COVID-19 and other global adverse developments

First, it must be emphasised that, even though it is an unprecedented health threat, the COVID-19 outbreak is not a stand-alone phenomenon. It arrived at a time when global communities and societies have, over the past decade, already been increasingly saturated with negative emotions, fears, anxieties and feelings of helplessness in response to a perception of serious global problems – from deepening inequality, the expected disastrous consequences of climate change, the proliferation of different forms of extremism, such as terrorism, the unexpected rise of authoritarian political tendencies and regimes, the migration crisis and the accompanying steep rise in xenophobia and polarisation of societies. It is likely that the converging negative nature of these problems will substantially affect mental health not in a purely additive sense, but with a more serious multiplicative effect. Therefore, psychiatry as a discipline should start to prepare effective strategies to deal with the entire cluster of these interlinked problems.

While commentators and social scientists have paid attention to these developments, psychiatry has not yet sufficiently acknowledged how mental health is affected by the pressure caused by rapidly escalating problems and the threats confronting global communities, or how individual mental health is dynamically constrained and affected by interactions between individual minds and brains in a social space. This is an inherently difficult perspective for the model of biomedical psychiatry today to embrace, embedded as it is in an individual-level perspective on brain disease. This model will increasingly prove incapable of dealing with the challenges ushered in by adverse global developments.

The mediating role of public representations

Second, while ultimately it is true that mental health professionals will always need to provide care to individuals with their specific needs, it is imperative to recognise that in a world perceived as volatile, unpredictable and filled with existential threats, a growing number of individual cases of anxiety, mood and other mental disorders are embedded and causally linked to the socially mediated and transmitted negative feelings and emotions connected to coping with such threats. The psychobiological aetiological factors for anxiety and mood disorders should be newly understood as also arising at this social environment level, rather than at the genetic, molecular or neural circuitry level. At the same time, it must be recognised that adverse social and traumatic experiences increasingly do not just stem from individual life experiences but are sustained by publicly transmitted and shared negative mental content. The unprecedented increase in connectivity between people and societies by means of the internet, electronic communication and, first and foremost, social media may play a principal role in forcing the spread of negatively valenced news and in deepening the impact that objectively existing problems have on mental health as a consequence. Therefore, of particular importance at present is to obtain a better understanding of the processes through which social stressors and traumatic experiences are transmitted by public representations – most notably by media news – and then shared in the social space.^{Reference Kesner3} Hence, the mediatory role of the media on mental health should be intensively studied as an indispensable prerequisite for developing effective prevention strategies to mitigate negative impacts.

Intolerance of uncertainty

Third, the common denominator of all the above-mentioned social burdens, of which the COVID-19 pandemic is the latest and most dramatic, is the heightened level of uncertainty they create. Intolerance of uncertainty has been highlighted as a basic transdiagnostic mechanism that underlies the development of different anxiety, mood and psychotic disorders as well as maladaptive coping styles, psychological defences such as avoidance behaviours, perceived burdensomeness, aggression and suicidality.^{Reference Flores, Lopez, Vervliet and Cobos4} On the other hand, the fact that anxiety and stress may facilitate and accelerate the development of new, adaptive coping styles in response to negative events^{Reference Aylward, Valton, Ahn, Bond, Dayan and Roiser5} opens up possibilities for effective interventions on both the individual and the society-wide levels.