The Intersection of Psychiatry and the Media during Public Health Disasters

Vol 8 #1

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Nadina Persaud¹, Ana Hategan^2,✉, James A. Bourgeois³

 

Author information:

1  Former book editor at Springer Nature (2014-2019), New York City, NY, USA.  [email protected]

2  Associate Clinical Professor, Geriatric Psychiatrist, Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. ✉ [email protected]

3  Clinical Professor (Affiliated), CL Psychiatrist, Chair, Department of Psychiatry, Baylor Scott & White Health, Central Texas Division; College of Medicine, Texas A&M University Health Science Center, Temple, TX, USA.  [email protected]

 

 

Communicable disease outbreaks, epidemics, and pandemics can propagate and sustain fear long after they are over [1]. The current pandemic of the COVID-19 coronavirus is a real threat to public health across the globe. The possibility of contracting COVID-19 remains a serious risk while medical systems and governments around the world work at containment. How can we sort through the plethora of contradictory information in order to get an accurate picture of what is really going on? Making important decisions in an informed manner is of the essence.

Staying well informed is vital in coping with a pandemic. The World Health Organization has advised the public to “get the facts” and to “stay informed” during this unprecedented time [2]. In a state of a life-threatening pandemic, it is essential to endeavor to remain as calm as possible, but the news sources and media coverage (broadcast news, print media, and the Internet) about the COVID-19 crisis may cause feelings of anxiety or other distress, particularly in individuals with pre-existing psychiatric illness [2, 3]. To illustrate, research has already established an association between disaster television viewing and various psychological adverse outcomes, especially posttraumatic stress disorder, but studies were probably too few to draw definitive conclusions about other forms of media coverage [4].

However, one recent study investigated the relationship between use of media to obtain information on radiation and associated anxiety among community residents in Fukushima, Japan, 5 years after the nuclear power plant catastrophic accident [5]. The authors showed that the acquisition of information through interpersonal interactions (including use of social networking sites) rather than gaining information through news media (including national broadcasting television networks), might have increased radiation-associated anxiety [5]. Therefore, clinicians can expect to see a spike in individuals seeking help for media-induced anxiety or other symptoms related to news about this pandemic; this may include a recurrence of distress among survivors of similar past cataclysmic events, even if the prior event was many years in the past. As media coverage continues to advance technologically and include the fast-growing digital networking platforms, future research is needed to investigate the association between disaster-related media consumption and psychological outcomes in the context of both natural and man-made disasters.

However, the severity of the threat does not explain the different responses of the social and news media to the coronavirus pandemic. In a world of frequent false claims or ideologically biased news (i.e., purposeful misinformation, exaggerations, oversimplified stories, spread via traditional news media or online social media) gathering accurate and actionable information from news media can prove particularly challenging. As the numbers of coronavirus cases worldwide increase exponentially, the problem with the news media has remained pivotal: scrupulous reporting needs to capture full and accurate facts to protect and support population mental health during this crisis.

With any large, population-threatening cataclysmic event, some increase in collective anxiety is inevitable; however, some “catastrophizing” can actually be adaptive in “healthy” doses. Crisis-related anxiety focuses people to attend to what is actually important and critical in the moment, while previously “apparently important” matters recede. For example, in U.S. academic medical centers, focus on Press-Ganey (satisfaction) rating scores, clinic appointment utilization, and relative value units (RVU) productivity are usually matters of high importance during “normal business.”  When facing a crisis that demands a comprehensive, “out-of-the-box” thinking response, these matters are suddenly of minimal concern. When basic safety of medical personnel, a potentially overwhelming volume of patients seeking care, exhaustion of basic medical supplies, and questionably adequate access to inpatient beds confront the medical center, these needs are of moment, while the aforementioned concerns are not.

The contagion effect of population anxiety can be mitigated by balanced, realistic, and honest communication. While one must always consider the source of mass information, information that is fact- (not “feeling- or impression-”) based, reproducible, and in concert with that of recognized experts in epidemiology is best. Medical institutions face two challenges in this regard. They are a constant in-demand information source on medical matters, more so during an epidemic. They are also the definitive data source on services (and limitations to services) at their own location. Direct, above board and reciprocal communication from academic medical centers to and from local, state/provincial, and national health authorities is essential. As often as is practicable, these entities should communicate using common, shared data, especially as pertains to the explanation of population/individual risk and the changes in public/social behavior that are recommended or mandated, depending on local government actions. Medical centers should use their public affairs offices for the bulk of these communications, but medical/scientific credibility is enhanced by providing public access to physician leaders, especially those with academic expertise in the areas of the relevant illness threat.

Individuals tend to seek external validation from sources they generally relate to and agree with. This can be mitigated by a conscious choice to seek information from multiple sources simultaneously. News sources should focus primarily on reporting on various aspects of the epidemic, shifting focus from news areas that are non-essential during a crisis (e.g., the arts, travel, sports). While reporting on governmental responses to health threats is centrally important, the medical/scientific community needs equal attention. The ideal partnership for public policy marries high quality, current scientific and medical opinion with thoughtful, integrative, and decisive government leadership. In this, the media can be a constructive partner if communicating clearly and realistically.

For psychiatric clinicians, there is the expectancy of anxiety responses on the part of the public. Public health announcements about epidemics should present this as expected rather than pathological, allowing people to verbalize anxiety that is proportional to the specific threat. Anxiety that exceeds this threshold and then limits or constrains adaptive threat-specific responses can justify clinical intervention. Clinicians may be asked to provide generic advice regarding the experience of socially disruptive events to the public via the news media. Clinicians doing this should emphasize the general, normative aspects of how people commonly respond to large, disruptive events. In addition, clinicians should encourage people with symptoms exceeding those of an adaptive response and/or functional impairment to seek clinical care through their own clinicians. Psychiatric support to other medical personnel is important and must not be neglected in the rush to duty. Medical personnel may struggle in dealing with overwhelming demand for service, the need to triage inevitably inadequate medical resources, and being called upon to work excessive hours with inadequate respite. Psychiatrists working in medical systems should remind medical leadership of these probable responses to an epidemic, and, to a reasonable degree, normalize them and encourage the use of support groups and clinician-health preserving personnel and management policies. Clinician burnout is already a challenge, and a pandemic is not going to help. For those clinicians who are excessively distressed by this role, a brief time away from epidemic-specific duties and/or brief psychiatric intervention may be needed.

Containing the spread of this infection requires the entire society to focus on the common good and respond to calls to commit to common objectives, including securing the protection of legal rights for all and, understandably, freedom of speech. However, with this comes social responsibility. The Hippocratic Oath stands as a model for medical professional ethics because it describes what we ought to do, not only what we ought not do. In this, governments and media (both social and news) can be partners in the promotion of community mental health by reporting on the “full picture” and being mindful of accurate language and ethical practices.

 

 

Conflict of Interest and Source of Funding:

The authors report no conflicts of interest concerning the subject matter of this article.

 

REFERENCES

1. Moukaddam N. Fears, outbreaks, and pandemics: Lessons learned. Psychiatric Times. 2019;36(11). https://www.psychiatrictimes.com/anxiety/fears-outbreaks-and-pandemics-lessons-learned. Accessed March 21, 2020.
2. World Health Organization. Mental health considerations during COVID-19 outbreak. March 6, 2020. https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf?sfvrsn=6d3578af_2. Accessed March 21, 2020.
3. Caporino NE, Exley S, Latzman RD. Youth anxiety about political news. Child Psychiatry Hum Dev. 2020 Feb 25. doi: 10.1007/s10578-020-00972-z. [Epub ahead of print].
4. Pfefferbaum B, Newman E, Nelson SD, et al. Disaster media coverage and psychological outcomes: Descriptive findings in the extant research. Curr Psychiatry Rep. 2014;16(9):464. 10.1007/s11920-014-0464-x.
5. Fukasawa M, Kawakami N, Nakayama C, et al. Relationship between use of media and radiation anxiety among the residents of Fukushima 5.5 years after the nuclear power plant accident. Disaster Med Public Health Prep. 2019 Nov 29:1-8. doi: 10.1017/dmp.2019.132. [Epub ahead of print].