Rising mental health crisis, suicide and other problems galore
By Muzzafar Ahmad Ganie & Nasir Geelani
The Coronavirus pandemic 2019 (COVID-19) began at the end of 2019 and has quickly spread globally. Millions of people around the world got infected and hundreds of thousands have died. The clinical manifestations of COVID- 19 vary from asymptomatic forms to severe clinical conditions characterized by respiratory failure, sepsis, septic shock and multiple organ dysfunction syndromes. Understandably, medical professionals and public health specialists are focused on taking care of individuals who are very sick, while containing the corona virus’s spread in the general population. In view of this global upheaval the world will likely witness a great mental health crisis. However, less attention is given to the psychiatric consequences of the COVID-19 crisis.
Multiple lines of evidence indicate that the COVID-19 pandemic has profound psychological and social effects. There is a pervasive awareness of uncertainty over the future and an understanding that the pandemic is far from over. It is possible that there will be economic privation and political upheaval. The psychological squeal of the pandemic will probably persist for months and years to come. Here we can suggest that the COVID-19 pandemic may increase the prevalence of psychiatric disorders and suicide rates during and after the pandemic.
The psychological impact of COVID-19.
Recently a large number of studies have been performed to examine the effect of the COVID-19 crisis on the mental health of the general population, health care professionals and individuals with psychiatric disorders. The psychological impact of the outbreaks moderate or severe depressive symptoms and other reported moderate to severe anxiety symptoms. Moreover, psychological distress and negative emotions including anxiety, depression and anger rose, where as the positive emotions and life satisfaction diminished.
. Researchers observed that anxiety was associated with stress and reduced sleep quality, and the combination of anxiety and stress reduced the positive effects of social capital on sleep quality. Research suggests that ‘anxiety and stress of isolated individuals were at high levels, whereas the sleep quality was low.’
Research done by Ahmed et al. did an online survey of 1074 people and found elevated rates of anxiety, depression, harmful alcohol use and decrease in mental wellbeing. Rates of anxiety
and depression were higher among young people aged 21–40 years in comparison to other age groups.. This study also showed that health care professionals were more likely to have poor sleep quality in comparison to other occupational groups.
The psychological impact of theCOVID-19 pandemic on individuals with or without mood and
Anxiety disorders. Worries about their physical health, anger, impulsivity and suicidal ideation were significantly higher in psychiatric patients than in healthy controls. Probably, alcohol consumption increased during the COVID-19 crisis. According to a market research sales of alcoholic beverages rose 55% in the week ending 21 March 2020 compared with the same period last year.
Suicidal behavior in the COVID-19 era
Social isolation, anxiety, fear of contagion, uncertainty, chronic stress and economic difficulties may lead to the development or exacerbation of stress-related disorders and suicidality in vulnerable populations including individuals with pre-existing psychiatric disorders, low-resilient persons, individual’s who reside in high COVID-19 prevalence areas and people who have a family member or a friend who has died of COVID-19
Individuals with pre-existing psychiatric disorders include not only patients who are treated by mental health professionals but also a very large number of people with psychiatric
conditions who do not receive psychiatric treatment. Community epidemiological research in the USA shows that a majority of individuals with mood disorders are either untreated or undertreated. Social isolation contributes to the pathophysiology of psychiatric disorders and suicidal behavior. Durkheim emphasized that social connectedness is a critical factor in emotional health and social stability.
Other research investigations demonstrated that social isolation and loneliness are associated with major depression and generalized anxiety disorder. Studies have shown that both objective social isolation (e.g. living alone) and subjective sense of being alone are associated with suicidal ideation and behavior. These observations are consistent across diverse cultures and populations.
Social disengagement has played arole in the increased suicide rate during the 2020 pandemic in world. One-third of suicide victims experienced social isolation during the covid 19 outbreak. From a suicide prevention perspective, it is troubling that the most important public health approach for the COVID-19 pandemic issocial distancing.Anxiety and fear of contagion during the COVID-19 crisis may be related to uncertainty, fear of unknown and panic inducing stories in traditional and social media. Repeated exposure to reports about the COVID crisis can intensify anxiety.Worries and fears cause various mental and physical symptoms and may lead to the development of anxiety disorders, depression and sleep disorders.24 Studies suggest that the relationships between insomnia and depression and insomnia and anxiety are bi directional. Sleeplessness contributes to symptoms of depression and anxiety and likewise, symptoms of depression and anxiety disturb sleep. Sleep disturbances are a stand-alone risk factor for suicidal behavior. Uncertainty, especially economic uncertainty is associated with stress-related disorders and suicide. It has been shown that uncertainty is a more stressful state to be in than really knowing something bad will happen. Uncertainty is associated with depression and anxiety. The research suggests that a spike in daily economic uncertainty lead to an immediate impact on suicides .which suggest that economic uncertainty may lead to an increase in the risk of suicide.
The impact of economic problems related to the COVID-19crisis on mental health may be severe. Millions of people around the world lost their jobs. Measures required to contain the virus, including self-isolation by workers and consumers, shutting of plants and stores and prohibitions on sports and entertainment events are detrimental for the economy. Historically, economic downturns were associated with mental health disorders and suicides. Studies observed that increases in the unemployment rate were associated with higher prevalence of depression, alcohol and other substance use disorders and suicide deaths. Both perceived job insecurity and unemployment constitute significant risks of increased depressive symptoms in prospective observational studies.
Economic decline during and after the COVID-19 pandemic will probably have a powerful and harmful effect on mental health and result in an increase in the prevalence of psychiatric disorders and suicidal behavior. It is important to note that financial problems may reduce access to psychiatric treatment. There is a high probability that the COVID-19 survivors especially survivors who had severe COVID-19 are at elevated suicide risk. Stressful experiences such as learning about the diagnosis of COVID-19, fear of infecting others, symptoms of the illness, hospitalization, especially admission to an intensive care unit and loss of income may lead to the development of anxiety, depressive and post-traumatic stress disorder.
There is a high probability that suicide rates will increase in many countries of the world. If suicide rates increase in the world, it will add to the trend of rising national rates of suicide. An increase in suicide rates may become a significant public health issue in all developed and developed countries.
In spite of the helplessness that we are facing due to this novel pandemic we have to do what is necessary and what is in our power. Among all measures like focusing on economy, working conditions, and physical health we need to take measures to provide mental health support to people and also help those who have been affected psychologically due to the ongoing stress. In addition to focusing on vulnerable populations we also need to help people who are already diagnosed with mental health illnesses, because the environmental stress has a definite effect on aggravating symptoms of mentally Ill people.
There is a need to provide treatment which can be provided by mental health professionals like psychiatrists and clinical psychologists. At the same time, we need to save the vulnerable population from pseudo-professionals which are doing more damage than helping people who have serious mental illnesses. As mental health professionals it’s our responsibility to save people from unprofessional, who are in great numbers throughout INDIA being recruited online and offline. As mentioned above the biggest antidote or prevention against covid-19 is social isolation and unfortunately it’s also a detrimental factor for mental health. We as professionals need to discover means and ways to connect with people. Although people are socially distant at societal level but have come together at familial level, this has both positive and negative aspects. Like togetherness may give emotional support, solace, reassurance, sense of belonging yet at the same time it has lead to increase in domestic violence. A psychologist has to help people in reaping the fruits of togetherness and also decimating tensions in families.
How can a clinical psychologist help in mental health crisis?
As clinical psychologists, we are qualified and dutiful to explore with our patients the psychological aftermaths of social isolation, job loss, fears of contagion and grief. We can identify and modify the factors responsible for suicide at primary level and can intervene at secondary and tertiary level. It is a great moral opportunity and interest in professionalism that we can provide support to the patients who may be going through major life changes with respect to the pandemic as this experience was new to almost majority of human population. With the professional help the victims can be seen, heard and held in mind.
There are different strategies for helping people who are vulnerable for mental health crisis like suicide. This is the ripe time to draw from our therapeutic arsenal, like we may employ different kinds of therapies suitable for different problems. For example, if we have a suicidal person, with the help of cognitive behavioral therapy we can modify and repair his maladaptive automatic negative thoughts about the current situation and exaggerated fears. These can be excessive fear of contamination, or becoming hopeless about maintaining social relationships again. With the help of behavioural activation and activity scheduling for helpful activities we can deal with the boredom and laziness associated with being secluded in homes which can breed ideas about suicide and other mental disorders. With the help of interpersonal therapy we can help patients deal with job losses , role transitions and to develop the new skills sets they can employ during covid and after covid world. We can help patients be aware about the present moment with the help of acceptance and mindfulness techniques so that they won’t ruminate or worry about the past and future respectively, which is a universal factor for all negativity. With the help of psychodynamically oriented therapies we can help patient’s explore how and which defenses they are employing in covid-19 crisis and how the childhood experiences can play a part in mental health issues during covid-19 and last but not least we can help patients who are hopeless and suicidal to draw meaning in life and change the pessimistic attitudes by principles of logotherapy and taking refuge in religious teachings.
(The authors are clinical psychologists and can be reached at phone numbers 7006073082/9906610120)