Mental health during and after the COVID‐19 emergency in Italy

Italy is the first European country to face the COVID-19 emergency in all its dramatic appearance. As we write this letter, the total number of positive cases in Italy is 97 689, with 10 779 deaths,1 and the situation is rapidly evolving. As mental health professionals, we must deal with both current and future mental health concerns. In Italy, about 25% of the overall burden of disease is attributed to neuropsychiatric disorders.2 Italian community-based psychiatric assistance is integrated into the national health system, includes 183 mental health departments, and cares for almost 780 000 patients. Currently, patients are continuously followed up, mainly with the use of Internet connections. However, the current stressful period and social isolation may increase the risk of recurrence and new episodes. In fact, people are now forced to live in isolation because social distancing is the most effective strategy for limiting the spread of the virus. However, social isolation, especially if protracted, may increase the risk of mental disorders, such as anxiety, mood, addictive, and thought disorders. Additionally, objective social isolation and subjective feelings of loneliness are associated with a higher risk of suicide.3, 4 Furthermore, people who “lose loved ones before their time” will not be comforted by the large number of deaths due to the pandemic crisis. On the contrary, they will be more prone to developing a so-called complicated grief that is associated with unexpected death, social isolation, and loss of a support system, like that we are now experiencing. Moreover, it is hard to predict the effects on the mental and social development of the hundreds of thousands of children and adolescents who have abruptly had a dramatic change of their normal life. We know that early life stressful events are associated with: disrupted neurodevelopment; social, emotional, and cognitive impairment; adult medical and psychiatric disorders; disability; and even earlier death.5 In the meantime, health-care professionals are experiencing an extraordinary burden of stress as they are faced daily with severe illness or death. Liu and collaborators recently identified rates of stress-related symptoms of 73.4%, depression of 50.7%, anxiety of 44.7%, and insomnia of 36.1% among 1563 medical staff in China.6 In the Italian situation, the risks of acute stress disorder, burnout syndrome, and full psychiatric disorders are currently very high in health-care professionals. In light of the above, it is important to provide the necessary mental health support. So far, few mental health professionals have been directly involved in the management of the crisis. Nonetheless, many independent – mainly online – initiatives have been established to provide psychological and psychiatric support to health professionals and laypeople, such as the “NON SEI SOLO” “YOU ARE NOT ALONE” and “Resilienza COVID-19” “Resilience COVID-19” projects of Rome's Fondazione Policlinico Universitario Agostino Gemelli. Therefore, we recommend the active and ongoing participation of mental health professionals in policy task forces during this critical period. We strongly believe that our expertise will help to: better describe the current mental health situation; provide a nationwide, centrally coordinated, and more efficient support group; increase trust between workers and organizations7; and prevent the development of widespread full-blown psychiatric disorders, which would be an additional social and economic burden on the looming post-epidemic crisis. Nothing to declare.