What China’s psychologists can tell us about COVID-19

Six months into the COVID-19 pandemic, China seems to have brought its infection rate under control. But now a new crisis is beginning—the trauma and other mental health concerns the illness has brought to both health-care professionals and the general public alike, says Buxhin Han, PhD, president of the Chinese Psychological Society.

COVID-19 has created a “public mental health crisis,” researchers agree (Dong, L., and Bouey, J., Emerging Infectious Diseasesopens in new window, Vol. 26, No. 7, 2020). COVID-19 survivors and front-line health-care professionals are experiencing depression, anxiety, and post-traumatic stress disorder (PTSD), while the public is struggling to overcome anxiety, fear, and lockdown’s psychosocial impact. And this “parallel epidemic” may increase the risk of infection, warn other researchers (Yao, H., et al., The Lancet Psychiatry, Vol. 7, No. 4, 2020). Cognitive impairment, lack of awareness of the risks and the importance of personal protection, confined conditions in psychiatric wards and lack of access to health care because of stigma may render those with serious mental illness more vulnerable to infection, for example. Co-morbid mental health problems may also make COVID-19 treatment more challenging—and possibly less effective, the researchers add.

Han and other Chinese psychologists have been sharing lessons learned about mitigating COVID-19’s psychological impact during an ongoing series of calls with top leaders of APA and psychological associations from around the world. APA’s Office of International Affairs organizes and chairs the calls.

Chinese psychologists suggest several strategies.

Chinese psychologists are targeting several populations. One is doctors and nurses, who are at significant risk of psychological distress and PTSD due to frontline contact, overwhelming workloads, the eye witnessing of lives lost and other factors. Nearly three-quarters of Chinese health-care workers report distress, half report depression and almost half report anxiety, researchers have found (Lai, et al., JAMA Network Openopens in new window, Vol. 3, No. 3, 2020).

Other priority groups include the exhausted community workers who delivered food and other essentials to those in lock-down and patients and family members who have experienced illness or death firsthand and may need support in grieving. While the Chinese Psychological Society initially planned to target older people, too, Han’s own, as-yet-unpublished research revealed that they were far more resilient than anticipated.

Online group counseling is one helpful strategy, says psychologist Guangrong Jiang, PhD, of Central China Normal University in Wuhan, who oversees supervisors who are supervising counselors providing online group support to community workers. More than 600 community workers have already participated in more than 50 groups, which they use to express and process their feelings, according to Jiang. These workers did their jobs with a spirit of altruism and heroism, says Jiang. “That kind of mental attitude could protect them from being traumatized,” he says.

Chinese psychologists are also developing programs to improve family functioning after the stressors of lockdown. One self-coaching program has attracted more than 170,000 participants and focuses on such issues as how to facilitate children’s online learning, how to improve marital relationships and even how to negotiate Wi-Fi and computer use within families, says Han.

“With COVID-19, this is complicated grief, not normal grief,” says psychologist/psychiatrist Jianping Wang, PhD, of Beijing Normal University. Friends and families often didn’t have a chance to say goodbye and couldn’t have face-to-face visits with the dying, she says. Plus, families often lost multiple members. And death has often brought other serious problems in its wake, such as cases where a family loses its sole breadwinner or children lose their parents. Those economic issues mean that some people haven’t had time to focus on their grief, says Wang, who is offering the public free online sessions with counselors as part of a university-funded research project on grief.

The Chinese Psychological Society has also been training psychologists about the grieving process and offers a grief hotline for the public. Recognizing the importance of public acknowledgment of loss, the society also persuaded the government to hold a national day of mourning coinciding with Tomb Sweeping Day, which is the traditional day for mourning loss.

APA is already putting some of the lessons learned from Chinese psychologists into practice. One highlight is a new psychoeducational program to provide information about healthy psychological functioning. While the program is aimed at those with mild or moderate distress, it can also identify those who are at higher risk and need more intervention. APA has already piloted the program with good success for several groups, including APA’s own employees.

“We plan to give this away for free to psychologists and other mental health practitioners, teachers, local symphonies, bus drivers and any other community members who could benefit,” says Jared Skillings, PhD, chief of professional practice at APA. “It’s a broad public health approach to get to as many people as we can.”

To access COVID-related resources from psychologists around the world or to share resources with international colleagues, access APA’s Google Drive compilationopens in new window. There is also an index of the resourcesopens in new window, which include documents in more than a dozen languages.