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Psychological crisis intervention during the outbreak period of new coronavirus pneumonia from experience in Shanghai

Identifieur interne : 000197 ( Pmc/Corpus ); précédent : 000196; suivant : 000198

Psychological crisis intervention during the outbreak period of new coronavirus pneumonia from experience in Shanghai

Auteurs : Xixi Jiang ; Lili Deng ; Yuncheng Zhu ; Haifeng Ji ; Lily Tao ; Li Liu ; Daoliang Yang ; Weidong Ji

Source :

RBID : PMC:7112608

Abstract

Highlights

We provide the possible methods for psychological crisis intervention during the outbreak period of new coronavirus pneumonia from experience in Shanghai. As we mentioned: an effective PCI surely requires the two-pronged approaches, online and onsite psychotherapy are recommended .


Url:
DOI: 10.1016/j.psychres.2020.112903
PubMed: 32146245
PubMed Central: 7112608

Links to Exploration step

PMC:7112608

Le document en format XML

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<name sortKey="Tao, Lily" sort="Tao, Lily" uniqKey="Tao L" first="Lily" last="Tao">Lily Tao</name>
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<nlm:aff id="aff0003">Key Laboratory of Brain Functional Genomics (MOE & STCSM), Shanghai Changning-ECNU Mental Health Center, Institute of Cognitive Neuroscience, School of Psychology and Cognitive Science, East China Normal University, Shanghai 200062, China.</nlm:aff>
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<p id="para0002">We provide the possible methods for psychological crisis intervention during the outbreak period of new coronavirus pneumonia from experience in Shanghai. As we mentioned: an effective PCI surely requires the two-pronged approaches, online and onsite psychotherapy are recommended .</p>
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</list>
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<journal-id journal-id-type="nlm-ta">Psychiatry Res</journal-id>
<journal-id journal-id-type="iso-abbrev">Psychiatry Res</journal-id>
<journal-title-group>
<journal-title>Psychiatry Research</journal-title>
</journal-title-group>
<issn pub-type="ppub">0165-1781</issn>
<issn pub-type="epub">1872-7123</issn>
<publisher>
<publisher-name>Elsevier B.V.</publisher-name>
</publisher>
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<article-id pub-id-type="doi">10.1016/j.psychres.2020.112903</article-id>
<article-id pub-id-type="publisher-id">112903</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Article</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Psychological crisis intervention during the outbreak period of new coronavirus pneumonia from experience in Shanghai</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" id="au0001">
<name>
<surname>Jiang</surname>
<given-names>Xixi</given-names>
</name>
<xref rid="aff0001" ref-type="aff">a</xref>
<xref rid="fn1" ref-type="fn">#</xref>
</contrib>
<contrib contrib-type="author" id="au0002">
<name>
<surname>Deng</surname>
<given-names>Lili</given-names>
</name>
<xref rid="aff0001" ref-type="aff">a</xref>
<xref rid="fn1" ref-type="fn">#</xref>
</contrib>
<contrib contrib-type="author" id="au0003">
<name>
<surname>Zhu</surname>
<given-names>Yuncheng</given-names>
</name>
<email>hellfiregenius@163.com</email>
<xref rid="aff0002" ref-type="aff">b</xref>
<xref rid="cor0001" ref-type="corresp"></xref>
</contrib>
<contrib contrib-type="author" id="au0004">
<name>
<surname>Ji</surname>
<given-names>Haifeng</given-names>
</name>
<email>cnjwjihaifeng@163.com</email>
<xref rid="aff0001" ref-type="aff">a</xref>
<xref rid="cor0001" ref-type="corresp"></xref>
</contrib>
<contrib contrib-type="author" id="au0005">
<name>
<surname>Tao</surname>
<given-names>Lily</given-names>
</name>
<xref rid="aff0003" ref-type="aff">c</xref>
</contrib>
<contrib contrib-type="author" id="au0006">
<name>
<surname>Liu</surname>
<given-names>Li</given-names>
</name>
<xref rid="aff0001" ref-type="aff">a</xref>
</contrib>
<contrib contrib-type="author" id="au0007">
<name>
<surname>Yang</surname>
<given-names>Daoliang</given-names>
</name>
<xref rid="aff0001" ref-type="aff">a</xref>
</contrib>
<contrib contrib-type="author" id="au0008">
<name>
<surname>Ji</surname>
<given-names>Weidong</given-names>
</name>
<email>jidong1999@126.com</email>
<xref rid="aff0001" ref-type="aff">a</xref>
<xref rid="cor0001" ref-type="corresp"></xref>
</contrib>
</contrib-group>
<aff id="aff0001">
<label>a</label>
Shanghai Changning Mental Health Center (Affiliated to East China Normal University), Shanghai 200335, China</aff>
<aff id="aff0002">
<label>b</label>
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China</aff>
<aff id="aff0003">
<label>c</label>
Key Laboratory of Brain Functional Genomics (MOE & STCSM), Shanghai Changning-ECNU Mental Health Center, Institute of Cognitive Neuroscience, School of Psychology and Cognitive Science, East China Normal University, Shanghai 200062, China.</aff>
<author-notes>
<corresp id="cor0001">
<label></label>
Corresponding authors.
<email>hellfiregenius@163.com</email>
<email>cnjwjihaifeng@163.com</email>
<email>jidong1999@126.com</email>
</corresp>
<fn id="fn1">
<label>#</label>
<p id="notep0001">These authors contributed equally to this work.</p>
</fn>
</author-notes>
<pub-date pub-type="pmc-release">
<day>28</day>
<month>2</month>
<year>2020</year>
</pub-date>
<pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="ppub">
<month>4</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>28</day>
<month>2</month>
<year>2020</year>
</pub-date>
<volume>286</volume>
<fpage>112903</fpage>
<lpage>112903</lpage>
<history>
<date date-type="received">
<day>25</day>
<month>2</month>
<year>2020</year>
</date>
<date date-type="rev-recd">
<day>27</day>
<month>2</month>
<year>2020</year>
</date>
<date date-type="accepted">
<day>27</day>
<month>2</month>
<year>2020</year>
</date>
</history>
<permissions>
<copyright-statement>© 2020 Elsevier B.V. All rights reserved.</copyright-statement>
<copyright-year>2020</copyright-year>
<copyright-holder>Elsevier B.V.</copyright-holder>
<license>
<license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p>
</license>
</permissions>
<abstract abstract-type="author-highlights" id="abs0001">
<title>Highlights</title>
<p>
<list list-type="simple" id="celist0001">
<list-item id="celistitem0001">
<label></label>
<p id="para0002">We provide the possible methods for psychological crisis intervention during the outbreak period of new coronavirus pneumonia from experience in Shanghai. As we mentioned: an effective PCI surely requires the two-pronged approaches, online and onsite psychotherapy are recommended .</p>
</list-item>
</list>
</p>
</abstract>
<abstract id="abs0002">
<p>Since the middle of December 2019, human-to-human transmission of novel coronavirus pneumonia (NCP) has occurred among close contacts. At the same time, greater attention should be paid to psychological crisis intervention (PCI) among affected populations, for the timely prevention of inestimable damage from a secondary psychological crisis. PCI has been initiated via remote (telephone and internet) and onsite medical services to help medical workers, patients, and others affected to overcome any psychological difficulties. This paper outlines experiences based on the work of the Shanghai Medical Team.</p>
</abstract>
<kwd-group id="keys0001">
<title>Keywords</title>
<kwd>New coronavirus pneumonia</kwd>
<kwd>Crisis intervention</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<sec id="sec0001">
<title>Introduction</title>
<p id="para0003">The outbreak of new coronavirus pneumonia (NCP, also called COVID-19) since January 2020 is a sudden public health crisis, which spread from the city of Wuhan, China, to the whole country within a month, posing serious threats to lives. In the current epidemic situation, psychiatric institutions have already implemented the protective requirements for infectious diseases based on the fifth edition of the ``New Coronavirus Pneumonia Diagnosis and Treatment Plan''. During the outbreak period of NCP, psychological crisis intervention (PCI) is urgently need for all affected, including patients, medical staff, close contacts, people in affected areas, as well as the general public (
<xref rid="bib0008" ref-type="bibr">Zhu et al., 2020</xref>
).</p>
<p id="para0004">In recent years, there has been a number of public emergencies in China, such as the severe acute respiratory syndrome (SARS) in 2003 (
<xref rid="bib0004" ref-type="bibr">Lau et al., 2006</xref>
), the natural disaster of Wenchuan earthquake in 2008 (
<xref rid="bib0001" ref-type="bibr">Chen et al., 2020</xref>
), and the human avian influenza A (H7N9) virus infections in 2013 (
<xref rid="bib0003" ref-type="bibr">Jiang et al., 2019</xref>
). Based on past experience, a large number of people will suffer from mental disorders soon after these unexpected events. Among them post-traumatic stress disorder is the most common illness (
<xref rid="bib0006" ref-type="bibr">Mak et al., 2010</xref>
). If medical care is delayed, affected persons may suffer inestimable damage caused by the psychological crisis.</p>
</sec>
<sec id="sec0002">
<title>Guiding principles</title>
<p id="para0005">Based on the ``Guidelines for the Psychological Assistance Hotline during the Prevention and Control of New Coronavirus Pneumonia'' issued by the State Council's Joint Prevention and Control Mechanism for the NCP epidemic, psychiatrists in psychiatric hospitals and psychological departments in general hospitals have major responsibilities to ensure psychological assistance in response to the outbreak(
<xref rid="bib0002" ref-type="bibr">Chinese Society of Psychiatry, 2020</xref>
).</p>
<p id="para0006">The basic principle of psychological care during the NCP outbreak is to incorporate PCI into the overall deployment of epidemic prevention and control. The main premise of PCI is to minimize psychological damages and provide timely assistance to the prevention and control of the epidemic. Under the condition of strict prevention of NCP infections among medical staff, the implementation of PCI must follow rigorous guidelines, in order to minimize the risk of infections among psychiatrists and psychologists, and to reduce their exposure to stress and trauma.</p>
</sec>
<sec id="sec0003">
<title>Organization and deployment</title>
<p id="para0007">Current PCI efforts are managed by each provincial, autonomous regional, or municipal government in response to the joint prevention and control efforts for the NCP epidemic, with organizational and financial guarantees. This work was initiated by the Chinese Society of Psychiatry, with a team of experts established to organize intervention efforts and provide technical guidance (
<xref rid="bib0002" ref-type="bibr">Chinese Society of Psychiatry, 2020</xref>
). The management of PCI efforts is being carried out under the unified coordination between the Ministry of Health and Health Administrative Department in Shanghai, because the strongest medical resource is reserved in Shanghai.</p>
<p id="para0008">The Shanghai Medical Team dispatched to Wuhan is a major component of the national medical response team. On January 28, the first four psychiatrists were dispatched to Wuhan after a 3-day NCP-specific skill training. The group established a PCI department in the Tongren Hospital of Wuhan University, and set up a work schedule to provide assistance. Due to different populations being affected by the epidemic to different degrees, the psychiatrists identified high-risk populations on which to prioritize their efforts, in order to prevent extreme events such as suicide and impulsive behavior. They drafted the signs of psychological crisis and provided feasible methods, providing timely report to the leading group of the joint prevention and control of the epidemic situation. Thus, the ninth batch of the Shanghai Medical Team was dispatched with 50 psychological therapists on February 21, as a second team for providing of mental health support.</p>
</sec>
<sec id="sec0004">
<title>Challenges and strategies</title>
<p id="para0009">In the current epidemic situation, face-to-face psychological counseling service requires high standards for onsite isolation to minimize risk. At present, this service is only implemented for front-line medical staff who have not been infected. However, infected people may face more severe psychological crisis and secondary trauma after the disaster(
<xref rid="bib0007" ref-type="bibr">Peng et al., 2010</xref>
). Therefore, to ensure the ongoing provision of mental health services and reduce the risk of cross-infections, a remote consultation network is being developed and implemented by the Chinese government, where telephone or internet consultations can be carried out in a safe setting (see
<xref rid="fig0001" ref-type="fig">Fig. 1</xref>
). The Shanghai municipal government has further employed third-party online platforms to deliver consultations and prescriptions. Patients who need onsite treatment or hospitalization will be recommended to choose a specialist agency near their home.
<fig id="fig0001">
<label>Fig. 1</label>
<caption>
<p>Psychologists unite to help front-line medical workers at Wuhan City No. 3 Hospital, (A) onsite and (B) remote consultation services. [Photo/the Xinhua News Agency].</p>
</caption>
<alt-text id="alt0001">Fig 1</alt-text>
<graphic xlink:href="gr1_lrg"></graphic>
</fig>
</p>
<p id="para0010">To improve efficiency and optimal use of limited medical resources, it is important in the initial stage to establish key target groups and set priorities accordingly. The guiding principles divide the population affected by NCP into 4 levels (see
<xref rid="tbl0001" ref-type="table">Table 1</xref>
), and require the first-level population to be the focus of PCI (
<xref rid="bib0002" ref-type="bibr">Chinese Society of Psychiatry, 2020</xref>
)(
<xref rid="bib0005" ref-type="bibr">Ma et al., 2020</xref>
). Psychiatrists and psychologists can then carry out assessment of the psychological state of target individuals in a more timely manner. The current PCI efforts provide onsite services to first and second-level populations, and 24/7 real-time remote (telephone and internet) psychological support to third and fourth-level populations.
<table-wrap position="float" id="tbl0001">
<label>Table 1</label>
<caption>
<p>Populations affected by NCP divided into 4 levels.</p>
</caption>
<alt-text id="alt0002">Table 1</alt-text>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top">Level</th>
<th valign="top">Population</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top">1</td>
<td valign="top">Patients with severe symptoms of NCP, front-line medical staff, CDC researchers or administrative staff</td>
</tr>
<tr>
<td valign="top">2</td>
<td valign="top">Patients with mild symptoms of NCP, close contacts, suspected patients, or patients with fever who come to hospital for treatment</td>
</tr>
<tr>
<td valign="top">3</td>
<td valign="top">People related to the first and second-level population, such as family members, colleagues or friends; rescuers, such as commanders, administrative staff, or volunteers</td>
</tr>
<tr>
<td valign="top">4</td>
<td valign="top">People in affected areas, susceptible groups, or general public</td>
</tr>
</tbody>
</table>
</table-wrap>
</p>
</sec>
<sec id="sec0005">
<title>Further perspectives</title>
<p id="para0011">The two-pronged approach (onsite and remote) outlined above is necessary to implement effective PCI efforts, at the same time minimizing risks of cross-infections in the epidemic situation. However, there are substantial shortcomings with remote consultation measures, because it lacks medical history data, psychometric data, body language, and effective follow-up observation. Remote psychological consultations services, therefore, cannot replace face-to-face onsite services. The present arrangement should only be used as temporary emergency backup in exceptional circumstances such as the current NCP outbreak.</p>
</sec>
<sec id="sec0006">
<title>Contributorship statement</title>
<p id="para0012">XJ wrote the paper with LD. YZ, HJ, LL and DY collaborated in the writing editing of the manuscript. LT polished the English language. WJ proofread the manuscript. All the authors contributed reviewing the final version of the manuscript.</p>
</sec>
<sec id="sec0007">
<title>Funding sources</title>
<p id="para0013">This work was supported by the
<funding-source id="gs0001">Research Project of Changning District Science and Technology Commission of Shanghai Municipality</funding-source>
, China (CNKW2018Y23), the
<funding-source id="gs0002">Research Project of Changning District Health and Family Planning Commission of Shanghai Municipality</funding-source>
, China (20164Y013), the
<funding-source id="gs0003">Project of Changing District Young Nursing Staff Capacity Improvement and Training of Shanghai Municipality</funding-source>
, China (20184Q013) and the
<funding-source id="gs0004">Innovation Research Team Project of Shanghai Changing District</funding-source>
.</p>
</sec>
<sec sec-type="COI-statement">
<title>Declaration of competing interest</title>
<p id="para0015">The authors have no conflicts of interests.</p>
</sec>
</body>
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<sec id="sec0009" sec-type="supplementary-material">
<label>Appendix</label>
<title>Supplementary materials</title>
<p id="para0014a">
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<media xlink:href="mmc1.xml">
<alt-text>Image, application 1</alt-text>
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<ack id="ack0001">
<title>Acknowledgments</title>
<p>We thank all the members of the Shanghai Medical Team dispatched to Wuhan.</p>
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<fn-group>
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<p id="para0003a">Supplementary material associated with this article can be found, in the online version, at
<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.1016/j.psychres.2020.112903" id="interref0001">doi:10.1016/j.psychres.2020.112903</ext-link>
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