Intended for healthcare professionals

Letters Covid-19: psychological effects on healthcare workers

Covid-19 and the future of mental health in primary care

BMJ 2020; 369 doi: (Published 30 June 2020) Cite this as: BMJ 2020;369:m2520
  1. Miquel Roca, professor of psychiatry1,
  2. Caterina Vicens, primary care unit coordinator2,
  3. Margarita Gili, professor of social psychology1
  1. 1Institut Universitari d’ Investigació en Ciències de la Salut (IUNICS/IDISBA, Rediapp), School of Medicine, University of Balearic Islands, 07122 Palma de Mallorca, Spain
  2. 2La Vileta Primary Care Unit (IUNICS/IDISBA, Rediapp), University of Balearic Islands, Palma de Mallorca, Spain
  1. mroca{at}

The spread of covid-19 has had a profound effect on the global economy, and the likelihood that the pandemic will lead to a huge recession and outstrip the financial crisis of 2008 is high.

Kisely and colleagues1 and Gold,2 along with Greenberg and colleagues,3 have pointed out the urgent need for strategies to minimise the psychological distress of healthcare workers. Current evidence indicates that after the pandemic begins to recede, the subsequent economic crisis will have a knock-on effect on the mental health of the general population.

Spain has one of the highest numbers of confirmed cases of covid-19 in Europe and was also one of the countries that was most deeply affected by the economic crisis of 2008. We compared mood, anxiety, and somatoform and alcohol related disorders among primary care attendees in Spain between 2006 and 2010, before and during the economic crisis.4 We found a substantial increase in several common mental health disorders significantly associated with both unemployment and mortgage payment difficulties. An economic crisis directly affects primary care, increasing attendance of people with mental health problems.

The high unemployment rates during the economic crisis of 2008 are probably going to be similar in the coming months. Based on the results of our previous study,4 there will be a greater demand for primary care in countries where it is already overloaded. In the next stages of the pandemic it will be essential to prevent the primary care system from being overwhelmed owing to the high demand caused by mental health problems. Forgetting or ignoring the lessons of the previous economic crisis by not be responding to the appropriate interventions and public health policies would be a false step.


This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.


View Abstract