Wang et al, 2020; Moccia et al, 2020) . In particular, elderly people, healthcare workers and psychiatric patients have been found to be at higher risk (Holmes et al, 2020) . People with preexistent mental health disorders seem to be more substantially influenced by the psychological responses brought on by the COVID-19 pandemic, resulting in relapses or worsening of an already existing psychiatric disorder (D'Agostino et al, 2020) . However, our clinical observation, achieved from some of the second and third-level outpatient clinics (e.g. eating disorders, adult high-functioning autism) of the Department of Mental Health of ASST Santi Paolo e Carlo in Milano, suggest that some specific categories of psychiatric patients paradoxically benefit from lockdown. Although we still do not have any statistical data for this phenomenon, we have observed that patients with difficulties in social interaction (e.g. patients with social phobia or high-functioning autism) or patients who fear the comparison with other people (e.g. patients with eating disorders), have often reported an improvement of their psychological well-being during the last three months. This observation lead us to formulate the following considerations, which might be clinically relevant now and in the future: (i) there are psychiatric patients who are able to handle social isolation and social distancing better than the general population. For example, people with high-functioning autism have often had to deal with social isolation during their entire lives (Barendse et al, 2018) . Exploring their coping strategies, such as time scheduling and adapting online learning to specific needs, could help people who greatly suffer lockdown to cope with it; (ii) a crucial theme in the psychopathology of those patients who benefit from social isolation is the comparison with others and the feeling of perceiving themselves as different from the majority of other people (considered subjectively as "normal"). Thus, the lockdown represents a situation where these patients manage to represent themselves as more similar to others, experiencing the same situation and facing the same difficulties. Focusing more on similarities rather than differences probably represents a shift in attention that might increase psychological well-being in these patients. This means, from a psychotherapeutic perspective, that the use of techniques and interventions aimed to normalize patients' life condition and to perceive themselves as similar to other people must be encouraged; (iii) the lockdown condition, which has dramatically reduced interactions and relational exchanges, allowed us to further highlight how the drive for achievement and competition/comparison with others are pervasive in our culture and deeply influenced our social interactions. These drives can be implicitly present in many situations related to the relationship with others, such as work activity. Although for some people they might represent a motivational factor, for others they represent a constant reference to incapacity and failure, which contributes to further fostering a state of suffering and psychological malaise. Social attention should therefore be diversified in order to produce drives connected also to the sense of common belonging and sharing; (iv) the lockdown condition, through messages addressed to common suffering and social responsibility, has enhanced the experience of feeling part of a community of individuals, supporting the perception of sharing, at the expense of the attention paid to individualism and personal achievement. Thus, we might hypothesize that, in these patients, the perception of belonging to a group, the feeling of sharing the same emotions/sensations/thoughts of others can promote their psychological well-being. From a psychotherapeutic angle, the use of techniques that enhance mentalization or metacognition might promote psychological well-being in these patients; (v) patients who paradoxically benefit from the lockdown condition might be at high risk of sudden worsening of their psychiatric symptoms during the period immediately after lockdown, when they are forced to come back to their pre-lockdown life condition (rebound effect). This risk should be carefully addressed by mental health services.

In conclusion, our clinical observation suggests that patients with difficulties in social interactions and who fear the comparison with others might benefit from a lockdown condition. However, future research studies are needed to confirm our impression.

BD and FF designed and conceptualized the study; drafted the manuscript for intellectual content VN drafted the manuscript for intellectual content AD and OG revised the manuscript for intellectual content

No role of the funding source.

Authors have no conflict of interests to declare. 

Social behaviour and social cognition in high-functioning adolescents with autism spectrum disorder (ASD): two sides of the same coin?

Mental health services in Italy during the COVID-19 outbreak

Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science

Affective temperament, attachment style, and the psychological impact of the COVID-19 outbreak: an early report on the Italian general population

Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China

None.

Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad