Armando D'Agostino

Benedetta Demartini

Federico Fortunato

Orsola Gambini

Veronica Nistico'

English

AIR Universita degli studi di Milano

Journal of Affective Disorders 282 (2021) 695–696Available online 31 December 20200165-0327/© 2020 Elsevier B.V. All rights reserved.Correspondence COVID-19 and mental health: the other side of the coin After almost three months from the beginning of the worldwide coronavirus disease 2019 (COVID-19) pandemic, it is arguably evident that its psychological effects are pervasive and could affect mental health now and in the future. In the last few weeks, there has been a surge in the literature exploring the psychological impact not only due to the COVID-19 pandemic itself but also to the subsequent strict lockdown ordered by the government authorities in many countries of the world. Although still preliminary, results underlined how levels of stress, anx-iety and depression have significantly raised in the general population since the beginning of the pandemic (Wang et al, 2020; Moccia et al, 2020). In particular, elderly people, healthcare workers and psychiatric patients have been found to be at higher risk (Holmes et al, 2020). People with preexistent mental health disorders seem to be more sub-stantially influenced by the psychological responses brought on by the COVID-19 pandemic, resulting in relapses or worsening of an already existing psychiatric disorder (D’Agostino et al, 2020). However, our clinical observation, achieved from some of the second and third-level outpatient clinics (e.g. eating disorders, adult high-functioning autism) of the Department of Mental Health of ASST Santi Paolo e Carlo in Milano, suggest that some specific categories of psychiatric patients paradoxically benefit from lockdown. Although we still do not have any statistical data for this phenomenon, we have observed that patients with difficulties in social interaction (e.g. patients with social phobia or high-functioning autism) or patients who fear the comparison with other people (e.g. patients with eating disorders), have often reported an improvement of their psychological well-being during the last three months. This observation lead us to formulate the following consider-ations, which might be clinically relevant now and in the future: (i) there are psychiatric patients who are able to handle social isolation and social distancing better than the general population. For example, people with high-functioning autism have often had to deal with social isolation during their entire lives (Barendse et al, 2018). Exploring their coping strategies, such as time scheduling and adapting online learning to specific needs, could help people who greatly suffer lockdown to cope with it; (ii) a crucial theme in the psychopathology of those patients who benefit from social isolation is the comparison with others and the feeling of perceiving themselves as different from the majority of other people (considered subjectively as "normal"). Thus, the lockdown rep-resents a situation where these patients manage to represent themselves as more similar to others, experiencing the same situation and facing the same difficulties. Focusing more on similarities rather than differences probably represents a shift in attention that might increase psycholog-ical well-being in these patients. This means, from a psychotherapeutic perspective, that the use of techniques and interventions aimed to normalize patients’ life condition and to perceive themselves as similar to other people must be encouraged; (iii) the lockdown condition, which has dramatically reduced interactions and relational exchanges, allowed us to further highlight how the drive for achievement and com-petition/comparison with others are pervasive in our culture and deeply influenced our social interactions. These drives can be implicitly present in many situations related to the relationship with others, such as work activity. Although for some people they might represent a motivational factor, for others they represent a constant reference to incapacity and failure, which contributes to further fostering a state of suffering and psychological malaise. Social attention should therefore be diversified in order to produce drives connected also to the sense of common belonging and sharing; (iv) the lockdown condition, through messages addressed to common suffering and social responsibility, has enhanced the experience of feeling part of a community of individuals, supporting the perception of sharing, at the expense of the attention paid to indi-vidualism and personal achievement. Thus, we might hypothesize that, in these patients, the perception of belonging to a group, the feeling of sharing the same emotions/sensations/thoughts of others can promote their psychological well-being. From a psychotherapeutic angle, the use of techniques that enhance mentalization or metacognition might pro-mote psychological well-being in these patients; (v) patients who para-doxically benefit from the lockdown condition might be at high risk of sudden worsening of their psychiatric symptoms during the period immediately after lockdown, when they are forced to come back to their pre-lockdown life condition (rebound effect). This risk should be care-fully addressed by mental health services. In conclusion, our clinical observation suggests that patients with difficulties in social interactions and who fear the comparison with others might benefit from a lockdown condition. However, future research studies are needed to confirm our impression. Author statement BD and FF designed and conceptualized the study; drafted the manuscript for intellectual content VN drafted the manuscript for intellectual content AD and OG revised the manuscript for intellectual content Role of the funding source No role of the funding source. Declaration of Competing Interest Authors have no conflict of interests to declare. Acknowledgements None. Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad https://doi.org/10.1016/j.jad.2020.12.189 Received 28 July 2020; Accepted 26 December 2020   Journal of Affective Disorders 282 (2021) 695–696696References Barendse, E.M., Hendriks, M.P.H., Thoonen, G., Aldenkamp, A.P., Kessels, R.P.C., 2018. Social behaviour and social cognition in high-functioning adolescents with autism spectrum disorder (ASD): two sides of the same coin? Cogn. Process. 19, 545–555. https://doi.org/10.1007/s10339-018-0866-5. D’Agostino, A., Demartini, B., Cavallotti, S., Gambini, O., 2020. Mental health services in Italy during the COVID-19 outbreak. Lancet Psychiatr. 7, 385–387. https://doi.org/ 10.1016/S2215-0366(20)30133-4. Holmes, E.A., O’Connor, R.C., Perry, V.H., Tracey, I., Wessely, S., Arseneault, L., Ballard, C., et al., 2020. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry 7, 547–560. https://doi.org/10.1016/S2215-0366(20)30168-1. Moccia, L., Janiri, D., Pepe, M., Dattoli, L., Molinaro, M., De Martin, V., et al., 2020. Affective temperament, attachment style, and the psychological impact of the COVID-19 outbreak: an early report on the Italian general population. Brain Behav. Immun. https://doi.org/10.1016/j.bbi.2020.04.048. Apr 20.  Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C.S., et al., 2020. Immediate psycho-logical responses and associated factors during the initial stage of the 2019 coro-navirus disease (COVID-19) epidemic among the general population in China. Int. J. Environ. Res. Public Health. 17, 1729. https://doi.org/10.3390/ijerph17051729. Benedetta Demartinia,b,c,*, Federico Fortunatod, Veronica Nisticòa,b,c, Armando D’Agostinoa,b, Orsola Gambinia,b,c a Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy b Unità di Psichiatria II, A.O. San Paolo, ASST Santi Paolo e Carlo, Milano, Italy c “Aldo Ravelli” Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy d Centro Medico Santagostino, Milano, Italy * Corresponding author at: Dipartimento di Scienze della Salute, Università degli Studi di Milano, A.O. San Paolo, via A. di Rudinì, 8, Milano, 20100, Italy. E-mail address: benedetta.demartini@unimi.it (B. Demartini). Correspondence                                                                                                                                                                                                                                  

COVID-19 and mental health: the other side of the coin

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COVID-19 and mental health: the other side of the coin

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