Acta Psychiatr Scand 2020: 141: 399–400 © 2020 John Wiley & Sons A/S.

Wiley & Sons A/S. Published by John Wiley & Sons Ltd
All rights reserved ACTA PSYCHIATRICA SCANDINAVICA
DOI: 10.1111/acps.13177

Editorial
Lifestyle behaviours during the
COVID-19 – time to connect
Loneliness and social isolation are associated with physical-distancing policies. Lifestyle behaviours
poor mental and physical health and may increase including dietary changes, restricted physical activ-
the likelihood of common mental disorders (depres- ity and the eect of increased indoor and screen
sive and anxiety disorders), substance use and cog- time remain an under-researched area (12). Of note,
nitive decline (1,2). At this moment, people around towards the end of the SARS epidemic, social sup-
the globe have been urged to self-isolate and refrain port, mental health awareness and other lifestyles
from social interaction due to the COVID-19 pan- changes (exercise, more time for relaxation and
demic. From public health and preventative care restorative sleep) were all associated with decreased
perspectives, there is a pressing need to provide perceived stress and incidence of PTSD (13).
individuals, communities and health agencies with The ongoing COVID-19 outbreak has led to an
information and interventions to maintain the unprecedented public health crisis worldwide. From
healthiest possible lifestyle while in isolation. our perspective, several actions are required to mini-
Healthy lifestyle (HL) behaviours have been mize the transition to a social crisis with long-last-
consistently associated with reduced all-cause mor- ing consequences. It is time that such interventions
tality, and increased lifespan and wellbeing (3). start to include lifestyle guidelines with the aim to
Unhealthy behaviours (poor-quality diet, lack of translate evidence into public health policies. This is
physical exercise, tobacco and alcohol use) are crucial for the vulnerable groups, such as low-in-
major contributors to the global burden of disease come families and children (14,15), the elderly,
(4) and have also been associated with worse out- socially isolated individuals and people with severe
comes across psychiatric disorders (5). Moreover, mental disorders (SMD). Regarding patients with
it is increasingly acknowledged that unhealthy life- SMD requiring admission, the eld is recommend-
styles may be a driving force in the epidemic of ing home hospitalizations to keep patients safe
common mental disorders (6). Evidence suggests while avoiding formal hospital admissions (16).
that the current pandemic-related, mandatory self- Regarding lifestyle guidelines, recent reviews
isolation may trigger depression and post-trau- have emphasized the role of maintaining a healthy
matic stress disorder (PTSD) (7) and that being a nutritional status (17) and engaging in physical
healthcare worker or having COVID-19 is risk fac- exercise at home (11) in the management of
tors for stress-related psychiatric disorders (8,9). COVID-19 outbreak. Similar recommendations
Given the lack of eective treatments for were made at the time of the inuenza pandemic in
COVID-19, non-pharmacological interventions 1918, when public health nurses adhered to pre-
(NPIs) are mandatory to decrease disease transmis- cepts of good hygiene, nutrition, fresh air and rest
sion. NPIs include personal restrictions and physi- (18). However, such lifestyle guidelines are not
cal-distancing policies, such as mass connement and entirely evidence based. Indeed, they are basically
compulsory home isolation. NPIs may modify, for the same guidance used during non-pandemic
better or for worse, lifestyle behaviours. Increased times. Observational data on how the general pub-
adoption of unhealthy nutrition and sedentary beha- lic and patients with psychiatric disorders actually
viour, and decreased outdoor time and increased deal with self-care, nutrition, physical activity or
screen time are expected to occur. These behaviours restorative sleep during connement are lacking
may have unforeseen medium- and long-term conse- and represent a research gap.
quences for mental and physical health (10). For To address such gap, observational studies of life-
instance, diminished physical activity resulting from style behaviours during the compulsory isolation
home isolation may increase a wide range of nega- are timely and clearly a necessary step for the
tive cardio-metabolic and mental eects (11). design of rational and eective public policies.
Research has mostly focused on the psychologi- Such studies would provide the much-needed evi-
cal impact, rather than lifestyle issues under dence to design interventions to prevent a new

399
pandemic of psychiatric disorders and cardio- 3. Larsson SC, Kaluza J, Wolk A. Combined impact of
metabolic comorbidities as proposed by the healthy lifestyle factors on lifespan: two prospective
cohorts. J Intern Med 2017;282:209–219.
COVID-19 Snapshot Monitoring (COSMO) initia- 4. Stanaway JD, Afshin A, Gakidou E et al. Global, regional,
tive (19). Furthermore, data collection must be fast and national comparative risk assessment of 84 beha-
and provide useful and reliable information in real vioural, environmental and occupational, and metabolic
time to health authorities, media and citizens. risks or clusters of risks for 195 countries and territories,
Psychiatry and behavioural medicine may be 1990–2017: a systematic analysis for the Global Burden of
Disease Study 2017. Lancet 2018;392:1923–1994.
particularly beneted from surveys and interven- 5. Firth J, Siddiqi N, Koyanagi A et al. The Lancet Psychiatry
tions carried out remotely to reach a large number Commission: a blueprint for protecting physical health in peo-
of individuals in need. Large-scale surveys will ple with mental illness. Lancet Psychiatry 2019;6:675–712.
require international networking to address 6. Sarris J, Logan AC, Akbaraly TN et al. International Soci-
changes in lifestyle behaviours and the expected ety for Nutritional Psychiatry Research. Nutritional medi-
cine as mainstream in psychiatry. Lancet Psychiatry
consequences after the COVID-19 (9). We urge the 2015;2:271–274.
eld to embrace and extend eHealth and mobile 7. Brooks SK, Webster RK, Smith LE et al. The psychological
health interventions, online monitoring surveys impact of quarantine and how to reduce it: rapid review of
and big data technologies. Remote data collection the evidence. Lancet 2020;395:912–920.
using social networks, georeferencing and the 8. Lai J, Ma S, Wang Y et al. Factors associated with mental
health outcomes among health care workers exposed to
available tools provided by data science is avail- coronavirus disease 2019. JAMA Network Open 2020;3:
able, feasible and necessary in the context of this e203976–e203976.
pandemic. Such tools provide the means of groups 9. Xiang YT, Jin Y, Cheung T. Joint international collabora-
across the globe to connect and generate the real- tion to combat mental health challenges during the coron-
time necessary data to inform policymakers. avirus disease 2019 pandemic. JAMA Psychiatry 2020.
Epub ahead of print. PMID: 32275289. https://doi.org/10.
1001/jamapsychiatry.2020.1057
Funding 10. Logan AC, Katzman MA, Balanza-Martınez V. Natural
The authors received no nancial support for the research, environments, ancestral diets, and microbial ecology: is
authorship and/or publication of this editorial. Dr. Balanz
a- there a modern “paleo-decit disorder”? Part II. J Physiol
Martınez acknowledges the support from Instituto de Salud Anthropol 2015;34:9.
Carlos III (PI16/1770, PROBILIFE Study). Dr. De Boni 11. Lippi G, Henry BM, Sanchis-Gomar F. Physical inactivity
acknowledges long-term funding from CNPq and FAPERJ. and cardiovascular disease at the time of coronavirus dis-
ease 2019 (COVID-19). Eur J Prevent Cardiol 2020. Epub
ahead of print. PMID: 32270698. https:///doi.org/10.1177/
Conict of interest 2047487320916823
12. Chen P, Mao L, Nassis GP, Harmer P, Ainsworth BE, Li F.
Dr. Balanza-Martınez has been a consultant, advisor or Con- Wuhan coronavirus (2019-nCoV): The need to maintain
tinuing Medical Education (CME) speaker over the last regular physical activity while taking precautions. J Sport
3 years for the following companies: Angelini, Ferrer, Lund- Health Sci 2020;9:103.
beck, Nutrici
on Medica and Otsuka. The other authors declare 13. Lau JT, Yang X, Tsui HY, Pang E, Wing YK. Positive men-
no conict of interest. tal health-related impacts of the SARS epidemic on the
general public in Hong Kong and their associations with
a–Martınez1,2
V. Balanz , B. Atienza–Carbonell3 , other negative impacts. J Infect 2006;53:114–124.
F. Kapczinski4 , R. B. De Boni6 14. Van Lancker W, Parolin Z. COVID-19, school closures,
1
Teaching Unit of Psychiatry and Psychological Medicine, and child poverty: a social crisis in the making. Lancet
Department of Medicine, University of Valencia, Valencia, 2Centro Public Health 2020. Epub ahead of print. PMID:
de Investigacion Biomedica en Red de Salud Mental (CIBERSAM), 32275858. https://doi.org/10.1016/S2468-2667(20)30084-0
Instituto de Salud Carlos III (ISCIII), Madrid, 3University of 15. Rundle AG, Park Y, Herbstman JB, Kinsey EW, Wang YC.
Valencia, Valencia, Spain, 4Graduate Program in Neuroscience, St. COVID-19 related school closings and risk of weight gain
Joseph’s Healthcare Hamilton McMaster University, Hamilton, among children. Obesity 2020. Epub ahead of print.
ON, Canada and 5Instituto de Comunicacßa~o e Informacßa~o Cientica PMID: 3222767. https://doi.org/10.1002/oby.22813
e Tecnologica em Sa ude / Oswaldo Cruz Foundation, Rio de Janeiro, 16. Garriga M, Agasi I, Fedida E et al. The role of mental health
Brazil home hospitalization care during the COVID-19 Pan-
E-mail: [email protected] demic. Acta Psychiatr Scand 2020;141:479–480.
17. Zhang L, Liu Y. Potential interventions for novel coron-
avirus in China: a systemic review. J Med Virol
References 2020;92:479–490.
18. Vessey JA, Betz CL. Everything old is new again: COVID-
1. Courtin E, Knapp M. Social isolation, loneliness and health 19 and public health. J Pediatric Nurs 2020. Epub ahead
in old age: a scoping review. Health Soc Care Community of print. PMID: 32273143. https://doi.org/10.1016/j.pedn.
2017;25(3):799–812. 2020.03.014.
2. Leigh-Hunt N, Bagguley D, Bash K et al. An overview of 19. Betsch C, Wieler LH, Habersaat K. Monitoring beha-
systematic reviews on the public health consequences of vioural insights related to COVID-19. Lancet
social isolation and loneliness. Public Health 2020;395:1255–1256.
2017;152:157–171.

400