Mental health is the biggest threat of 2021

  • Mental health distress is on the rise as the second wave of Covid-19 ripples through 2021

  • As the physical risks are better managed, the permanent impact of the pandemic weighs heavy on our mental health 

  • The high level of stress associated with the pandemic is making people more vulnerable to depression and anxiety

  • It is important to seek help when you recognise a shift in your mental health and to be mindful of the misconceptions and unfounded stigmas associated with seeking psychiatric care

  • Psychiatrists urge all to take steps to reduce stress and their risk of aggravated mental health conditions

 

With the sudden emergence of the Covid-19 pandemic last year and the impact of the second wave as the new year gets under way, it was perhaps inevitable that cases, if not swathes, of psychological distress would emerge. And how you manage stress is crucial in finding some form of relief. 

 

Dr Kagisho Maaroganye, psychiatrist and public sector national convenor of the South African Society of Psychiatrists (SASOP) says that with the high levels of grief, uncertainty, stress and anxiety caused by the pandemic, we need to ask ourselves “how does the nation ‘sanitize’ or protect their minds and build resilience?” 

 

Globally, mental health professionals predict that the pandemic is going to impact significantly on the mental health of the population with an increase in cases of depression, suicide, and self-harm due to Covid-19, and other related symptoms reported internationally.[1]

 

Although statistics from South Africa have not been released as yet, a study conducted by the Indian Psychiatric Society showed a 20% increase in mental illnesses since the coronavirus outbreak in India[2]. A meta-analysis on mental health and Covid-19 among the general population in China estimates the prevalence of anxiety to be around 31.9%, and depression around 33.7%.[3]

 

In Georgia a survey amongst 2088 respondents observed high levels of symptoms for anxiety (23.9% women, 21.0% men), depression (30.3% women, 25.27% men), PTSD (11.8% women, and 12.5% men), and adjustment disorder (40.7% women, 31.0% men). Factors significantly associated with increased Covid-19 concerns included stressful household economic situation, larger household size, non-communicable diseases (NCDs), symptoms of anxiety, adjustment disorder and post-traumatic stress disorder (PTSD) [4]

 

Dr Maaroganye says the impact on the mental state of those people who had a mental condition prior to the pandemic may be disproportionate due to reduced psychological resilience, and this may lead to relapse and worsening of their condition. 

 

“There is a lot to bear and it can be crippling for our mental health. We are not experiencing stressors equally and many, even those without mental conditions, were at risk before the pandemic. We find ourselves in uncharted waters, perhaps for the first time, needing to attend to early signs of distress and do this without self-medicating with alcohol and drugs. We also have to support our more vulnerable sectors of the population like children should they start withdrawing and becoming silently depressed. At work we have to recognize the angry and frustrated boss as he/she copes with uncertainty and equally the bewildered employee who might be dealing with the fear of retrenchment and not knowing how they will feed their family.”

 

“As such we are all directly and indirectly affected by the virus with daily fears of losing loved ones and/or contracting a life-threatening disease and the social impact this pandemic is having”.  

 

Dr Maaroganye says psychological resilience is borne out of one’s ability to face stress and adapt or cope with it by correctly appraising or judging the severity or relevance of the stress. 

“Whilst there is a need for social isolation and restriction to our homes during this pandemic, this can also compromise the buildup of psychological resilience. As such, protecting our physical health can be at the expense our mental health leading to more stress, some of which can be ‘toxic’.”

 

“Research shows that stress can become ‘toxic’ if an individual feels that they do not have control over it, have no support systems or resources to handle the stress. Furthermore, we know that high stress levels can have a negative impact on both mental and physical health, particularly when it is prolonged.”

 

“Although everyone can become stressed, there are those who are more vulnerable to ‘toxic’ stress (which can lead to chronic cardiovascular diseases and perhaps diminished immune response to COVID-19). As a society and clinicians, we should be concerned about those with prior history of multiple stressful events, children and adolescents who have lacked the time and experience to build psychological resilience and employees who despite their advanced age, often have no control of the company’s purses and knowledge of its future long-term prospects. Our attention should not waver from the previously traumatised, the young and the breadwinners.”

 

He says that the same methods that psychiatrists would recommend to reduce one’s high stress levels, can also enhance one’s immune system (so called psychoneuroimmunity) and help one deal better with Covid-19. 

 

“Focus on the basics of adequate sleep, healthy meals, movement, spending time outdoors with loved ones and pets, taking your chronic medication, and keeping to doctors’ appointments. We need to take care of ourselves and each other if we are going to keep our mental health, healthy for this challenging hear ahead.” 

 

The study conducted in Georgia also found that response strategies significantly associated with reduced mental disorder symptoms included meditation and relaxation exercises, physical exercise, positive thinking, planning for the future, TV/radio, housework/DIY, and working. Drinking alcohol was associated with a greater probability of increased mental disorder symptoms[5]

 

“Above all,” says Dr Maaroganye, “avoid anger, violence, alcohol and any other form of substance abuse to deal with the waves of anxiety and stress that we all will face at some point. Obey the rules to avoid being faced with a stressful situation of wondering whether you have contracted the virus during its incubation phase. Unnecessary stressors may weaken one’s immune system without you realising it and possibly make you more prone to a severe form of Covid-19.”

 

Dr Maaroganye encourages persons who experience the early signs of psychological distress like insomnia, irritability and lack of interest in pleasurable activities or even self-care, seek help from professionals. “Whilst psychiatrists and psychologists are on the ready to help those who seek help, SASOP also recognises that the general public may have misconceptions about psychiatry.” 

 

“These may include having negative attitudes towards mental illness or those with mental illness, missing early signs of distress because of perceived ideas about what constitutes mental illness and believing that recovery from mental illness is impossible 6.” 

 

Other misconceptions that mental health professionals encounter: 

  • Psychiatric medicine is addictive (most of the medications used are not addictive. There addictive ones are benzodiazepines if taken for too long. Professionals do not only rely on benzodiazepine to treat mental illnesses)

  • All psychiatric medication has terrible irreversible side effects (qualified psychiatrists would be able to identify these quickly and change or reduce the dose of the medicine)

  • Psychiatric treatment takes forever to be effective (yes it does but only over a matter of a few weeks or months and once the patient recovers - from certain mental illnesses - medication can be stopped if the medication has been taken as prescribed and the triggering stressor has been removed)  

  • All mental illnesses need drugs to remit (for some acute mental illnesses such as Adjustment Disorder or mild depression, exercise and counselling or psychotherapy without the need for drugs may often be enough)

  • Being admitted to a psychiatric hospital means having your freedom taken away and being secluded from society (as some mental illnesses such as depression are quite common, patients often find that there will be many patients at these in-patient clinics presenting similarly and having the same life challenges. These patients often have the freedom to move around in their own clothes, associate with others and participate in group activities with others to help overcome their challenges. Some patients simply need time out to reflect on their challenges and through that they may emerge from the hospitals with their own self-generated solutions).   

Therefore, Dr Maaroganye implores the general public not to fear seeking help from professionals who will be aware of all these misconceptions and will be able to address them to give you comfort in receiving treatment should you need it. 

 

REFERENCES

[1] Liu, S., Yang, L., Zhang, C., Xiang, Y., Liu, Z., Hu, S., & Zhang, B. (2020). Online mental health services in China during the COVID19 outbreak. The Lancet Psychiatry, 7(4), e17–e18. https://doi.org/10.1016/S2215-0366(20)30077-8

2 Loiwal, M. (2020, March 2020). 20% increase in patients with mental illness since coronavirus outbreak: Survey. India Today. https://wwwindiatoday.in/india/story/20-per-cent-increase-in-patients-with-mentalillness-since-coronavirus-outbreak-survey-1661584-2020-03-31

3 Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate Psychological 554 Responses and Associated Factors during the Initial Stage of the 2019 555 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health. 2020;17(5):1729

The influence of concern about COVID-19 on mental health in the Republic of Georgia: a cross-sectional study | Globalization and Health | Full Text (biomedcentral.com)

The influence of concern about COVID-19 on mental health in the Republic of Georgia: a cross-sectional study | Globalization and Health | Full Text (biomedcentral.com)

6 Gaiha SM, Taylor Salisbury T, Koschorke M, Raman U, Petticrew M. Stigma associated with mental health problems among young people in India: a systematic review of magnitude, manifestations and recommendations. BMC Psychiatry. 2020;20(1):538. Published 2020 Nov 16. doi:10.1186/s12888-020-02937-x