Covid-19 and mental health: ‘We will need to completely reimagine healthcare’

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  • The Covid-19 pandemic has negatively affected mental health all over the world
  • Studies have shown that Covid-19 itself can lead to mental illness, including mood disorders like depression
  • Data show that suicide rates have remained unchanged during this period, although data from lower-income countries are lacking

“Trauma, a word we use very frequently in the context of mental health, can take many shapes. It is characterised by the toxic effects of extreme fear, uncertainty, insecurity, helplessness, and grief on our minds. In this sense, trauma is sweeping across India and many other countries,” said Vikram Patel, The Pershing Square Professor of Global Health in the Department of Global Health and Social Medicine at Harvard Medical School.

Patel was speaking at a virtual webinar on Covid-19 and mental health, hosted by the British Medical Journal (BMJ) last week.

The increase in the prevalence of mental health distress, he believes, will inevitably fuel an increase in clinically significant mental disorders. 

“The sobering fact is that the mental healthcare systems of most countries were barely able to meet the need that existed even before the pandemic,” he said. “We will need to completely reimagine healthcare if we’re going to make a difference on this occasion.”

Researchers on the panel discussed several aspects of their research on mental health during the pandemic, including anxiety, depression, suicide, and self-harm.

Covid survivors develop mental illness

Professor Paul Harrison from the Department of Psychiatry, University of Oxford, and colleagues used electronic health records of 62 000 Covid-19 patients to assess whether the disease has any link to psychiatric illness. 

According to their study, which was largely based on a US population and published in the BMJ, around one in five patients received a psychiatric diagnosis in the three months after their Covid infection.

“This shows there is going to be an increase in common mental health conditions seen in patients who recovered from their infection,” Harrison said.

Second study by the same authors

In a more recently published study with a longer follow-up, Harrison and his colleagues assessed the records of more than 236 000 Covid-19 survivors.

They found that in patients who had no previous record of psychiatric disorders, one in eight received such a diagnosis, with anxiety and depression disorders being most common. This suggests that the pandemic could lead to a wave of mental and problems and that mental health services need to be made available to the large number of people who could be living with these symptoms.

Moreover, Max Taquet, a psychiatrist at Britain's Oxford University, who co-led the work, told Reuters: "Our results indicate that brain diseases and psychiatric disorders are more common after Covid-19 than after flu or other respiratory infections.”

Harrison, however, cautioned that it remains to be seen whether these results can be generalised to other populations. Researchers also need to assess what happens beyond six months of infection, he added.

What may be the cause?

According to Professor Hamish McAuley who’s a researcher on the 18-month PHOSP-COVID study led by the University of Leicester, ongoing inflammation appears to play a role in mental health and physical symptoms in patients who have recovered from Covid infection.

The UK-wide study has recruited 10 000 patients in an attempt to understand the impact of Covid disease on patient health and recovery.

A study published in the New England Journal of Medicine looked at the brain tissue of people who died from Covid and spotted a combination of inflammation and leaking blood vessels in the brain. The virus has also been found to enter the central nervous system, Health24 reported, which can result in significant psychiatric illness.

And, to put it in the words of Patel, “There is also the trauma of those who had Covid infection itself – of being breathless and ventilated,” that needs to be investigated.

Did suicide rates increase?

Also on the panel was Dr Praveetha Patalay, Associate Professor based across the Centre for Longitudinal Studies, whose research focuses on whether mental health in the UK deteriorated during the pandemic.

According to the findings, there is very mixed evidence, not only in the UK, but also in other countries.

Dr Duleeka Knipe from the University of Bristol weighed in, saying: “Early on in the pandemic … there was concern over the impact of [it] on mental health, specifically on suicide. You saw media reports coming out almost daily saying that the pandemic and lockdown measures were having a negative impact on suicide and a rise in self-harm. There was a great deal of uncertainty around these stories.”

These concerns were driven by risk factors such as social isolation caused by physical distancing; stress experienced by frontline workers; a rise in domestic violence and alcohol misuse; and the economic recession's impact.

“There is reason to believe that suicide might increase during the pandemic [and] knowing what’s happening in terms of suicide rates is a priority,” said Knipe. But, a large collaboration of studies showed that suicide rates and hospitalisations for suicide attempts or self-harm were largely unchanged, or even lower, during this time, she added.

Data limited to particular groups

It’s worth noting that these studies were based primarily on data from high- and upper-middle-income countries. “It represents 20% of the world’s population and we’re missing data, so the picture we have is very narrow. It’s missing parts of the world where the global burden of suicide is the greatest,” said Knipe.

The full impact of this pandemic is also not yet known, so researchers will need to continue to monitor the situation to see whether there will be any long-term effects, Knipe added.

Early in the webinar, Patel said: “What really worries me is the impact this pandemic is having on amplifying inequalities. It is this toxic combination of absolute poverty with inequality, which I believe is a perfect storm for a similar surge of depths of despair in parts of the world.

“The pandemic has reminded us of the structural inequalities in all our countries which also then translate into disproportionate effects on mental health, in particular for women, young people, low-income groups, and people with existing mental disorders.”

What existing SA data show

In a 2020 South African study looking at the pandemic’s effects on a group of individuals in Soweto, researchers found that 14.5% of participants surveyed were found to be at risk of depression, with 20% indicating that the pandemic caused them deep worry, anxiety, or led to them to "thinking too much" about the virus and its impact, Health24 reported.

Another study by Dr Adeola Oyenubi, a senior lecturer at the School of Economics and Finance, Wits, and Uma Kollamparambil, head of the School of Economics & Finance at Wits, also showed that the prevalence of depressive symptoms doubled between 2017 and June 2020. 

The authors suggested that the negative impact of the pandemic was found to disproportionately affect vulnerable groups in terms of income and health, and that policymakers need to make adequate provision for a potential upsurge in mental health issues that could, if not addressed, become chronic and prolonged.

SA part of global mental health study

Health24 previously reported on the Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT), currently running, that is measuring the impact of the pandemic on people’s physical and mental health worldwide. It is the largest global study of its kind, and in South Africa, it's led by Stellenbosch University researchers, Professor Soraya Seedat and Dr Georgina Spies.

Spies told Health24 that according to research, 30 months after the SARS 2003 outbreak post-traumatic stress disorder (PTSD) was the most prevalent long-term psychiatric condition, followed by depressive disorders.

South African data from the COH-FIT study will be available in the coming months, Spies told Health24.

If you're feeling anxious or depressed and feel like you need help, you can reach SADAG on their 24-hour helpline: 0800 456 789.

For a suicide emergency, dial 0800 567 567. 

*For more Covid-19 research, science and news, click here. You can also sign up for our Daily Dose newsletter here.

READ | OPINION | The mental health effects of Covid-19 are as important to address as the physical effects

READ | SA involved in massive global study on effects of Covid-19 pandemic - and you can play your part

READ | Mental health effects of Covid-19 pandemic, lockdown - and concern over suicide risk

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