Narrator/Interview with Lu Lin
/Compiled by Zhou Shiling
Editor/Lu Yi
Recently, many people who have had yang are worried and anxious because they cannot get medicine, are inconvenient to seek medical treatment, and have uncomfortable symptoms. People who have not had yang are also troubled by "cynophobia" and "phantom yang syndrome".
Under the impact of Omicron, the epidemic has not only changed people's physical condition, but also profoundly affected their mental health.
A set of data provided by Lu Lin, an academician of the Chinese Academy of Sciences and president of Peking University Sixth Hospital, shows that in the three years since the COVID-19 outbreak, there have been nearly 70 million new patients with depression, 90 million patients with anxiety disorders, and 100 million people suffering from insomnia around the world. The impact of the epidemic on the mental and mental health of all mankind will last for at least 10-20 years.
Since 2020, he and his research team have begun to pay attention to the psychological impact of the epidemic. A long-term study found that 12 months after the outbreak, anxiety and insomnia showed a significant improvement trend, but depression showed a mild worsening trend, and the public's Internet addiction behaviors, especially among teenagers, also increased significantly. Front-line workers such as medical staff and grassroots workers, people infected with the new coronavirus and their families, people in quarantine, people whose economic income has been affected or unemployed due to the epidemic, as well as the elderly, children and adolescents, etc., all need continued attention.
Lu Lin pointed out that China has a large population and is also a country with great mental health, and the prevalence of mental illness is on the rise. Taking depression as an example, the number of patients is nearly 100 million, among which the detection rate of depressive symptoms among teenagers is 24.6%. In addition, in the past three years, the COVID-19 epidemic has further impacted mental health. In the post-epidemic era, mental health issues related to the epidemic still require urgent attention.
Lu Lin came to Wuhan Leishenshan Hospital as an expert on the Joint Prevention and Control Mechanism of the State Council.
What will be the psychological impact of the epidemic? How should the public and policy levels respond to the impact? In response to these issues of public concern, Lu Lin said:
Post-epidemic mental and psychological rehabilitation work is urgent.
Since the outbreak of the new coronavirus pneumonia in 2020, our research team has done a lot of work to study the psychological impact of the epidemic. We conducted an online survey of 50,000 people in February 2020. The results showed that during the COVID-19 outbreak, the detection rates of depressive symptoms, anxiety symptoms and insomnia symptoms among the Chinese public were 27.9%, 31.6% and 29.2% respectively, and the detection rate of acute stress symptoms was 24.4%. We later conducted long-term research and found that 12 months after the outbreak, anxiety and insomnia symptoms showed a significant improvement trend, but depressive symptoms showed a mild worsening trend, and the Internet addiction behavior of the public, especially teenagers, also increased significantly.
According to the World Health Organization assessment, the outbreak of the new coronavirus pneumonia epidemic may be reduced, alleviated, and even well controlled within one or two years. However, at the beginning of the outbreak, the World Health Organization (WHO) judged that the impact of the new coronavirus epidemic on the mental and mental health of all mankind would last for at least 10-20 years. Why do you say that?
First of all, because of the epidemic, many people stay at home for a long time. In a limited space, it is easy to become depressed, even irritable and erratic. Secondly, the public is afraid of infectious diseases themselves, fearing that accidental infection may damage their health. In addition, the epidemic has made many people confused about the future. Not being able to go to work or work from home may put pressure on the economy and income, directly affecting life. The new coronavirus itself and the resulting impact are stressful events for us. For most people, they will ease as the stress decreases, but the psychological problems of some sensitive people may last for a long time.
During the epidemic, the occurrence of mental and psychological problems will be different for different groups. The mental and psychological problems of front-line workers such as medical staff and grassroots workers, people infected with the new coronavirus and their families, people in isolation, people whose economic income has been affected or unemployed due to the epidemic, as well as special groups such as the elderly, children and adolescents, all need continuous attention.
After the emergence of the new coronavirus epidemic in 2020, I called for urgent mental and psychological rehabilitation after the epidemic. The work progress in the past two years has been good.
In response to the mental and psychological problems caused by the epidemic, as early as the early stage of the outbreak, that is, in February 2020, the National Health Commission issued a series of psychological emergency rescue and psychological counseling measures, and established more than 600 psychological assistance hotlines, mainly in public hospitals across the country. After epidemics broke out in various places, psychiatric professionals from psychiatric hospitals and general hospitals in various places formed psychological rescue teams and entered isolation wards, shelters, isolation points, etc. in severe epidemic areas to carry out timely psychological crisis intervention work. Psychiatric experts from all over the country have provided many suggestions on formulating psychological intervention policies during the epidemic. They have also publicized and promoted psychological adjustment methods through different channels to strengthen people's mental health awareness, carry out active science publicity and education, help the public understand emotions, regulate emotions, eliminate the public stigma of the disease, reduce patients' sense of shame, and increase psychological immunity skills training and strategic intervention.
These measures have achieved very good results. The public's awareness of mental and psychological problems has been continuously improved, and many people are willing to seek help from professionals when they encounter psychological problems. Through the popularization of mental health knowledge by the state, media, and psychological experts during the epidemic, the public has paid more attention to their own health, especially mental health, and has spent more time with their families.
As work experience increases, prevention, treatment and rehabilitation become easier than before. But at the same time, changes in the epidemic and prevention and control policies have also brought challenges to the level of response to public health events, the formulation of relevant policies, and the improvement of the public mental health system. Research on psychiatry and psychological crisis intervention in my country started late, and the psychological crisis intervention system is not perfect enough and needs further professionalization, specialization and standardization.
Lu Lin at work
How should the public cope with the psychological impact of the epidemic?
The psychological state of an individual is closely related to the state of society. Since the outbreak of the COVID-19 epidemic in 2020, the number of people seeking psychological counseling and psychological hotline help has increased sharply. The main psychological states are anxiety, depression, insomnia, panic, helplessness, anger and guilt. When these psychological states appear or intensify in many people, they may have a certain impact on social behavior.
For example, when a person has experienced the difficulty and helplessness of seeking medical treatment, and then seeks medical treatment again, he may easily get angry over trivial matters, blaming the incompetence of those around him, and adding obstacles to his own medical treatment and recovery. This is one of the psychological defenses against the feeling of helplessness. Although it has no actual effect, it can temporarily relieve the person's helplessness. If similar examples occur frequently, there will be more and more frictions and conflicts between people, which may lead to more social problems.
Under such circumstances, I have the following suggestions for the general public to deal with the mental and psychological impact of the epidemic:
1. Scientific prevention, awareness of emotions, and acceptance of yourself. Facing the epidemic, people may have psychological emotions such as worry, anxiety, and even panic. This is a normal response when we face a crisis event and helps us remain highly alert to stressors. We must allow ourselves to have such a situation, do not worry too much, accept our negative emotions, and realize that they will slowly subside as the epidemic ends. This will help us let go of anxiety and maintain a stable mentality. In the self-media era of information explosion, it is difficult to distinguish the authenticity of various information on the Internet. It is necessary to screen the information obtained, obtain scientific and reliable information from official channels, accept objective facts, and prevent diseases scientifically. Learn relevant knowledge about epidemic prevention and control, strictly implement prevention and control measures such as "wear a mask", "wash hands frequently", "ventilate more", "reduce going out" and "keep a distance of one meter", and build confidence in scientific prevention and control of the epidemic.
2. Regular work and rest, moderate exercise. Evidence shows that self-immunity is crucial in the prevention and treatment of COVID-19. A balanced diet, good sleep and moderate exercise can not only maintain human immunity, but also help relieve negative emotions and maintain mental health.Eating three regular and rationed meals, eating a reasonable amount, doing indoor aerobic exercise for about 30 minutes a day, and sleeping regularly for no less than 7 hours a day can help us improve the body's ability to resist disease risks, and also help us maintain a good mental and working condition.
3. Talk actively, vent reasonably, adjust yourself, and relax your body. Because of the epidemic, people's communication and exchanges with the outside world have decreased, exacerbating negative emotions such as anxiety and helplessness. Active talking and reasonable venting can prevent excessive emotional suppression and help maintain a stable mentality. You can communicate with relatives and friends through phone calls, videos, etc., talk to each other, support and encourage each other. At the same time, you must also learn appropriate self-psychological adjustment methods and techniques. When negative emotions occur, you can adjust them through psychological suggestions and diverting attention. Watching movies, listening to music, and doing appropriate exercise can all help calm your emotions, and use positive actions to get yourself out of panic.
4. Seek professional help. When your emotional state continues to deteriorate, or is accompanied by severe insomnia, anxiety, depression, irritability, etc., which cannot be effectively relieved through self-regulation, you should seek professional help in time. Professional institutions have opened free psychological assistance hotline services. You can call the psychological assistance hotline for consultation. If conditions permit, you can also go to offline medical treatment.
In March 2022, the United Nations website published an article stating that in the first year of the COVID-19 pandemic, the global incidence of anxiety and depression increased by 25%
Multiple factors contributed to the increase in the prevalence of mental illness in China
The prevalence of mental illness in China is indeed on the rise. Epidemiological surveys before the epidemic showed that the prevalence of mental disorders in Chinese adults was about 17%, which did not include sleep disorders and childhood mental disorders. During the COVID-19 pandemic, a scientific briefing released by the World Health Organization showed that the incidence of anxiety and depression has increased significantly by 25% globally. In my own clinical practice, I have also found that there has been a significant increase in the number of patients seeking treatment for mental and psychological problems caused by stress events such as the epidemic and isolation. The current burden of mental illness in the country is relatively heavy, and it is likely to be further exacerbated during the epidemic.
The occurrence of mental diseases will be affected by factors such as gender, age, region, and economy. For example, depression, anxiety and other diseases are more likely to occur in women. Mental disorders are also related to age and region. We need to pay more attention to the physical and mental health of rural areas, teenagers, and the elderly. In addition, there will be differences in mental and psychological problems among different groups of people during different periods of the epidemic.
The increased prevalence of mental illness is the result of a combination of genetic and environmental factors. Some bad lifestyles, such as " in " that is often mentioned in recent years, will increase the risk of depression, anxiety and other diseases to a certain extent.
In the past, due to public misunderstandings about mental and psychological problems, or because mental illnesses were subject to discrimination or stigmatization, many people were unwilling to seek medical treatment because of the stigma. Nowadays, as the public's knowledge about mental health becomes more and more abundant, people pay more attention to mental health and are more active in seeking medical diagnosis, which helps in the early detection of diseases. Early identification and early treatment can more effectively ensure our physical and mental health.
In recent years, my country's mental health system has also made great progress, and the number of medical institutions and professionals has continued to increase. However, compared with the huge population in our country, mental health medical institutions and staffing are still insufficient, especially at the grassroots level and in remote areas. Problems of nowhere to see a doctor and difficulty in registration also exist. Especially under the current severe epidemic situation, mental health service capabilities are far from meeting the actual needs of patients, and it also affects patients' timely medical treatment.
At present, the country is actively adopting a variety of strategies to alleviate these problems, such as carrying out online consultations and artificial intelligence to support smart medical care. At the same time, our research has found that online therapies for mental and psychological problems such as eCBT-i can also have a good therapeutic effect on people with insomnia. These methods help improve diagnosis and treatment capabilities.
Experts from Hunan Provincial Brain Hospital conduct psychological intervention for frontline community workers
The mental and psychological problems of children and adolescents highlight
The mental and mental health of children and adolescents also deserves attention.
A UNICEF and World Health Organization survey report shows that currently, about 20% of the world's 1.2 billion adolescents aged 10 to 19 have mental health problems. Surveys in China show that the prevalence of mental illness among children and adolescents aged 6-16 is about 17.5%. This situation occurs mainly because adolescence is a transition period from childishness to maturity. The nervous system is immature, has a weak endurance, is psychologically sensitive, and is susceptible to external influences. In addition, some parents and teachers have insufficient psychological knowledge and do not provide correct guidance. Instead, they exert pressure, which further worsens their situation, promotes depression, and even goes to extremes.
When psychological problems occur, teenagers often manifest themselves as emotionally unstable, prone to losing temper, prone to contradicting parents, sleeping too much, prone to fatigue, unwilling to go to school, as well as decreased concentration and memory, and declining grades. At this time, do not arbitrarily think that the child is in a rebellious stage. Children who have these problems should pay special attention to them and seek medical treatment in time when necessary.
However, parents also need to note that not all depression is depression, and it is normal to feel depressed occasionally. When the above symptoms persist for at least two weeks, you should go to the hospital for professional evaluation to determine whether the child has a mental health problem.
In actual clinical work, we have also clearly felt that more and more teenagers have been visiting the hospital in recent years.
Every time I go to the clinic, there are many children who cannot go to school and have stayed at home for half a year to a year. They are from junior high school, high school, and university. It is a pity that it has a great impact on the family and society. There are various reasons for not going to school. Some are due to the parent-child relationship and divergence from parents, some are taking online classes and don’t want to go to school, and some feel that life is meaningless, etc.
The increase in medical treatment among teenagers is related to the improvement of the psychological quality and medical awareness of parents and teachers on the one hand. On the other hand, it is also due to the high pressure of study, and the prevalence of mental and psychological problems among teenagers has also increased significantly. Especially since the epidemic, depression among teenagers has shown an explosive growth trend, and Internet addiction among teenagers has also significantly increased, which requires special attention.
The epidemic has a more prominent mental and psychological impact on young people. Because teenagers take online classes for long periods of time, cannot go out to communicate with peers, lack adequate physical exercise, and are addicted to games and mobile phones, the rate of Internet addiction has increased significantly. Staying at home for a long time is also prone to conflicts with parents, or being strictly supervised by parents, etc., which leads to children's mental health problems and significantly increases the incidence of depression and anxiety in children and adolescents.
Even after the epidemic passes, the mental and psychological effects may still remain for a long time. More importantly, today's teenagers will be the mainstay of society and the builders of the future of the country and nation in 5, 10 or 20 years. Therefore, their mental health problems are very important. Once mental and psychological problems are discovered, they must be treated and intervened in time.
In terms of 's response to and protection of adolescents' mental and mental health, parents should increase their awareness of mental and psychological problems, and do not think that their children's absence of illness is a sign of health. In fact, health is not only the absence of physical disease, but also mental health. When your child suffers from depression, anxiety and other emotions, do not think that the child is complaining for no reason. This understanding will further increase the child's psychological burden. We need to make our children feel understood, provide them with care, support and companionship, and work with them to overcome the disease.
Schools cannot just emphasize grades, but also pay attention to the mental health of students. They must have relevant psychological courses and psychological teachers to guide children to correctly understand bad emotions and let them know how to deal with similar problems. In addition, help students develop and maintain good living habits: regular work and rest, regular diet, adequate sleep, moderate exercise, adequate relaxation, etc. These are the foundation of physical and mental health.
Society should also give more understanding and care to young people with mental health problems. The news media should guide the entire society to be tolerant and understand their situation, increase health science publicity, strengthen public mental health education , and gradually change social prejudices.
In 2021, the issue involving suicide in the student psychological assessment questionnaire has attracted public attention
We must be very cautious when dealing with the psychological problems of minors
We must be very cautious about the mental and psychological problems of children and adolescents, and they must be carried out under the evaluation and guidance of professional child psychiatrists.
Previously, some places carried out depression screening and distributed suicide questionnaires to primary and secondary school students, which caused a certain amount of social attention and controversy. The education system wants to do this because it believes that children and adolescents have many problems in this area. It is understandable that children should be screened for depression, self-injury and other problems, but these things should not be done by non-professionals.
When it comes to sensitive issues such as depression and suicide, they should be handled by professionals. For example, if an oncologist tells a patient that his or her condition requires strict training, family members may not be able to accept it if told directly. The same goes for psychiatrists. Doctors have procedures for asking if a person has suicidal thoughts. Even if the patient is unwilling to say it, the doctor can make a judgment through comprehensive consultation without directly asking whether he doesn't want to live anymore. This is inappropriate. That's why you need professionals to do professional things.
But the problem with is that our needs do not match the service capabilities we can provide, and we lack talents. There is not only a shortage of trained and qualified psychiatrists, but also psychological counselors and social workers, especially child psychiatric service personnel.
The internationally promoted approach is to serve a school, community or several communities with a team of about 10 people, including at least 1 psychiatrist, 3 psychotherapists, and 5 social workers. If the condition is serious, you need to take medicine, or you need to deal with complex problems, you can see a doctor. For the rest, you don’t need a doctor. Psychological counselors can solve school and family problems, and even social workers can solve some daily problems, such as students fighting, couples quarreling, etc. But our country does not yet have this system.
It may be difficult to train doctors, and results may not be achieved in 10 years. It sometimes takes at least 20 years to train a qualified doctor, but social workers may be trained in 5 or 8 years. In the final analysis, the talent issue is also a system issue, and its implementation is very complicated.
In this regard, I believe that we must strengthen the talent cultivation of children and adolescents in the mental psychology profession in my country, and improve the overall quality of practitioners, their remuneration and social recognition. Second, we must improve the mental and psychological service capabilities of children and adolescents in the whole society, promote normalized and standardized mental and psychological hierarchical diagnosis and treatment models for children and adolescents, strengthen the management capabilities of grassroots mental and mental health institutions, and improve the utilization efficiency of mental health resources. Third, we must continue to improve the construction of my country's public psychological crisis intervention system, establish a normalized psychological rescue team and system for young people, and build a relevant social psychological crisis early warning system. Fourth, we must increase the popularity of mental health knowledge among our people. Strengthen national mental health education, improve mental health literacy, promote a scientific and rational attitude towards psychological problems, and eliminate the stigma of mental illness.
Mental health also requires the establishment of a public health system.
The COVID-19 epidemic has made everyone realize that the public health system is very important. Like infectious diseases, mental health also requires the establishment of a public health system. The construction of the public mental health system is a major public health issue, people's livelihood issue and social issue related to my country's economic and social development and the physical and mental health of the people. The following are some of my thoughts on the construction of the public mental health system:
First, be down-to-earth and continue to implement mental health and mental health service initiatives. Specifically, it includes the "Mental Health Promotion Action" of the "Healthy China Action (2019-2030)", the "Healthy China Action-Children and Adolescents Mental Health Action Plan (2019-2022)", the National Psychological Care Project Pilot for the Elderly, etc., and serves to improve the mental health status and happiness level of the whole people steadily.
Second, create a social atmosphere that cares for patients with mental disorders and eliminate the stigma of mental disorders.
Third, build a mental health professional medical consortium and alliance.Make full use of the Internet and big data platforms to actively carry out remote consultations, promote the formation of hierarchical diagnosis and treatment models including first diagnosis at the grassroots level, two-way referral, acute and slow treatment, and linkage between up and down, and improve the diagnosis and treatment capabilities at the grassroots level.
Fourth, form a high-level talent training system, improve the comprehensive quality of mental health professionals, and improve the treatment and social recognition of mental health professionals.
Fifth, strengthen the construction of the psychological crisis system in public mental health, and formulate a normalized and standardized mental and psychological graded rescue system to ensure rapid response when a crisis occurs.
The above points are all important. I think the most important one is the design of the system and the other is talent. But if you want to build a complete system, all aspects are important.
The example I often give is that in some developed countries, there is no difference in medical resources between big cities and medium-sized cities, because their system is that wherever there is a shortage of doctors, doctors will be paid better. Assuming that the salary of grassroots doctors in rural areas is raised to be as high as that of big cities such as Beijing and Shanghai, there will be no shortage of doctors at the grassroots level. The same goes for professionalism. When I worked in the United States 20 years ago, there was a shortage of anesthesia doctors in the United States. Medical students were unwilling to go to the anesthesiology department after graduation. The local government raised the salary of anesthesiologists by 20% next year compared with this year, while other departments may only increase by 3%-5%. As the salary increases, more people may be willing to become anesthesiologists, and talent training will be in place.
Our current system design and management are still being explored. If the treatment of grassroots doctors cannot be guaranteed, they will feel that their abilities have not been fully utilized, so they will go to big cities and large hospitals. Basic hospitals often cannot solve this problem by themselves. We require doctors in large hospitals who apply for higher-level professional titles to have three months of experience in grassroots support. However, this is a temporary measure and cannot fundamentally solve the problem of uneven medical resources. It also needs to be constructed, designed and improved from the institutional system.
Similarly, there are still many shortcomings in the construction of my country's public mental health system. In the future, relevant government departments and scholars and experts in the field of mental health should work together to continuously improve the construction of the public mental health system to ensure the physical and mental health and happy life of the people.
