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Review article

COVID-19 – current state of mental health with a reference to health workers

Milan Latas1,2, Maja Pantović Stefanović1,2, Bojana Đukić2
  • Clinic for Psychiatry, University Clinical Center of Serbia, Belgrade, Serbia
  • Faculty of Medicine, University of Belgrade, Belgrade, Serbia

ABSTRACT

Introduction: The COVID-19 pandemic has brought many problems and challenges to the medical profession, including psychiatry. These include the emergence of de novo disorders in the population, the worsening of the condition in previously diagnosed patients, but also problems in the mental functioning of health professionals, who were involved in the treatment of COVID-19 patients. Numerous international papers address these problems and challenges, as is the case with a large number of studies and papers published by Serbian researchers and experts in Serbian and international publications.

Objective: The objective of the paper is to present research conducted in the Republic of Serbia related to the COVID-19 infection and its impact on mental health.

Methods: This paper presents the results of Serbian research as well as expert opinions related to the COVID-19 infection and its impact on mental health. The basis for the preparation of this paper were publications of Serbian authors published mostly in international journals. These publications present the results of original studies, but also expert considerations related to the impact of the COVID-19 infection on mental health.

Results: Previous research and extensive clinical practice in the Republic of Serbia show the existence of frequent and intensive problems related to mental health, resulting from the COVID-19 pandemic, present in both the general population and in specific populations, such as health workers and patients suffering from psychiatric disorders.

Conclusion: Based on the presented results, the conclusion is that, in order to deal with this issue, a number of specialized institutions should be opened in the territory of the entire Republic of Serbia, where patients could find support and help for their problems.


INTRODUCTION

The COVID-19 pandemic has brought many problems and challenges to the medical profession, including psychiatry. These include the emergence of de novo disorders in the population, the worsening of the condition in previously diagnosed patients, but also problems in the mental functioning of health professionals, who were involved in the treatment of COVID-19 patients. Numerous international papers address these problems and challenges, as is the case with a number of studies and papers published by Serbian researchers and experts in Serbian and international publications.

The results of Serbian research as well as expert opinions related to the COVID-19 infection and its impact on mental health will be presented in this paper. The basis for the preparation of this paper were publications of Serbian authors published mostly in international journals. These publications present the results of original studies, but also expert considerations related to the impact of the COVID-19 infection on mental health.

MENTAL HEALTH STATUS OF THE NATION IN THE PANDEMIC

In the previous year and a half, psychiatrists and other experts involved in mental health have noted numerous problems in mental functioning that emerged in the first phase of the pandemic, which included the period of quarantine and lockdown. In their paper, Vujičić et al. [1] analyzed the effect of the COVID-19 pandemic on the mental health of the general population in Serbia, at the same time researching the factors that led to the worsening of mental health in the period of the state of emergency. The study was carried out via an online questionnaire (the methodology that was feasible in the period in question) which tested, on a sample of the general population, the level of intensity of depression, anxiety and stress. In their conclusion, the authors stated that stress, anxiety and depression, measured with the Depression, Anxiety and Stress Scale - 21 Items (DASS-21), were elevated during quarantine and lockdown, while the feeling of helplessness was mostly connected to the above stated problems. On the other hand, good health and a higher socioeconomic status were connected to a lesser intensity of the symptoms of anxiety, depression, and stress.

Authors from Novi Sad, Sadiković et al. [2], followed the emotional state of the general population over a longer period of time. On a sample of 1,526 participants in the study, from the general population, the authors concluded that problems related to the emotional state in connection with the COVID-19 pandemic varied over time, and that, with time, the symptoms of worry, fear, and boredom decreased the most, which was the result of successful adaptation to new life circumstances.

STATUS OF HEALTH WORKERS IN THE PANDEMIC

During the pandemic, health workers, including doctors, nurses, and other medical staff, have met with a series of different problems, which did not exist before – encountering an unknown disease, adjusting to a different organization of work, worrying about one’s own and the wellbeing of one’s family, worrying about the wellbeing of the patients, working intensively, being overburdened. Upon meeting with medical staff working in covid hospitals, the personal impressions of the authors of the present study were that these health workers exhibited extreme fatigue, exhaustion, concern; they complained of not sleeping properly and of being haunted by worry. As to the development of symptoms, the most prominent symptom was insomnia, followed by anxiety, worry and fear, on the one hand, and dysphoria and irritability, on the other. However, the impression is that most health workers demonstrated resilience, i.e., success in functioning, both personally and professionally, despite the new difficulties and challenges.

In fact, a study carried out in Kragujevac [3] indicates that the risk factors for stress in medical staff during the COVID-19 pandemic were younger age and a genetic basis for the development of mental disorders, while resilience was a protective factor against stress-related symptoms. The results of a study carried out by Dr. Marija Lazarević, from Loznica, also speak in favor of the resilience of health workers during the pandemic [4]. In this study, the conclusion was that health workers were emotionally stable and that the pandemic did not cause major insecurity, even in times of the greatest rise of the number of COVID-19 cases.

A research team from Niš [5] compared the mental state of medical staff working in the covid system against the mental state of medical staff not working in the covid system. The results of this study show that the medical staff working in the covid system displayed a higher intensity in symptoms of stress, anxiety, and depression, as compared to their colleagues who were outside the covid system, which is why it was suggested that appropriate measures should be taken in order to alleviate the intensity of these symptoms and improve the mental functioning of health workers. A similar study was carried out by Stojanov et al. [6]. This group of authors analyzed anxiety and depression in health workers as well, but they also focused on the quality of life and sleeping patterns in the analyzed sample. In their conclusion they state that a problem for medical workers is insomnia, which is linked to symptoms of anxiety and depression, with an additional comment that individual subjects needed psychological support.

THE PANDEMIC AND SPECIFIC POPULATION GROUPS

In addition to mental health problems analyzed on samples of the general population, studies of mental functioning also included particular groups of the population such as children, college students, etc. A group of authors from the Institute of Mental Health in Belgrade indicated that children represent a particularly vulnerable population in times of crisis, and that mental problems in children most commonly occur due to difficulties in understanding the new circumstances, fear, separation from their peers, changes in the mental state of their parents [7]. Additionally, impaired mental functioning is also the result of systemic administrative changes, such as the closing down of preschools, schools and other educational institutions, as well as the limiting of the scope of work of institutions that help and support vulnerable children and families. This is especially true of children with preexisting mental disorders, children with neurodevelopmental difficulties, and children from vulnerable and minority groups, who require additional care and support from the system.

On the one hand, the population of college and university students often demonstrates resilience in stressogenic circumstances, however, on the other hand, it can represent an especially vulnerable group requiring particular attention. A study by authors from Niš, on a sample of a university population indicated increased intensity of stress, which was connected to specific variables, such as female gender and avoidance as a coping mechanism [8].

In addition to the abovementioned specific population groups, special attention during the COVID-19 pandemic should be given to patients suffering from psychiatric disorders. According to the newest research carried out on the territory of the Republic of Serbia on a sample of 1,785 patients with previously diagnosed psychiatric disorders (mostly anxiety and depressive disorders), it was established that most of the subjects (almost three quarters of them) displayed signs of increased anxiety resulting from different aspects related to the pandemic, as measured by the Generalized Anxiety Disorder Assessment (GAD-7) scale [9]. All of this indicates the importance of considering the change of the mental state of patients suffering from mental disorders in connection to the COVID-19 pandemic.

MANAGEMENT STRATEGIES – TREATMENT AND HEALTH SERVICE ORGANIZATION

The new circumstances of the pandemic have led to a change in the organization of care for patients suffering from psychiatric disorders [10]. These changes included or were supposed to include the following: special assessment of the mental status of people belonging to different subpopulations, under the influence of the outbreak of the COVID-19 pandemic; the identification of persons who are at increased risk of displaying behavioral disturbances (suicide attempts, manifestation of aggression, etc.); as well as providing appropriate mental health care interventions for those in need of assistance.

The application of specific pharmacotherapy in individuals suffering from mental disorders needed to undergo certain modifications during the pandemic, as it was to be expected that some of the patients suffering from mental disorders would be infected with COVID-19. Special attention during the simultaneous application of COVID-19 therapy and psychopharmaceuticals must include the consideration of the interaction between psychopharmaceuticals and other medicaments and medicinal products, at the level of the Cytochrome P450 enzymes (CYP) [11].

In addition to what has already been stated, it has been noted that, in hospital settings, COVID-19 patients very often display signs and symptoms of psychomotor agitation and delirium. It is of the utmost importance to recognize these difficulties early on, at the very onset, in order to avoid further compounding of the symptoms and prevent numerous complications and problems. The most common causes of these symptoms are hypoxia, hyperthermia, hypoglycemia, hypovolemia, change in the acid-base balance, as well as preexisting damage to the CNS. In order to facilitate the treatment of these patients, the Psychiatry Section of the Serbian Medical Society has published therapeutic guidelines for treating psychomotor agitation in the COVID-19 pandemic [12]. In an instructive manner, these guidelines describe the procedure for treating patients with psychomotor agitation and delirium, which can be helpful in resolving these issues.

CONCLUSION

As previously mentioned, the COVID-19 pandemic has led to many problems in the spheres of personal, family, and social life, for every individual, but it has also led to many changes in the functioning of the healthcare system. Numerous challenges have necessitated the opening of new hospitals and services specialized in treating and supporting COVID-19 patients. Thus, thanks to the support of the University Clinical Center of Serbia (UCCS) management, a specialized outpatient facility for treating post-covid psychiatric disorders and problems was formed within the Clinic for Psychiatry of the UCCS in Belgrade. This is a facility where patients with previous psychiatric problems and disorders are treated, but also patients who have been diagnosed with de novo mental disorders.

Previous research and extensive clinical practice in the Republic of Serbia show the existence of frequent and intensive problems related to mental health, resulting from the COVID-19 pandemic. This is why it is important that a number of specialized institutions should function in the territory of the entire Republic of Serbia, where patients could find support and help for their problems.

The paper was presented at the national symposium "COVID-19 - What have we learned so far?" Which was held in Vrnjačka Banja on October 16, 2021.

  • Conflict of interest:
    None declared.

Informations

Volume 2 No 4

December 2021

Pages 386-391
  • Keywords:
    pandemic, COVID-19, mental health, population
  • Received:
    06 December 2021
  • Revised:
    09 December 2021
  • Accepted:
    10 December 2021
  • Online first:
    13 December 2021
  • DOI:
  • Cite this article:
    Latas M, Pantović-Stefanović M, Đukić B. COVID-19: Current state of mental health with a reference to health workers. Serbian Journal of the Medical Chamber. 2021;2(4):386-91. doi: 10.5937/smclk2-35256
Corresponding author

Milan Latas
Clinic for Psychiatry, University Clinical Center of Serbia
D2 Pasterova Street, 11000 Belgrade, Serbia
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.


  • 1. Vujčić I, Safiye T, Milikić B, Popović E, Dubljanin D, Dubljanin E, et al. Coronavirus Disease 2019 (COVID-19) Epidemic and Mental Health Status in the General Adult Population of Serbia: A Cross-Sectional Study. Int J Environ Res Public Health. 2021 Feb 17;18(4):1957. doi: 10.3390/ijerph18041957.[CROSSREF]

    2. Sadiković S, Branovački B, Oljača M, Mitrović D, Pajić D, Smederevac S. Daily Monitoring of Emotional Responses to the Coronavirus Pandemic in Serbia: A Citizen Science Approach. Front Psychol. 2020 Aug 19;11:2133. doi: 10.3389/fpsyg.2020.02133.[CROSSREF]

    3. Ignjatović Ristić D, Hinić D, Banković D, Kočović A, Ristić I, Rosić G, et al. Levels of stress and resilience related to the COVID-19 pandemic among academic medical staff in Serbia. Psychiatry Clin Neurosci. 2020 Nov;74(11):604-5. doi: 10.1111/pcn.13124.[CROSSREF]

    4. Lazarević M. Anksioznost kod zdravstvenih radnika u vreme pandemije COVID-19. Medicinski časopis. 2020;54(1):14-7. doi: 10.5937/mckg54-27871.[HTTP]

    5. Antonijevic J, Binic I, Zikic O, Manojlovic S, Tosic-Golubovic S, Popovic N. Mental health of medical personnel during the COVID-19 pandemic. Brain Behav. 2020 Dec;10(12):e01881. doi: 10.1002/brb3.1881.[CROSSREF]

    6. Stojanov J, Malobabic M, Stanojevic G, Stevic M, Milosevic V, Stojanov A. Quality of sleep and health-related quality of life among health care professionals treating patients with coronavirus disease-19. Int J Soc Psychiatry. 2021 Mar;67(2):175-81. doi: 10.1177/0020764020942800.[CROSSREF]

    7. Grujičić R, Bogdanović J, Stupar S, Maslak J, Pejović-Milovančević M. COVID-19 pandemija - uticaj na decu i mlade. Psihijatrija danas. 2020;52(1- 2):99-111. doi: 10.5937/PsihDan2001099G[HTTP]

    8. Kostić J, Žikić O, Đorđević V, Krivokapić Ž. Perceived stress among university students in south-east Serbia during the COVID-19 outbreak. Ann Gen Psychiatry. 2021 Apr 7;20(1):25. doi: 10.1186/s12991-021-00346-2.[CROSSREF]

    9. Đukić B, Lalović N, Latas M. Uticaj pandemije Kovid-19 na intenzitet anksioznosti kod pacijenata obolelih od mentalnih poremećaja. Rad u pripremi.

    10. Stašević-Karličić I, Đorđević V, Stašević M, Subotić T, Filipović Z, Ignjatović-Ristić D, et al. Perspectives on mental health services during the COVID-19 epidemic in Serbia. Srpski arhiv za celokupno lekarstvo 2020;(148):379-82. doi: 10.2298/SARH200504028S.[HTTP]

    11. Milosavljević M, Vuković O. Primena psihofarmaka u toku lečenja COVID-19. Psihijatrija danas. 2020;52(1-2):89-97. doi: 10.5937/PsihDan2001089M.[HTTP]

    12. Opanković A, Latas M, Milovanović S. Psihomotorna agitacija terapijske smernice psihijatrijske sekcije Srpskog lekarskog društva u sklopu epidemije COVID 19 u Republici Srbiji. Engrami. 2021;43(1):70-81. doi: 10.5937/engrami42-33720.[HTTP]


REFERENCES

1. Vujčić I, Safiye T, Milikić B, Popović E, Dubljanin D, Dubljanin E, et al. Coronavirus Disease 2019 (COVID-19) Epidemic and Mental Health Status in the General Adult Population of Serbia: A Cross-Sectional Study. Int J Environ Res Public Health. 2021 Feb 17;18(4):1957. doi: 10.3390/ijerph18041957.[CROSSREF]

2. Sadiković S, Branovački B, Oljača M, Mitrović D, Pajić D, Smederevac S. Daily Monitoring of Emotional Responses to the Coronavirus Pandemic in Serbia: A Citizen Science Approach. Front Psychol. 2020 Aug 19;11:2133. doi: 10.3389/fpsyg.2020.02133.[CROSSREF]

3. Ignjatović Ristić D, Hinić D, Banković D, Kočović A, Ristić I, Rosić G, et al. Levels of stress and resilience related to the COVID-19 pandemic among academic medical staff in Serbia. Psychiatry Clin Neurosci. 2020 Nov;74(11):604-5. doi: 10.1111/pcn.13124.[CROSSREF]

4. Lazarević M. Anksioznost kod zdravstvenih radnika u vreme pandemije COVID-19. Medicinski časopis. 2020;54(1):14-7. doi: 10.5937/mckg54-27871.[HTTP]

5. Antonijevic J, Binic I, Zikic O, Manojlovic S, Tosic-Golubovic S, Popovic N. Mental health of medical personnel during the COVID-19 pandemic. Brain Behav. 2020 Dec;10(12):e01881. doi: 10.1002/brb3.1881.[CROSSREF]

6. Stojanov J, Malobabic M, Stanojevic G, Stevic M, Milosevic V, Stojanov A. Quality of sleep and health-related quality of life among health care professionals treating patients with coronavirus disease-19. Int J Soc Psychiatry. 2021 Mar;67(2):175-81. doi: 10.1177/0020764020942800.[CROSSREF]

7. Grujičić R, Bogdanović J, Stupar S, Maslak J, Pejović-Milovančević M. COVID-19 pandemija - uticaj na decu i mlade. Psihijatrija danas. 2020;52(1- 2):99-111. doi: 10.5937/PsihDan2001099G[HTTP]

8. Kostić J, Žikić O, Đorđević V, Krivokapić Ž. Perceived stress among university students in south-east Serbia during the COVID-19 outbreak. Ann Gen Psychiatry. 2021 Apr 7;20(1):25. doi: 10.1186/s12991-021-00346-2.[CROSSREF]

9. Đukić B, Lalović N, Latas M. Uticaj pandemije Kovid-19 na intenzitet anksioznosti kod pacijenata obolelih od mentalnih poremećaja. Rad u pripremi.

10. Stašević-Karličić I, Đorđević V, Stašević M, Subotić T, Filipović Z, Ignjatović-Ristić D, et al. Perspectives on mental health services during the COVID-19 epidemic in Serbia. Srpski arhiv za celokupno lekarstvo 2020;(148):379-82. doi: 10.2298/SARH200504028S.[HTTP]

11. Milosavljević M, Vuković O. Primena psihofarmaka u toku lečenja COVID-19. Psihijatrija danas. 2020;52(1-2):89-97. doi: 10.5937/PsihDan2001089M.[HTTP]

12. Opanković A, Latas M, Milovanović S. Psihomotorna agitacija terapijske smernice psihijatrijske sekcije Srpskog lekarskog društva u sklopu epidemije COVID 19 u Republici Srbiji. Engrami. 2021;43(1):70-81. doi: 10.5937/engrami42-33720.[HTTP]

1. Vujčić I, Safiye T, Milikić B, Popović E, Dubljanin D, Dubljanin E, et al. Coronavirus Disease 2019 (COVID-19) Epidemic and Mental Health Status in the General Adult Population of Serbia: A Cross-Sectional Study. Int J Environ Res Public Health. 2021 Feb 17;18(4):1957. doi: 10.3390/ijerph18041957.[CROSSREF]

2. Sadiković S, Branovački B, Oljača M, Mitrović D, Pajić D, Smederevac S. Daily Monitoring of Emotional Responses to the Coronavirus Pandemic in Serbia: A Citizen Science Approach. Front Psychol. 2020 Aug 19;11:2133. doi: 10.3389/fpsyg.2020.02133.[CROSSREF]

3. Ignjatović Ristić D, Hinić D, Banković D, Kočović A, Ristić I, Rosić G, et al. Levels of stress and resilience related to the COVID-19 pandemic among academic medical staff in Serbia. Psychiatry Clin Neurosci. 2020 Nov;74(11):604-5. doi: 10.1111/pcn.13124.[CROSSREF]

4. Lazarević M. Anksioznost kod zdravstvenih radnika u vreme pandemije COVID-19. Medicinski časopis. 2020;54(1):14-7. doi: 10.5937/mckg54-27871.[HTTP]

5. Antonijevic J, Binic I, Zikic O, Manojlovic S, Tosic-Golubovic S, Popovic N. Mental health of medical personnel during the COVID-19 pandemic. Brain Behav. 2020 Dec;10(12):e01881. doi: 10.1002/brb3.1881.[CROSSREF]

6. Stojanov J, Malobabic M, Stanojevic G, Stevic M, Milosevic V, Stojanov A. Quality of sleep and health-related quality of life among health care professionals treating patients with coronavirus disease-19. Int J Soc Psychiatry. 2021 Mar;67(2):175-81. doi: 10.1177/0020764020942800.[CROSSREF]

7. Grujičić R, Bogdanović J, Stupar S, Maslak J, Pejović-Milovančević M. COVID-19 pandemija - uticaj na decu i mlade. Psihijatrija danas. 2020;52(1- 2):99-111. doi: 10.5937/PsihDan2001099G[HTTP]

8. Kostić J, Žikić O, Đorđević V, Krivokapić Ž. Perceived stress among university students in south-east Serbia during the COVID-19 outbreak. Ann Gen Psychiatry. 2021 Apr 7;20(1):25. doi: 10.1186/s12991-021-00346-2.[CROSSREF]

9. Đukić B, Lalović N, Latas M. Uticaj pandemije Kovid-19 na intenzitet anksioznosti kod pacijenata obolelih od mentalnih poremećaja. Rad u pripremi.

10. Stašević-Karličić I, Đorđević V, Stašević M, Subotić T, Filipović Z, Ignjatović-Ristić D, et al. Perspectives on mental health services during the COVID-19 epidemic in Serbia. Srpski arhiv za celokupno lekarstvo 2020;(148):379-82. doi: 10.2298/SARH200504028S.[HTTP]

11. Milosavljević M, Vuković O. Primena psihofarmaka u toku lečenja COVID-19. Psihijatrija danas. 2020;52(1-2):89-97. doi: 10.5937/PsihDan2001089M.[HTTP]

12. Opanković A, Latas M, Milovanović S. Psihomotorna agitacija terapijske smernice psihijatrijske sekcije Srpskog lekarskog društva u sklopu epidemije COVID 19 u Republici Srbiji. Engrami. 2021;43(1):70-81. doi: 10.5937/engrami42-33720.[HTTP]


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