The COVID-19 pandemic has caught the health authorities around the world off guard, leading to a global health crisis. A number of stress factors have been identified in this pandemic, from psychophysiological, confinement, to social and work-related. Depending on the level of severity and the country of origin, a variety of interventions have been applied that establish different ways of returning to normalcy and preparing new interventions. This new stress factor has a direct impact on the mental health of the people.
In this pandemic, the psychophysiological approach enables us to understand how the psychological and social experiences can influence the physiological homeostasis of the individual. During the current COVID-19 pandemic, the lockdown measures, fear, uncertainty, economic instability, social disconnection and trust in others and institutions are becoming new psychophysiological stressors. Fear can be one of the strongest triggers. Fear of infection, but also fear of the future, of losing one’s job in professions in which it is not possible to work from home. Fear of having insufficient financial resources to pay regular bills. Fear of the uncertainty of being unable to see family members. Fear of how the virus is transmitted. Perhaps the worst fear: will I be infected? Am I infecting my loved ones without realizing it? Am I part of the asymptomatic population helping to spread the virus? This new, stressing situation has psychological consequences in the medium and long term.
Physiologically, acute fear might not have a negative impact on health, but when it is prolonged over time, there are changes to the autonomic nervous system and the immune system, endocrine functions and level of hyperactivity, in addition to the interruption of the sleep/wakefulness cycle, eating disorders and deregulation of the hypothalamic-pituitary-adrenal axis, and an increase in the production of hypothalamic and amygdaloid corticotropin-releasing hormone, a precursor of the famous cortisol. This physiological situation does nothing but worsen the psychological state, increasing the production of inflammatory cytokines, increasing intestinal permeability and, in the end, increasing the severity and deaths associated with the COVID-19 pandemic.
Other contextual factors that can increase the co-morbidities among the population are related to physical inactivity due to an imposed quarantine, which even before the COVID-19 pandemic was already a significant global health problem. Given that the quarantine is a long-term suppression measure, metabolic syndromes can appear or worsen, increasing the risk of insulin resistance, oxydative stress, inflammation, obesity, endothelial disfunction and cardiovascular disease. All of this, in turn, increases the severity of COVID-19.
In the fight against the COVID-19 pandemic, until we have achieved herd immunity with an effective and safe vaccine, the behavior of the global population plays a crucial role in stopping the spread of the virus. The current outlook for tackling the pandemic is limited to the impact on physical health and minimizing the risks of transmission (that is, masks, social distancing, frequent hand washing). This focus takes attention away from the psychological consequences of the social stress factors. Along this line, authors suggest that most of the global population did not feel that the lockdown had an impact on their general mental health. Today, the media and government communication systems could be an excellent way of improving prevention and increasing social trust. However, fake news (such as consuming hydroxychloroquine, sodium chlorite, antibiotics, conspiracy theories) and the fights for political power have taken over social media and the airwaves, together with the pandemic, and, as a result, distrust and insecurity have increased. In addition, the growing concern regarding the socioeconomic impact, possible future waves and market uncertainty are significant social stress factors, and their effects have still not been studied in the long term.
Meanwhile, the unpredictable global financial consequences and the local socioeconomic impact will have a devastating effect on employment and the socioeconomic balance of individual homes. However, pandemics rarely affect everyone in the same way, so official actions must be designed and adapted appropriately. Differences in gender, race or social status require the same level of intervention during and after the COVID-19 pandemic. Gender violence, high levels of stress in pregnant women, the increased risk of infection among ethnic groups, different levels of mortality by race and suicide in impoverished social groups promote new political decisions in search of competent, free actions in terms of general mental health. Most socially vulnerable people run the risk of considering the COVID-19 pandemic a lifelong traumatic experience . Some authors believe that the COVID-19 crisis must be tackled from the perspective of trauma, threat and fear, with special focus on young people, who are less able to develop strategies of positive coping. In addition, people with lower academic qualifications, low social status groups and gender differences must receive quick and appropriate attention to prevent future mental illnesses.
Vicente Javier Clemente Suárez is professor of Physical activity in the Programa de Doctorado en Actividad Física y Deporte and in the Máster en Actividad Física y Salud