Thirteen days into the Hubei lockdowns in which 15 cities and more than 51 million people are under quarantine, much has been said about the food and medical supply, but what about mental health? This unprecedented measure means that people are isolated inside their homes, going out for a limited amount of time to get food, always with an enormous cloud of worry and fear hanging over their heads. Even non-locked-down areas, like Beijing, have fewer businesses open and, both streets and parks, are almost empty, creating the sense of another city on the verge of quarantine. 

During the SARS outbreak in 2003 there was no formal lockdown, but living through that epidemic left mental scars across society, as several studies showed, and these can now help face this virus. Dr. Lam Ho Bun, from the Department of Psychiatry at the Chinese University of Hong Kong and co-author of one of those studies, explained to CGTN Digital that two mental disorders occur commonly after an outbreak.

Depression and Post-Traumatic Stress Disorder

"Depression is the commonest disorder," he said, adding that about 40 percent of survivors suffer from depression, especially those who have long-term medical complications, experienced loss of relatives in the outbreak, and loss of economic status.

The second most common disorder is Post-Traumatic Stress Disorder (PTSD)." Almost 30 percent of the survivors suffer from it. Medical professionals are especially prone to suffer from the disorder as they are involved, and therefore witness many medical procedures, such as resuscitation," Lam Ho Bun said.

Medical professionals can develop a high level of anxiety and, besides patients, are vulnerable to develop a mental problem.

"Other common mental disorders after outbreak are panic disorder and Obsessive-Compulsive Disorder," he added, noting that somatoform disorder and chronic fatigue disorder were also common, but they may be the long-term sequelae of use of high dose steroids during the SARS outbreak.

Lockdown effects

"The long-term effect of a lockdown depends on its duration, and it cannot be estimated now. Those who have relatives and business outside the lockdown cities are of course the most affected," Lam Ho Bun stated.

For the general population, limited in their daily activities, besides depression and PTSD, Obsessive Compulsive Disorder (OCD) can happen and even have a long-term effect. In the case of SARS, about 30 percent of survivors showed persistent symptoms after the first five years, and they need regular psychiatric treatment, even after 17 years.

"Residents are taught to have very high hygiene awareness throughout the months of the outbreak. Some of them may develop an obsession with dirt, which eventually leads to compulsive washing. They may wash their hands' dozens of times every day, take over one-hour baths, and cannot tolerate little dirt," the doctor explained.

In the long term, they may become withdrawn at home to avoid contamination. Lam Ho Bun continued saying that whenever there is another epidemic, like the previous avian flu, swine flu, and MERS, this obsession and compulsion may worsen.

In the short term, Xiang Yutao, a psychiatry professor at the University of Macao, indicates that anxiety, irritability, sense of losing control and sleep problems are some of the common psychological symptoms. But some may also experience fear, depressed mood, helplessness and loss of interest in everyday activities. For this reason, "people should take extra self-care."

Facing the lockdown and the virus head-on

Xiang, who is also leading a team of psychotherapists and counselors on a mission to provide psychological support to quarantined patients and staff in the Macao SAR, recommends scheduling time to see the news to avoid excessive exposure, maintain a regular schedule for activities, even when homebound, including activities that generate good feelings.  

If it becomes too much, Xiang recommends the use of available mental health hotlines or professionals. In the Macao SAR, the government is coordinating and arranging psychological support for various groups of people in the community through different hotlines and medical workers.

On the other hand, such incidents can elicit a strong desire to help others, so volunteers need to be careful when helping others and also take a break if the emotional load is too much.

The aftermath of the outbreak

Because other mental health problems can arise in the long term, both professionals defend that early identification and intervention is crucial.

"We need to continue to provide public education, so people can pay attention to their mental health and seek treatment early," said Xiang.

Since some people's mental health problems may manifest in somatoform symptoms, such as head and stomach-aches, general practitioners need to have the competence to screen such conditions and refer the patient to the appropriate psychiatric and psychological services.

Lam Ho Bun recommends the distribution of screening questionnaires to the survivors, relatives of the deceased and medical health professionals; and training to social workers and related professionals to help identify those at risk.

On an important topic, the doctor stresses the need to "educate on destigmatization of the survivors," the perception of stigmatization was found to be a risk factor for a mental problem.

According to the Lam Ho Bun study on "Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors," the risk of psychiatric problems for people who felt socially stigmatized tripled.