Maíra Menezes (IOC/Fiocruz)
Although respiratory symptoms are the best-known face of Covid-19, post-traumatic stress (PTSD), depression, and anxiety have also been described in patients with the disease. In an article published in Frontiers in Immunology, researchers of the Oswaldo Cruz Institute (IOC/Fiocruz) and of Universidade Federal Fluminense (UFF), in the state of Rio de Janeiro, discuss how the new coronavirus can affect mental health, pointing to neural, immunological and endocrinological alterations related to the infection and to social distancing, which may contribute to psychological issues. In addition to tracing hypothesis, scientists suggest lines of research to clarify the mechanisms of the disease, as well as measures that can help mitigate its impact on mental health.
Remembering studies on Severe Acute Respiratory Syndrome (SARS) and Middle-East Respiratory Syndrome (MERS), the researchers draw attention to the potential psychiatric impact of coronavirus infections. Many researches have identified mental involvement in infected patients, and some have also pointed to long-term damage, with survivors reporting memory loss, sleep alterations, and higher levels of post-traumatic stress, depression, and anxiety, months or years after recovering from the viral condition. Also taking into account the risk for mental health associated to social distancing, researchers emphasize the relevance of studies on this subject when it comes to Covid-19.
“It is imperative to make an effort to understand the physiopathology of Covid-19, including the infection of the central nervous system and the risk of compromising one’s mental health, as well as the effects of the pandemic in healthy individuals impacted by the social distancing situation. If nothing is done, we will probably be facing a new pandemic in the future, this time related to mental health”, states immunologist Wilson Savino, researcher of the Thymus Research Laboratory of IOC and coordinator of the National Institute of Science and Technology on Neuroimmunomodulation (INCT-NIM) and of the Faperj Network of Research on Neuroinflammation, with headquarters at IOC.
Interaction between biochemistry pathways
Based on data observed in patients and on research on animals considered experimental models, scientists argue that different mechanisms may contribute to the development of mental disorders in the Covid-19 pandemic. Firstly, there is evidence that the new coronavirus is able to infect central nervous system cells. Secondly, the immune reaction to infection by the virus is marked by a large amount of inflammatory substances, which may be the link between the pathogen and the psychiatric manifestations. Different sets of evidence indicate that these substances alter neuron plasticity (the ability to form new connections between neurons) and reduce the production of neurotransmitters (molecules that send chemical signals between neurons, working as messengers). In addition, the intense inflammatory process may affect the production of cortisol, a hormone whose unbalance is associated to psychiatric disorders.
The stress motivated by social distancing can also lead to immunological alterations, with higher production of inflammatory substances even in people who have not been infected. In this sense, the researchers want to draw attention to the higher vulnerability of a few groups in particular, such as health workers, the elderly, and the obese, who are more susceptible to severe Covid-19 infections as well as to psychiatric disorders. The researchers point to measures that may ease the negative effects of the disease on mental health. For instance, surveys made during the SARS and MERS outbreaks, as well as in the beginning of the Covid-19 epidemic in China, indicate the potential of suitable information to reduce psychological damage during quarantines. Tightening social bonds over social networks, sleep habits and healthy nutrition are also mentioned by the scientists, who also mention the potential of music in modulating the level of inflammatory cytokines and the neural-immune-endocrinological response to stress.
“It is important to note that the evidence highlighted here do not contradict the need for social distancing in order to control the pandemic. However, they draw attention on the usefulness of strategies that focus on reducing the negative effects of social distancing on the mental health of people in general, including improvement of psychological intervention and reduction of socioeconomic inequalities”, emphasizes Savino.