Sandro Galea (email:, Raina M. Merchant and Nicole Lurie


Galea S, Merchant RM, Lurie N. The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention. JAMA Intern Med. Published online April 10, 2020. doi:10.1001/jamainternmed.2020.1562

JAMA Internal Medicine
Release date

The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention

Research opinion


The authors discuss the how the physical distancing measures to curb the spread of the COVID-19 pandemic can affect mental health of people. The available scientific literature on the subject of mental health in pandemics focus on the disease itself and not physical distancing. However, research show, large-scale disasters, whether traumatic (eg, the World Trade Center attacks or mass shootings), natural (eg, hurricanes), or environmental (eg, Deepwater Horizon oil spill), are almost always accompanied by increases in depression, posttraumatic stress disorder (PTSD), substance use disorder, a broad range of other mental and behavioral disorders, domestic violence, and child abuse.

In the context of the COVID-19 pandemic, it appears likely that there will be substantial increases in anxiety and depression, substance use, loneliness, and domestic violence; and with schools closed, there is a very real possibility of an epidemic of child abuse. The authors discuss 3 steps which can be taken to proactively prepare for the inevitable increase in mental health conditions and associated sequelae that are the consequences of this pandemic.

First, it is necessary to plan for the inevitability of loneliness and its sequelae as populations physically and socially isolate and to develop ways to intervene. Authors suggest digital technologies to bridge the gap while physical distancing is in place. Normal structures where people congregate such as workplace, gyps, places of worship etc. can have virtual sessions.

Many observers note that outreach that involves voice and/or video is superior to email and text messaging. Extra efforts should be made to ensure connections with people who are typically marginalized and isolated. Social media can also be used to encourage groups to connect and direct individuals to trusted resources for mental health support. Even with all of these measures, there will still be segments of the population that are lonely and isolated. This suggests the need for remote approaches for outreach and screening for loneliness and associated mental health conditions so that social support can be provided.

Developing and maintaining routines are important. Online substitutes for routines help to do so. Particularly for children who are out of school, ensuring that they have access to regular programmed work.

Second, it is critical that we have in place mechanisms for surveillance, reporting, and intervention, particularly, when it comes to domestic violence and child abuse. Individuals at risk for abuse may have limited opportunities to report or seek help when shelter-in-place requirements demand prolonged cohabitation at home and limit travel outside of the home. Systems will need to balance the need for social distancing with the availability of safe places to be for people who are at risk, and social services systems will need to be creative in their approaches to following up on reports of problems.

Third, it is time to bolster our mental health system in preparation for the inevitable challenges precipitated by the COVID-19 pandemic. Stepped care, the practice of delivering the most effective, least resource-heavy treatment to patients in need, and then stepping up to more resource-heavy treatment based on patients’ needs, is a useful approach. Communities and organizations could consider training nontraditional groups to provide psychological first aid, helping teach the lay public to check in with one another and provide support. Telemedicine mental health visits, group visits, and delivery of care via technology platforms will be important components of stepped care for both acute crisis management and more routine communication and support.

This difficult moment in time nonetheless offers the opportunity to advance our understanding of how to provide prevention-focused, population-level, and indeed national-level psychological first aid and mental health care, and to emerge from this pandemic with new ways of doing so. The worldwide COVID-19 pandemic, and efforts to contain it, represent a unique threat, and we must recognize the pandemic that will quickly follow it—that of mental and behavioral illness—and implement the steps needed to mitigate it.