Our Public Health consultant, Rithika Nair, discusses the mental health effects of covid-19, and the need to prioritise measures for short term support and long term solutions
‘Conventional’ disasters such as climate based calamities, wars and pandemics, leave an emotional upheaval in their wake. Sierra Leone saw evidence of anxiety among 48% and post-traumatic-stress-disorder among 76% of participants in a study conducted in the aftermath of the Ebola outbreak in 2015. Available data indicates that more than 50% of Syrian children born since the start of the war, display symptoms of post-traumatic stress disorder and a quarter face intellectual and developmental challenges. A study of the great recession that began in 2007, found that for every percentage point increase in the unemployment rate, there was about a 1.6% increase in the suicide rate. The impact Covid-19 is having on human life, the global economy and the inevitable strain it is putting on citizens’ ability to withstand uncertainty and solitude, suggests the world is walking into a mental health crisis that is not only accompanying the current pandemic, but will hit its deepest low in its aftermath.
While covid-19 is taking lives globally, it is also leaving behind a severely blighted population. From the hard-hit richer economies to the indirectly affected fragile ones, the crisis is resulting in mass unemployment, starvation, exhausted social safety programmes, an increase in gender-based-violence and a complete breakdown of global order and human relations as we know it. Unfortunately, many of these situations and symptoms are being swept aside.
People with pre-existing conditions and mental vulnerabilities such as anxieties, panic attacks, depression, substance use, suicidal behaviour, the constant fear of falling ill and impulse control disorders are facing significant difficulties in keeping their thoughts and actions in check in such a stressful environment. These vulnerabilities are further exacerbated by the constant barrage of bad news regarding the pandemic. Closure of schools and in-person therapy sessions have reduced support from peer-groups and other forms of coping mechanisms for those already mentally overwhelmed. Rapid country studies conducted during April 2020 found that the prevalence of depression in China was at 50.7%, general anxiety was at 44.7% and insomnia at 36.1%; in India, perceived mental healthcare need was seen in more than 80% of participants in a cross-sectional digital self-reported study; and a federal emergency hotline for people in emotional distress in the USA registered a 1,000% increase compared to the same time last year.
Efforts to reduce the transmission of the virus have completely reordered social and interpersonal relationships. This has seen social media, or online platforms, the only form of human connection for many who live on their own, leaving the elderly, those in vulnerable groups and those without internet access cut off from emotional support and interaction. Studies have revealed that “a lonely person’s immune system responds differently to fighting viruses, making them more likely to develop an illness.” The power of affective touch reduces stress hormones in the body, and when neglected can lead to emotional, physical and cognitive impairments. There is evidence to show the rise of anxiety and depression among people subjected to isolation and human disconnection. The situation is made worse for those who are unable to work from home and swing between elongated periods of boredom and feeling pressured to “make the most of this time”.
Millions of people across the world are losing their ability to earn a daily living as their income-earning potential, along with national GDPs, are falling as industries and businesses closed their doors to prevent disease transmission. The US economy has reported a loss of 20.5 million jobs in April 2020, taking its unemployment rate to 14.7%. Estimates released by India’s National Sample Survey in March 2020 predicted a loss of 136 million non-agricultural jobs, ahead of data from April showing an unemployment rate of a staggering 23.4%. This economic fallout is leaving people in fear of losing their homes, their ability to pay bills and uncertainty about their next meal. There are predictions from across the world that there may be a significant rise in the number of “deaths of despair” caused by this crisis.
People are finding themselves experiencing the stress of the pandemic in close quarters with families. While this is a great source of support for many and an opportunity to spend quality time with loved ones, there is emerging evidence that domestic violence and physical abuse is rapidly rising. Violence against women or what’s now called ‘the shadow pandemic’ has escalated globally bolstered by unemployment, economic insecurity and inhospitably close living conditions. Women trapped with their abusers are unable to leave or reach out for help.
An unrecognized pandemic?
The concerns noted here require governments to focus on mental health needs among populations, concurrently with combatting the physical health emergency. Despite general awareness of the impending psychological crisis in the pandemic’s wake, we do not know what specific mental health disorders will have been caused by this crisis or their prevalence and distribution among populations. A rapid country-specific assessment of outbreak-associated mental disorders for both civilians and health workers will be critical to determine the extent of mental trauma caused directly by the pandemic and indirectly by distancing and lockdown measures. A recent study in Lancet Psychiatry stressed that a scientific perspective on mental health during the pandemic will provide data on ‘population-level behavior change initiatives’ aimed at reducing the spread of the virus. To address this need, multiple disciplines and sectors including psychology, psychiatry, clinical medicine, public health, behavioral and social science to name a few, will need to integrate their services to address immediate concerns and to develop medium to long term solutions. Immediate measures such as phone counseling services, affordable digital therapeutic interventions, chat-lines and forums for those who are socially isolated and information campaigns that foster positivity, resilience and altruism, will be necessary to urgently address and mitigate mental health difficulties for vulnerable groups under pandemic conditions; and governments must be prepared to set aside the budgets to meet these priorities.
A study by Oxford University in 2017 estimated that one in seven people globally live with a mental health disorder. Despite being such a burden on global health, studies have found that dedicated assistance for mental health accounted for less than 1% of all development assistance for health. Mental healthcare and psychosocial support is not fully integrated into the global standards of humanitarian medical response, and counseling for mental disorders remains a luxury in most low-and middle-income countries.
The Covid-19 pandemic does not seem to have changed this. Health, health systems and health care have become central to conversations since the outbreak of the virus in January 2020. Treating the physical symptoms and manifestations of the disease, while not easy, has been given universal attention and resources. However, its mental and impalpable repercussions have remained comparatively neglected. While there has been a sudden surge in research studies, news articles, blogs, and even Zoom Webinars talking about coping with and preventing emotional breakdowns, governments have not yet made this a priority or even realised the significance of psychological stability as an indicator of economic progress. Covid-19 may not be a war in the conventional sense, but it is affecting populations across the world and leaving the same kind of impact in terms of mental trauma as left by the world's greatest and deadliest wars.