[General sanitary containment during the Coronavirus epidemic: Medico-psychological consequences in general population, caregivers, and subjects suffering previously from mental disorders (Retrospective on the repercussions of lethal mass risks, scientific models of collective confinement, first clinical observations, implementation of countermeasures and innovative therapeutic strategies)]

Yann Auxéméry, Cyril Tarquinio
Annales Médico-psychologiques 2020 June 5

Background: The situation we are currently experiencing is unprecedented. Declaring a state of health emergency in order to curb a frightening epidemic, the authorities have decreed the home confinement of the majority of the population of our country for several weeks. In a few days, innumerable questions arise for very diverse spaces: epidemiological, immunological, sociological, information scientists, medical, administrative, political, etc.

Objective: We propose a reflection intended to describe the psychological risks, to clarify the disorders found, and to discuss the means to take care of them in the duration.

Material and methods: We base our thinking on a review of the literature confronted with our current clinical experience, including concerning the possibilities of dematerialised medico-psychological monitoring.

Results: We recall the collective repercussions of emerging lethal mass risks, and in particular viral infectious agents, before approaching the existing scientific models of collective confinement according to military operations in war zones, polar wintering missions and aerospace conquest. It appears that for the study of a global containment, somewhat studied during previous pandemics, the conceptions of stress reaction and psychodynamic adaptation prove to be relevant. We detail the psychological consequences of confinement on individual mental health and their countermeasures according to three population typologies: general population, population of caregivers on the front line against the epidemic, and population of subjects already suffering from mental illness or seeing their disorders reappear. We also refer to works in social cognitive psychology explaining how, in an anxiety-provoking situation, reasoning can be biased and lead to choices that ultimately prove to be not very rational, in the opinion of those who made them. The current situation in the health sector is favourable in this, as evidenced by the "debate on chloroquine" widely reported in the media and on social networks, opposing conclusions most often decided on the basis of beliefs on contrary to evidence based medicine.

Discussion: The psychological repercussions of confinement appear conditioned by the multiple forms that it can take: voluntary or suffered, more or less prolonged, spent at home or in another place, lived in individual isolation or in a small community, associated other stressors and/or traumatic factors, etc. The home confinement of a population across a country has never been assessed. This experience seems to us to confront our society as a whole with the taboo of death, which is imposed, death more and more evaded as the "Western man" tries to move away from his terrestrial origins. In this sense, psychotraumatic type repercussions are to be prevented. In order to face multiple challenges, the healthcare system has adapted with, in particular, the development of the use of the Internet for the provision of information intended to better experience confinement, or even the generalisation of e-psychotherapy asking as many questions as it provides answers. These intricacies of computer techniques in the area of psychotherapy, techniques with which we had some questioning, became established as quickly as the virus: the task of clinicians and researchers to measure the issues and the consequences.

Conclusion: Public health programs could emerge on the model of those already existing in order to manage well-known chronic endemic disorders: protection against the effects of an unbalanced diet associated with a sedentary lifestyle, fight against smoking and alcoholism, prevention of self-aggressive behaviour, etc. We will also need to support the caregivers who have been on the front line and who will emerge tested from this pandemic: depending on the sustainability of the action capacities of our healthcare system to return to its nominal state and also perhaps, so that it can face consequences resulting from other crises, especially social ones.

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