Screening for mental health problems in epidemics: Is it justifiable?

Abstract

Background: Given the overwhelming mental health consequences of infectious epidemics, timely identification and treatment of people with mental health problems is essential. In this narrative review, screening instruments and procedures for identification of mental health problems at the time of epidemic crises are reviewed and the results are discussed in the context of our experience in the recent COVID-19 epidemic in Iran. Methods: Forty studies were retrieved from searches in several databases which used screening procedures for identification of mental health conditions during infectious epidemics. Results: Studies were performed on three groups of health care workers, at-risk general population, and patients with confirmed/suspected infection, using a wide range of instruments. Most have used screening instruments for the purpose of prevalence estimation and only 5 have included it as a health intervention while none has investigated its effectiveness. Conclusion: The evidence base for screening at the time of epidemics is weak. If it is used to identify the needs and enhance help seeking, the screening instruments should have adequate psychometric properties; moreover, their integration in the available services is strongly recommended. Original studies are needed to investigate the usefulness of mental health screening programs in crises such as the COVID-19 epidemic.