The impact of Covid-19 on Latin American Psychology: research, profession, and public policy

O impacto da Covid-19 na Psicologia Latino-Americana: pesquisa, profissão e políticas públicas

Abstract

In this paper, we offer an in-depth analysis of relevant scientific literature and a series of critical reflections based on a narrative review of the impact that the early stages of the Covid-19 pandemic had on Latin American psychology. We performed a non-exhaustive search, selection, and analysis of different documentary sources in scientific databases, institutional repositories, and websites of national and regional psychology organizations between May 25 and 31, 2020. In particular, we consulted SciELO, Redalyc, Dialnet, and Google Scholar using the following individual key words associated to psychology: “Coronavirus”, “Covid-19” and “Pandemic”. Various types of documents were retrieved for a subsequent in-depth analysis (e.g., articles, institutional documents, notes, bulletins, recommendation guides, etc.). Our review allowed us to identify three challenges for psychology in the region: (1) insertion of psychology in public policies; (2) construction of an own agenda of psychological research; (3) evaluation of practices and reorientation of professional training processes.

Keywords
Covid-19; Latin America; Mental health; Psychology; Psychosocial intervention

Resumo

Neste artigo, é oferecida uma análise aprofundada da literatura científica relevante e uma série de reflexões críticas baseadas em uma revisão narrativa do impacto que os estágios iniciais da pandemia de Covid-19 tiveram na psicologia latino-americana. Foi realizada uma busca não exaustiva, seleção e análise de diferentes fontes documentais em bancos de dados científicos, repositórios institucionais e websites de organizações nacionais e regionais de psicologia entre 25 e 31 de maio de 2020. Em particular, foram consultadas as bases SciELO, Redalyc, Dialnet e Google Scholar usando as seguintes palavras-chave individuais associadas à psicologia: “coronavírus”, “Covid-19” e “pandemia”. Vários tipos de documentos foram recuperados para uma análise posterior em profundidade (por exemplo: artigos, documentos institucionais, notas, boletins, guias de recomendação, etc.). A revisão feita pelos autores permitiu identificar três desafios para a psicologia na região: (1) inserção da psicologia nas políticas públicas; (2) construção de uma agenda própria de pesquisa psicológica e (3) avaliação das práticas e reorientação dos processos de formação profissional.

Palavras-chave
Covid-19; América Latina; Saúde mental; Psicologia; Intervenção psicossocial

Covid-19, the infectious disease caused by the latest discovered form of coronavirus (SARS-CoV-2), has become a health crisis of international magnitude. The World Health Organization declared it a pandemic on March 11, 2020, when it spread globally to about 114 countries. Although the Latin American region had a window of opportunity to take action and prepare its response capacity since the virus was detected in China in December of 2019, it quickly became the center of pandemic in May of 2020. This was partially due to the dynamics and speed of the virus’ spread, but problems of poorly run health systems, inequality, poverty, misery, and obstacles to access basic resources for personal hygiene and health protection contributed greatly as well (López-López & Velandia, 2020).

Most countries have experienced profound disruption in their social and economic activity. From a public health perspective, one of the greatest challenges that health systems are experiencing is the impossibility of providing simultaneous assistance to a large number of sick people, especially when existing health resources are in high global demand and access to them is sharply unequal among regions and countries. In response, health officials have urged people to help “flatten the curve” (i.e., slowing the rate of new infections through measures of population isolation) to reduce the pressure on the limited services for care of seriously ill patients.

Unfortunately, forecasts of the effects of Covid-19 do not appear to be very encouraging, as large numbers of fatalities, affected families, job losses, economic issues, adverse psychosocial consequences, and worsening mental health and other health manifestations are expected (International Monetary Fund, 2020; United Nations, 2020; World Health Organization, 2020). An adequate understanding of these problems and their respective diagnoses will be important in order to act in timely manner and reduce the multiple negative impacts of the Covid-19 pandemic.

By the end of 2020 – when this paper was finalized – the second wave of the Covid-19 pandemic was in full force and one third of the 15 countries with the highest number of confirmed cases by November 30 were located in Latin America: Brazil, Argentina, Colombia, Mexico, and Peru (Statista, 2020a). The total number of deaths due to the novel coronavirus (Covid-19) in these countries was close to 400,000 by December 3 of 2020 (Statista, 2020b) with no end in sight.

Past coronavirus outbreaks such as those caused by the Severe Acute Respiratory Syndrome (SARS) and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) offer important insights about their psychological impact and the role that psychology can play in mitigating it (Khan et al., 2020). Jeong and his colleagues (2018) identified risk factors associated with symptoms of anxiety and anger after home quarantine during the MERS outbreak in Korea in 2015. Their results showed that suffering MERS during isolation, insufficient supplies (e.g., food), social networking activities (e.g., Internet), history of psychiatric illnesses, and financial difficulties were important risk factors. Further findings from Ro et al. (2017) showed that people in Korea experienced greater anxiety as their knowledge about MERS increased and as they reported greater trust in unofficial information. The study of infodemia or “the epidemic of rapidly spreading misinformation through social media” (Khan et al., 2020, p. 2), emerged in the context of the SARS outbreak and its role during the coronavirus pandemic is likely to be comparatively more consequential.

Psychology in Latin America not only has a significant history as a discipline and profession, but also an important capacity for organization and response to exceptional phenomena such as the current one (Ardila, 1986; Gallegos, 2010, 2016a; García et al., 2017; Klappenbach et al., 2018; López-López et al., 2015; Saforcada, 2003). As psychologists and other health scientists began the novel task of examining the impact of the Covid-19 pandemic in the region, the number of studies has increased dramatically. In order to provide an overview of the impact that the Covid-19 pandemic has had on Latin American psychology, we conducted a narrative review and offer an in-depth analysis of relevant scientific literature and a series of critical reflections.

Method

Procedures

We performed a non-exhaustive search, selection, and analysis of different documentary sources in scientific databases, institutional repositories, and websites of national and regional psychology organizations between May 25 and 31, 2020. In particular, we consulted SciELO, Redalyc, Dialnet, and Google Scholar using the following individual key words associated to psychology: “Coronavirus”, “Covid-19” and “Pandemic”. Various types of documents were retrieved for a subsequent in-depth analysis (e.g., articles, institutional documents, notes, bulletins, recommendation guides, etc.) and critical reflections.

Our narrative review of the scientific literature about Covid-19 offers an informed and integrative overview of the main theoretical and empirical themes related to psychology in Latin America in its research, professional, and public policy dimensions. According to Pautasso (2020, p. 303), “narrative reviews are qualitative summaries of the relevant literature, whether this made use of statistical tests or not”. Unlike systematic reviews, narrative reviews focus only on a selection of the evidence available and do not provide a replicable method that would allow others to reproduce the same results (Franco et al., 2018; Zillmer & Díaz-Medina, 2018). Schmidt et al. (2020), for instance, followed a similar approach to investigate psychological interventions in the context of the Covid-19 pandemic to offer a rapid assessment of the relevant literature available. As a heuristic method, narrative reviews can lead to overarching analytical themes and insightful reflections. Other recent works have used this method to organize and synthesize critical information about the Covid-19 pandemic in the Latin American region as well (Gallegos, Zalaquett et al., 2020; Scholten et al., 2020).

Results

Psychological research and professional applications

Psychology’s large corpus of knowledge, derived from scientific research and empirical evidence, can strategically guide actions taken by practitioners and governments in the face of the pandemic. In Latin America such knowledge is already being applied to key issues such as behavioral economics (Franco Pedraza, 2020), people’s representations and cognitive assessment of risk (Do Bú et al., 2020; Vera-Villarroel, 2020), the adequate management of expectations, facing fear and uncertainty (Quezada-Scholz, 2020), substance abuse (Mansilla, 2020; Rojas-Jara, 2020), sexuality in physical isolation (Granero, 2020; Pineda Roa, 2020), domestic violence (Litter & Hernández Martínez, 2020; Luna, 2020), mood swings, sleeping, and dreaming (Brienza et al., 2020), mental health disorders (Gallegos, Zalaquett et al., 2020; Huarcaya-Victoria, 2020; Schmidt et al., 2020), changes and challenges in work environments (Peiró, 2020; Penagos-Corzo, 2020), impact on schools (Salas et al., 2020), human rights (López-López, Velandia et al., 2020), and psychological aspects associated with sport (Cervigni & Pereyra, 2020; Cusinato & Gallegos, 2020; Mira y López, 2020), among others.

Preliminary reports show that psychology is indeed providing answers in multiple areas of research and intervention with respect to the current pandemic (Gallegos, Cervigni et al., 2020; López-López, Velandia, 2020; López-López, Salas et al., 2020; Lorenzo Ruiz et al., 2020; Polanco-Carrasco, 2020; Urzúa et al., 2020). In some cases, the contributions have been guided by scholars and practitioners, and in others they have been articulated in a limited way with governmental actions. However, psychological knowledge still needs to be incorporated into the design of health protection and primary prevention measures in relation to Covid-19.

Several containment, accompaniment and psychological care measures have been implemented, some of which are face-to-face, but mostly virtual (Gallegos, 2020; Rigoni & Cornejo, 2020). These measures cover different aspects: some are aimed at emotional support and assistance for frontline health workers (Morales-López, 2020; Oliveira et al., 2020); others focus on the elderly, children, young people, university students, victims of violence, and the general population (Cunha, 2020; Hermosilla & Filippi Villar, 2020; Lorenzo Ruiz, 2020; Rossi & Freijo Becchero, 2020). Several awareness campaigns, informative videos, and educational materials on Covid-19 have been developed for different vulnerable populations (Bregman & Vega, 2020; Molina, 2020).

Numerous distance learning courses and seminars have been developed for professionals to increase their knowledge and address specific requirements and demands related to the pandemic (Castrillón, 2020; Gallegos, Luna et al., 2020). Several action protocols, guidance guides and recommendations on different psychological and psychosocial aspects have been developed, covering various risk populations and specific problems: children, youth, elderly, people with disabilities, etc. (Enumo et al., 2020; Salas et al., 2020). Despite its negative effects, the role of infodemic on mental health (Khan et al., 2020) has not been addressed by psychologists in Latin America yet.

Among the multiple capabilities of psychology is not only the diagnosis and assistance of individual, family and collective problems but also preventive actions of guidance and reduction of psychological and psychosocial problems. Biomedical and epidemiological strategies should be combined with the contributions of psychological knowledge, since this would prevent further repercussions on the health, quality of life, and well-being of the population, while at the same time achieving greater effectiveness in public health strategies.

Psychology and public health policy

Although government officials have at their disposal scientific and technical knowledge in the field of psychology to design, implement, and evaluate public health policies, this does not warrant its use (López-López, 2019; López-López, 2020a). A case in point is the role of psychology in the implementation of public health measures of protection in the form of “social distancing”, “quarantine” or “confinement” of people in their homes. This is a public health measure that aims to stop the spread of infection, but at its core it is not a strictly biomedical or even pharmacological measure, but rather a behavioral and psychosocial one. Quarantines have a long history of implementation and their use has been instrumental to contain transmissible diseases capable of generating epidemics and pandemics (Gensini et al., 2004). Unfortunately, the way in which social isolation was communicated and the names it acquired, in some cases, generated serious challenges. Expressions such as “confinement” or “seclusion” have been mistakenly used. Even the expression “social isolation” is inaccurate since what is considered social does not necessarily involve a physical dimension and, therefore, one can be actively non-isolated from the social environment. Some of these confusing expressions were substituted by others such as “sanitary distancing” (Scholten et al., 2020) or “healthy distancing” (Gallegos, Zalaquett et al., 2020) or “social discipline” (López-López, 2020c). The government of Mexico, for example, coined the expression “Your healthy distance”, which is much more friendly and effective communicatively.

“Stay at home” was another compelling, but paradoxical measure implemented and communicated by governments and health authorities. As people were constantly reminded to shelter in place, this conveyed the idea that the outside world is dangerous and threatening and that the best way to be safe and protected is to be isolated. However, the paradox is that not everyone can stay at home because many people are forced to go out to survive while many others are not recommended to stay in their homes for their own safety. The paradox of the “stay at home” message is also situated within the temporal nature of the motto, given that it is not possible to sustain it for an indefinite period. At some point it will be necessary to return progressively to daily activities, but this return to outer life can logically cause confusing expectations, anxiety and fear, both for the citizens themselves and for governments that fear the failure of public health measures and new outbreaks.

When quarantine planning began, a set of psychological, psychosocial and communication psychology strategies that would have made some measures more effective on the one hand, and mitigated certain negative impacts on the well-being and health of the population, on the other, were not considered. Apparently the health professionals who intervened or participated in the advisory teams did not seem to have used social marketing or social marketing applied to health at all (Suárez Lugo et al., 2019). Although there is an Ibero-American Health Marketing Network, its technical resources did not seem to have been used. Social marketing is fundamentally social psychology applied to the study of use and consumption behaviors not mediated by money, and its contributions could improve the scope and implementation of specific policies aimed at mitigating the impact of the pandemic.

While several countries are racing to develop a vaccine and studying the effects of diverse medications, toward the second half of 2020, health professionals could only treat Covid-19 symptoms (López-Cañón & Pérez-Acosta, 2020). The prevention of the contagion points to behavioral habits, some related to personal hygiene and housing, and others related to social interaction; these are precisely the issues that psychology could contribute with its knowledge, skills, strategies, and know-how techniques. Although paradoxical, we did not find overwhelming evidence that psychology was a field considered in the first actions that were implemented following the appearance of the Covid-19, in the early stages of the pandemic.

It is no coincidence that several national, regional and international psychology organizations have expressed the need to include psychological knowledge in the development of action plans aimed at mitigating the effects of the pandemic (Evans, 2020; Gallegos, Luna et al., 2020). However, the impact of these actions did not find much support in the decisions taken by governments in the region, since no call for psychology professionals has been contemplated by government authorities.

Planning for everyday life during and after the pandemic

Although the current crisis has yet to pass, many people are already talking about a return to normality, post-quarantine, and ending confinement. However, perhaps the most sensible thing to do is to indicate that in the short and medium term we will not have any kind of return to the conditions of everyday life before the pandemic. Even the idea of a return to a certain normality could give a false sense of security or control over the situation of the pandemic, which is not advisable and is precisely contrary to the increasing levels of contagion that have taken place in Latin America.

Instead talking about a return to normality, it is preferable to talk about planning for daily life during the pandemic. This would imply taking into account a series of psychological and psychosocial problems and organically integrating them into public health policies because of the effects that social isolation measures have on people (Brooks et al., 2020; Lorenzo Ruiz & Guerrero, 2017). In the same way that quarantine confronted us with various issues, some foreseeable from a behavioral and psychosocial point of view, any new phase of daily life will also require specific capacities to deal with the re-establishment of the dynamics of social interaction.

If we assume that the new normality is the one imposed by the pandemic, the planning of daily activities is not exempt from certain restrictions. However, such planning must not only address the administrative matters across different sectors, but also the organization of the behavior of the people involved. It is one thing to gradually organize how various sectors of the economy will function, but it is quite another to organize how individuals, families, and communities will function.

One risk of all such planning may be using a one-size-fits-all approach that assumes that all people will understand and follow all regulations in the same way or treating everyone as a rigid entity. For this reason, it is important to pay special attention to the different social segments and their respective micro-cultures. It will be necessary to strategically plan the design and dissemination of messages conveyed by health officials and to foresee how the recipients will be able to decode them.

Any program designed to progressively end social isolation must prepare the population, establishing preventive rules rather than punishing and aiming at responsibility, solidarity, and individual, family and collective mutual care. It has been demonstrated that when the population is directly involved in the actions of their environment, behaviors of involvement with the situation are generated and the sense of community is increased (Barreto et al., 2015; López-López, 2020c).

Covid-19 pandemic: a post-normal problem

Should Covid-19 and its associated effects be characterized as a normal problem or as a post-normal problem? In the scientific field, a normal problem is something that can be approached and solved from a disciplinary framework or a delimited set of disciplines. A post-normal problem, on the contrary, implies the inter and transdisciplinary while it implies an epistemological change with respect to the current strict disciplinary frameworks.

A post-normal problem is not defined simply by its inherent complexity or the scale of its consequences, but rather by magnitudes that cannot be predicted or calculated, by uncertainties, whether in the short, medium, or long term. In other words, a post-normal problem is defined by its enormous complexity, multidimensionality, and interrelationality, that is, by its capacity to synergistically affect incalculable areas of social, cultural, political, economic, ecological, bioethical life, etc. (Funtowicz & Ravetz, 2000; Gallegos et al., 2014).

The pandemic imposes on us a reality where it is necessary to take into account, on the one hand, the interrelation of the multiple factors involved and, on the other hand, the need for different disciplinary knowledge, without reductionism. The effects of the pandemic have caused an almost total paralysis of the social, economic, and cultural life of the world and, thus, it is necessary to recognize that any attempt to provide a solution will involve much more than a single disciplinary or professional approach.

Health: a more complex and less reductionist conception

What should be considered “health”, “physical health”, “mental health”, “public health”, “international health”, “global health”, “collective health” or “community health” has been debated for a long time (Canals & Cáceres, 2020). Although its meaning can vary across different fields, “health” is a concept that transcends the biological and even the pathological; it is not merely the absence of disease and implies the bio-psychosocio-cultural in relation to well-being and quality of life according to different moments of the life cycle, where multiple dimensions (e.g., law, justice, gender, ecological, cultural, economic, political, environmental, ethnic, among others) intervene.

There is sufficient evidence that supports the application of multidimensional approaches as well as policies of multilateral agencies for disease prevention and health promotion, since all levels of care involve an ecosystem and multiprofessional perspective on health (Saforcada, 2003). However, politicians and health officials often do not adequately employ this perspective. Problems of coordination between policies, professional teams, and community stakeholders are also often recurrent. Even diagnoses and analyses are often fragmented, which can multiply the negative effects of a health emergency.

In the current context of the pandemic, “health” cannot be reduced to just one aspect, but must be approached globally, without reductionism. This implies being based on a theoretical perspective rooted in a systemic paradigm (López-López, 2020a; 2020b) that takes into account this complexity, which in turn will allow for the design of more strategic and appropriate policies (Gallegos, 2016b; López-López, 2020b; Morin, 1996).

Covid-19 has paralyzed the world and demands a great mobilization of resources. To a certain extent, the crisis generated by it has called into question the usual disciplinary and professional scope, given that we still do not have the knowledge that would allow us to provide an adequate treatment to the problem. The default response to the crisis has relied fundamentally on an old-fashioned epidemiological perspective, but what we need is a less quantitative and more socio-cultural discipline that tackles the complexity of the problems to be solved without disciplinary reductionism that would consider the contributions of social and psycho-socio-cultural disciplines (Gálvez Ibáñez, 2018).

A single health discipline, such as biomedicine or epidemiology, cannot deal with the complexity of the pandemic and its effects on people’s quality of life, well-being, mental health as well as other related psychosocial processes. Psychology is also a health discipline and contemplates multiple fields of action, as well as different levels of assistance and application that could be used to mitigate the Covid-19 pandemic and its effects (Morales Calatayud, 2015, 2016; Saforcada, 2012).

Health vs. Economy: a false dilemma

The Covid-19 pandemic has confronted humanity with complex challenges that are difficult to avert. A dilemma has arisen as to whether States should prioritize health over the economy or vice versa (Gans, 2020); this controversy has emerged in Latin America, but in our opinion, it presents a false dichotomy. The economy is part of the health of a society and should not be underestimated because when a country’s economy is negatively affected, there is a significant impact on people’s living conditions.

Latin American economies have collapsed and will severely impair any recovery efforts. Job losses, lack or little economic assistance, supply chain disruptions, business failures, among other consequences, will have ripple effects not only on the economy but also on quality of life and well-being of millions. When confronted with consequences such as “loss”, “break”, “deterioration”, “bankruptcy”, “disappearance,” it is important to pause and consider their deeper meaning. At the surface, they can be easily identified as material consequences of an economic crisis, but they do not work the same way in the subjectivity of individuals, families, and communities. It is not merely a question of lack of resources, material loss or not having money, but of despair, uncertainty, paralysis, helplessness, and so on. Therefore, the dilemma of economy vs. health only exposes another type of reductionism that we must avoid. Given that governments have limited resources and capacity to address the current economic crisis, different forms of solidarity, prosocial behaviors, and social welfare will be needed. This work can be spearheaded by social psychologists, sociologists, and anthropologists, among other others, to promote the common good and improve the quality of life of people (Barreto et al., 2015).

Conclusion

In this paper, we offer an in-depth analysis of relevant scientific literature and a series of critical reflections based on our narrative review of the impact that the initial stages of the Covid-19 pandemic has had on Latin American psychology.

In the areas of research and professional applications, the Covid-19 pandemic has generated a wave of studies and actions that raised the bar among professionals in terms of their knowledge and know-how capabilities to deliver more effective practices and interventions. In the context of the current pandemic, psychology’s biggest challenge is to work on more preventive actions that can guide and reduce psychological and psychosocial problems among large segments of the population in Latin America.

Despite the fact that psychologists have responded to the Covid-19 pandemic in the areas of research and professional applications, they have yet to play a more decisive role in the design and implementation of public health policies. Unfortunately, a corpus of scientific and technical knowledge in the field of psychology does not warrant its use. Psychology’s influence on public policy remains a formidable challenge that calls for a more dynamic field that informs decision makers in junctures such as the one posed by the Covid-19 pandemic.

Based on our narrative analysis, we consider that there are at least three crucial aspects that psychology must take into account as Latin America battles the Covid-19 pandemic. First, our efforts should include a multidimensional, interdisciplinary, and an ecological perspective in the analysis and design of public policies, programs, and interventions in the field of mental health. Psychology can greatly enhance and create better policies to mitigate the harmful effects of the pandemic and improve people’s social well-being and welfare.

Secondly, psychologists must define an interdisciplinary and collaborative research agenda in accordance with the psychosocial problems and the impact on the mental health of the people in Latin America. There are problems that are specific and interconnected in the region that have little to do with those observed in other contexts. Latin America needs a greater degree of cooperation and synergy among representative entities of psychology, professional bodies, and scholars.

Lastly, and related to the previous point, an organized and active psychology is needed to address the multiple demands of the pandemic, quarantines, and post-quarantines. Professional training should provide curricular content that addresses emerging and post-normal issues as well as virtualization and its challenges. Organizations such as federations, associations, societies, and colleges should update their training so that professionals can adapt their practices to the new normal, ensuring compliance with ethical and deontological standards. Psychological practices (virtual or not) should be constantly monitored to be able to know the current state of affairs, correct mistakes, and promote successes.

Narrative analysis is not exempt from limitations and our conclusions and reflections do not exhaust the plethora of challenges and opportunities that we have identified in this paper. When we conducted our search, early on during the Covid-19 pandemic, only a handful of papers related to Covid-19 had been published in scientific journals in Latin America. A bibliometric analysis of the production in SciELO, for instance, identified only six documents in the Brazilian Journal of Psychiatry and four in Estudos de Psicologia. Our search was not exhaustive as it left important electronic databases (e.g., Latindex and Lilacs) out. Given the rapid pace and remarkable number of reports related to Covid-19 being published, different types of reviews, like ours, will need to be conducted on a regular basis to gauge the progress made by psychology in Latin America as it addresses the challenges posed by the current pandemic.

How to cite this article

• Gallegos, M., Morales Calatayud, F., Saforcada, E., Lopéz Lopéz, W., Cervigni, M., Elgier, A., Burgos Videla, C., & Portillo, N. (2022). The impact of Covid-19 on Latin American Psychology: research, profession, and public policy. Estudos de Psicologia (Campinas), 39, e200165. https://doi.org/10.1590/1982-0275202239e200165

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Publication Dates

• Publication in this collection
  13 May 2022
• Date of issue
  2022

History

• Received
  01 Aug 2020
• Reviewed
  15 Dec 2020
• Accepted
  18 Mar 2021