Strategies for the Management of Patients with Mental Illness during the Resurgence of the COVID-19 Pandemic in China

Updated 2 years ago on October 17, 2022

Since the COVID-19 pandemic began in early 2020, China has adopted a continuous, dynamic, community-based COVID-19 zero policy. However, as the highly transmissible variant of Omicron becomes prevalent, the cost of implementing a COVID-19 zero policy increases.

China may be preparing to end its zero-covid policy.

Given the increasing prevalence of vaccination, declining COVID-19 mortality rates, and the development of herd immunity, some health professionals and researchers are advocating de-escalation and relaxation of restrictions to mitigate the economic impact of mass isolations.

China may be preparing to end its zero-covid policy.

Strategies for rediscovery in the coming COVID-19 era in China.

However, there are a number of challenges that some susceptible populations face, such as patients with mental disorders.

First, although 89% of the population of mainland China had been vaccinated twice with the SARS-CoV-2 vaccine by April 28, 2022,

Coronavirus vaccination tracking around the world.

and 52% received a third dose of booster vaccination, there is no data on vaccination rates among patients with psychiatric disorders in China. A study of six major psychiatric hospitals in China is troubling.

Fluctuations in COVID-19 vaccine in community-dwelling and hospitalized patients with severe mental illness.

involving 1,853 patients with severe mental illness (including major depressive disorder, bipolar disorder, and schizophrenia) found that 45% of patients were unwilling to be vaccinated. Based on lifetime prevalence estimates of major depressive disorder (3-4%), bipolar disorder (0-6%), and schizophrenia (0-6%) in China,

  • Huang Y.
  • Wang Y.
  • Wang X
  • et al.

Prevalence of mental disorders in China: a cross-sectional epidemiological study.

and the reported level of hesitancy to vaccinate, up to 29 million patients with severe mental illness may not want to be vaccinated. In addition, patients with severe mental illness may have more difficulty complying with infection control measures than the general population. Increased risk of infection may increase the likelihood of developing severe COVID-19 and mortality in this population. Cohort Study

  • Nemani K.
  • Li C
  • Olfson M.
  • et al.

Association of psychiatric disorders with mortality among patients with COVID-19.

in the United States found that patients with schizophrenic spectrum disorders have an increased risk of mortality from COVID-19. Consequently, patients with psychiatric disorders, especially those with severe mental illness, should be strongly encouraged to be vaccinated, including with heterologous booster vaccines, before public health measures are relaxed.

Strategies for rediscovery in the coming COVID-19 era in China.

Second, it remains unknown how COVID-19 interacts with pre-existing mental disorders, and long-term studies of outcomes in patients with mental illnesses infected with SARS-CoV-2 are needed. Immune system dysfunction is common in this population, and there is a positive association between some mental disorders and autoimmune diseases.

Autoimmune diseases and psychotic disorders.

In a 1-year follow-up study of adults living in the community, people who had COVID-19 were more likely to experience pain, anxiety and depressive symptoms than those who did not have COVID-19 infection.

  • Huang L.
  • Yao Ts.
  • Gu X
  • et al.

1-year outcomes in survivors of hospitalization with COVID-19: a longitudinal cohort study.

Third, patients with psychiatric illness generally have worse overall physical health and are less likely to use health care services for their medical needs than the general population. Many patients with mental illness infected with SARS-CoV-2 may not want to be tested or seek care from health care providers. Therefore, regular COVID-19 antigen and nucleic acid tests should be readily available and accessible to both patients with psychiatric illness and their caregivers when containment measures are relaxed.

Fourth, given that children and the elderly in the general population have a lower vaccination prevalence than other age groups in China,

Strategies for rediscovery in the coming COVID-19 era in China.

we assume that children and the elderly with mental disorders will also have low vaccination rates. There is an acute shortage of child psychiatric services in China (less than 500 child psychiatrists for the entire country).

There is a shortage of child psychiatrists in China.

and mental health services for older adults. Thus, these subpopulations will be at risk of neglect due to poor delivery of health services and may have a high exposure to the negative impact of the COVID-19 pandemic. Adequate public and mental health resources must be allocated to serve these at-risk populations.

Finally, at the beginning of the COVID-19 pandemic, Chinese health authorities and national and regional mental health scientific associations responded quickly by publishing guidelines and expert consensus on mental health and psychiatric service delivery.

  • Xiang Yi-T
  • Zhao N.
  • Zhao Yi-J.
  • et al.

Review of the Expert Consensus on Mental Health Treatment and Services for Essential Mental Disorders during the COVID-19 Outbreak: The China Experience.

for people affected during the pandemic. However, these recommendations were developed in the context of COVID-19 "zero" policy and may not be applicable in the pandemic resumption phase. Thus, the guidelines and expert consensus are in urgent need of updating to ensure that the needs of people with mental disorders are addressed in the forthcoming pandemic resumption phase.

In conclusion, China's health and mental health services face a number of challenges that they must address in transitioning away from the "zero QID-19" policy if they are to provide appropriate care for patients with mental illness. Advance preparation is needed to minimize the negative effects of policy renewal on this susceptible population.

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