Building up resilience in an uncertain world: mental health challenges in the aftermath of the first modern pandemic

Now more than ever, preventative and interventional strategies need to be put in place to overcome the collateral damage caused by the pandemic. Mental health is one of the casualties. A long time has passed since the Wuhan outbreak, and the world is or will be soon experiencing the aftermath of the first modern pandemic. Now is, therefore, the time to take notice of the effects of sustained stress on mental and physical health over time and to take action to address them. The uncertainty of the COVID-19 pandemic has been a challenge to mental health globally, transforming the way people make sense of the world and how they relate to one another. The pandemic has presented us with both physical and mental challenges, including the continued stress of lockdowns, restrictions, social distancing, job losses, income insecurity, health and social inequality, suffering, and isolation. Provision of services has changed [1], and the consequences of the pandemic for mental health have become particularly evident in vulnerable groups such as people with pre-existing mental health conditions and individuals at risk for mental disorders, children and adolescents in particular. The incidence of stress-related mental disorders has increased throughout the pandemic, with suicidal crises, anxiety disorders, eating disorders, and major depressive episodes been the most compelling in this population [2]. A recent survey to estimate the impact of the COVID-19 pandemic on child and adolescent psychiatry services in Europe [2] found a dramatic increase in referrals for assessment and hospitalizations 1 year into the pandemic, with perception of the impact of the pandemic on mental health and psychopathology in this population escalating from moderate in 2020 to extreme in 2021. In this context, lessons must be learnt about mechanisms of cope, resilience, and adaptation. As Chmitorz et al. [3] noted in this issue of European Archives of Psychiatry and Clinical Neuroscience, there is an urgent need to investigate protective mechanisms that support the maintenance of mental health during and after adversity. These authors focus on cognitive, physiological, and neural pathways (i.e., resilience mechanisms) that may provide protection against stress-related impairments in a large sample of 1191 individuals. They present baseline descriptive data from the ongoing Longitudinal Resilience Assessment (LORA) study, a population-based study aiming to characterize resilience as a continued process of biological, neural, and cognitive adaptation to stressors and daily hassles, directly assessing their influence on the human organism over a period of at least 3 years. It is very timely that these authors are using a comprehensive, granular approach to the investigation of the general (lifestyle, cortisol reactivity, microbiome, genetic, epigenetic and cognitive) mechanisms involved in resilience in adults from the community, performing an in-depth exploration of their mental health status, ability to recover from stress, major life events, daily hassles, and perceived stress mechanisms, with the aim of clarifying the cognitive and biological mechanisms that may determine whether or not clinical psychopathology develops. It is well known that long-term exposure to stress is involved in and increases the risk of mental disorders. However, the factors that influence stress levels and regulatory mechanisms of the brain are not well understood. Some of the previously suggested plausible biological and cognitive contributing factors to the stress and resilience response, such as cortisol reactivity and perceived anxiety, have been investigated before. For instance, recent findings point to a blunted cortisol stress response and greater perceived anxiety in a dose–response relationship in children * Marta Rapado-Castro mrapado@iisgm.com