Coping with a pandemic: Lessons from previous infectious disease outbreaks

Researchers in Singapore have synthesized in a recent review several psychological responses seen across infectious disease outbreaks in the past, including anxiety, depression, loss, stigmatization, isolation and cognitive restructuring.

For the current coronavirus disease 2019 (COVID-19) pandemic, practical considerations must be directed to the individual in the context of the larger social environment, focusing on raising awareness of the range of possible psychosocial responses, access to psychological help, selfcare and sustained engagement, according to the researchers.

“The extent to which each type of coping strategy was helpful for relieving psychological distress was associated with varied factors, including one’s risk appraisal, demographic factors and severity of the outbreak,” they said.

A narrative synthesis was conducted on published literature over the last 20 years, with a quality appraisal of included articles reporting both psychological responses and coping strategies within infectious disease outbreaks. The search yielded 144 papers, of which 24 met the inclusion criteria.

Eighteen studies assessed the psychological responses of the general population towards the severe acute respiratory syndrome (SARS) epidemic, four studies covered the Ebola epidemic, and two studies examined the H1N1 outbreak.

Although most of the common themes in psychological responses were mainly deleterious (eg, anxiety/fears, anger, grief, depression, guilt, loss, stigmatization and post-traumatic stress), a greater sense of empowerment and compassion towards others also emerged. [Singapore J Med 2020;doi:10.11622/smedj.2020046]

Coping strategies that were adopted in previous outbreaks included the following: problem-focused coping (ie, seeking alternative, self- and other-preservation), seeking social support, avoidance and positive appraisal of the situation.

“The use of different coping methods in reducing psychological distress differed across studies,” the researchers said. [Health Qual Life Outcomes 2017;15:8]

A study by Yeung and Fung found that problem-solving reduced sadness, but in other studies, such approach contributed to or was not associated with an increase in anxiety levels. [J Pers 2005;73:261-285; Br J Health Psychol 2014;19:592-605]

“The use of problem-focused strategies such as problem-solving should predict better adjustment in controllable situations, while emotion-focused strategies such as avoidance and denial would be favoured in uncontrollable situations,” the researchers said.

Epidemic survivors from several studies also found solace in religious practices and in the support of fellow survivors, as well as the presence of empathetic healthcare workers throughout their treatment and discharge. [Prehosp Disaster Med 2017;32:234-239; J Nurs Res 2015;23:217-224; Int J Nurs Pract 2005;11:150-160; Front Public Health 2016;4:142]

Across studies, survivors also attempted to cope through positive thinking and appraisals, with individuals putting their confidence in alternative treatments, the government or the healthcare system. [J Epidemiol Community Health 2003;57:857-863; J Formos Med Assoc 2010;109:524-532; Soc Sci Med 2002;54:955-969]

“Further research endeavours should seek to understand the longitudinal psychological impact of disease outbreaks, differences in psychosocial responses among population subgroups, inter-relationships with social media, and the influence of past experiences with infectious disease outbreaks, in order to better prepare ourselves psychologically to face future outbreaks,” the researchers said.

COVID-19 was first discovered in the city of Wuhan in China, but government censorship and inaction led to its global outbreak. As of this writing, more than 1.8 million people have been infected worldwide, with nearly 113,000 deaths reported.