Mitigating the impacts of COVID-19: where are the mental health trials?
Mitigating the impacts of COVID-19: where are the mental health trials?
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DOI：
10.1016/s2215-0366(21)00204-2
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发表时间：
2021-08
期刊：
影响因子：
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通讯作者：
Wright J
中科院分区：
文献类型：
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作者：
Gilbody S;Littlewood E;Gascoyne S;McMillan D;Ekers D;Chew-Graham CA;Creswell C;Wright J
评论648柳叶刀。COM/精神病学第8卷，2021年8月，重新调整药物用途(如羟氯喹)。疫苗接种的有效性在第二阶段和第三阶段试验中迅速确立，为推出成功的疫苗方案提供了信心。试验是应对全球大流行的基础，但心理健康并不是这一成功故事的一部分。简而言之，心理健康研究界在描述新冠肺炎影响的性质方面取得了成功，但在生成解决方案和提供临床试验数据以确定哪些因素在缓解影响方面则不太成功。首先，可以通过回顾精神卫生界在规划不断演变的大流行方面所做的最初努力来获得洞察力。2020年3月，一篇重要的快速综述发表在《柳叶刀》上。1Brooks和他的同事探索了新冠肺炎预期的心理影响(特别是封锁、感染和隔离将导致的社会混乱)，以及可以采取什么措施来缓解这种影响。他们预测了对心理健康的负面影响，并对公共卫生对策提出了广泛的建议，包括确定那些风险最高的人(如卫生工作者或既往患有精神疾病的人)。根据有限的试验证据，作者建议了一些治疗方案来减少这些影响，例如为在家中隔离的人提供支持小组。然而，他们注意到缺乏以试验为基础的证据来说明减轻心理影响，并且无法自信地说什么会起作用。大流行初期的两份立场文件也强调了在了解大流行的心理影响方面的研究优先事项；2、3这些构成了协调和部署研究努力和资源的起点。人们普遍认识到，需要收集证据证明什么方法能有效缓解精神疾病，但这些论文并没有特别鼓励实施一项雄心勃勃的试验计划。这两份文件的重点都是描绘心理影响和潜在机制。自从这些最初的发表以来，其他人观察到精神健康研究界的活动迅速增长，4，5但这项研究更多地是描述问题，而不是干预。Demkowicz和他的同事们发表了一篇深思熟虑的论文，详细描述了快速但支离破碎的反应，提到了
Comment648 www. thelancet. com/psychiatry Vol 8 August 2021 repurposed drugs (such as hydroxychloroquine). The effectiveness of vaccinations was quickly established in phase 2 and 3 trials, providing the confidence to roll out successful vaccine programmes. Trials have been fundamental to the global pandemic response, but mental health has not been part of this success story. In short, the mental health research community has been successful at describing the nature of the impact of COVID-19, but less successful at generating solutions and providing clinical trial data to establish what works in mitigating the impacts. In the first instance, insight can be gained from looking back at the initial efforts of the mental health community, in planning for the evolving pandemic. In March, 2020, an important rapid review was published in The Lancet. 1Brooks and colleagues explored the anticipated psychological impact of COVID-19 (specifically the societal disruption that lockdown, infection, and quarantine would cause), and what might be done to mitigate this. They predicted negative effects on mental health, and made broad suggestions for a public health response, including identification of those at greatest risk (such as health workers or people with pre-existing psychiatric illness). On the basis of limited trial evidence, the authors suggested some therapeutic options to reduce these effects, such as support groups for people who were quarantining at home. However, they noted a dearth of trial-based evidence to inform the mitigation of psychological impact and were unable to say with any confidence what would work. Two Position Papers from early in the pandemic also highlighted research priorities in understanding the psychological impact of the pandemic; 2, 3 these formed a starting point from which to coordinate and deploy research effort and resources. The need to assemble evidence of what works to mitigate mental illness was generally recognised, but the papers offered no specific encouragement to deliver an ambitious trials programme. The emphasis in both of these documents was on mapping psychological effects and underlying mechanisms. Since these initial publications, others have observed a rapid growth in activity among the mental health research community, 4, 5 but this research has been more about describing the problem rather than intervening. A thoughtful paper by Demkowicz and colleagues5 detailed a rapid but fragmented response, referring to