Mental health effects of Covid-19 pandemic, lockdown - and concern over suicide risk
- The Covid-19 pandemic is causing people to feel distressed and depressed
- Experts say this may show up in a nation's suicide rate
- Governments are being urged to take the mental health consequences of the pandemic seriously
It is clear that the new coronavirus is affecting everyone around the world. The Johns Hopkins Coronavirus Resource Centre indicates that more than 6.6 million people have been infected and Covid-19 has claimed the lives of over 391 000 people globally. Making matters worse, it presents a threat to psychological health as well as physical health.
Linked to this is the fact that many countries, including South Africa, are facing the additional threat of economic instability as millions of people have lost their jobs since the lockdowns started. The New York Times reports that the ultimate impact of the virus’s mental toll, according to some experts, may show up in countries' suicide rates in 2020 and beyond.
SADAG calls doubled during lockdown
Before the national lockdown was implemented on March 27, the South African Depression and Anxiety Group (SADAG) averaged around 600 calls per day, Cassey Chambers, SADAG’s operations director, told Health24. However, during the course of the lockdown, in April alone, the organisation received more than double this number per day.
According to SADAG, many callers are dealing with a combination of issues, including the spread of the virus, finances, relationship problems, job security, grief, gender-based violence (GBV) and trauma. SADAG also carried out an online survey during lockdown (April). The main challenges people reported to be facing during lockdown included anxiety and panic, financial stress and pressure, depression, poor family relations, feelings of suicide, and substance abuse.
“The impact of mental health during Covid-19 has been a growing issue and concern, and SADAG has been monitoring call volumes on a daily basis. We do anticipate that, as the impact of Covid-19 worsens over the next couple of months, that the need for mental health support and help is going to increase drastically too,” Chambers explained.
“These conditions could certainly be exacerbated by the lockdown, particularly if the individual lives alone or in a dysfunctional home situation,” SADAG Board Chairperson, psychiatrist and psychologist, Dr Frans Korb said in a press statement.
Barriers to mental healthcare access
As we start to see people lose livelihoods and businesses, we could see its negative mental health effects that are likely to include suicide, Vincenzo Sinisi, clinical psychologist and psychoanalyst in private practice in Cape Town told Health24.
“People have begun to suffer the effects of living with less social contact, reduced daily structure, limited exercise, fewer rewarding and distracting tasks, and so on. Added to this are increased financial- and health-related concerns and, of course, fears of losing loved ones' and our own lives. Many people are finding that they are bearing more strain and uncertainty with few resources available to help them cope.”
This is especially hard on those who are trying to manage an existing mental condition, Sinisi adds, and says that he and his colleagues are noticing clients who were doing well, but are now regressing. “This may translate into an increase in future admissions and suicides.”
Each death must be ‘carefully investigated’
In his article for the New York Times, Benedict Carey writes that for many months following the start of the pandemic, doctors won’t necessarily know for certain whether suicide has spiked in 2020, and that each death will have to be carefully investigated. However, Carey later states that the impact of economic hardship often serves as a strong impetus, and that historically, job losses and evictions have led to a spike in the numbers of suicides.
“I think during the actual crisis, suicide will be lower,” Dr Marianne Goodman, a psychiatrist at the Department of Veterans Affairs, in the Bronx, told the publication. “And once the longer-term economic impact is felt, I suspect, suicide will be rising again.”
Matthew Nock, a psychology professor at Harvard also offered some insight: “It’s a natural experiment, in a way. There’s not only an increase in anxiety, but the more important piece is social isolation,” further adding that: “We’ve never had anything like this – and we know social isolation is related to suicide.”
However, Sinisi has also been seeing some noteworthy changes during this crisis.
The paradoxical side of mental health during this crisis
When the lockdown first started, TherapyRoute, a platform used by people to find therapists, saw a significant rise in traffic, yet, at the same time, a paradoxical drop in the number of people who were reaching out to therapists, Sinisi says.
“These were most prominent towards the beginning of lockdown and seemed to be reducing as we adjusted to the new ‘normal’. While one might have expected people who were suffering under normal living conditions to suffer more under lockdown, many did not.
“Some, for example, felt relief as the pressure to go outside and socialise, or become successful, was removed; or the crippling envy they experienced at others’ happiness evaporated; or their sense of isolation (longing) and failure was unexpectedly replaced with an experience of ‘going through difficult times together’ (belonging),” he adds.
Is it more difficult to reach out for online therapy?
Online, or virtual, therapy is seeing a growth, especially during lockdown, and includes many people who are seeking therapy for the first time. However, this form of therapy may not be for every person or practitioner, as some may prefer traditional, face-to-face consultations.
Sinisi explains that based on his experience, he doesn’t see virtual therapy as challenging, although some therapists have chosen to press the pause button and prefer waiting for things to return to normal.
“Some people enjoy the convenience and reduced anxiety they feel when in the same room as another person. I have also seen an increase in the number of people asking for online or telephone consultations. The general state of uncertainty and instability seems to be contributing to greater patient turnover, such as some people preparing for financial losses, but the demand remains high,” Sinisi says. He, however, acknowledges the challenges:
“Public awareness of the availability of online consultations remains low, while some question the efficacy of meeting via a screen. And, there are cases where it is more difficult to establish rapport using this method.”
In an article for the World Health Organization (WHO), when it comes to life post the Covid-19 pandemic, Dr Konstantinos Petsanis, a Swiss neurologist who specialises in general cognitive disorders and dementia, worries the most about mental health especially due to the long period of economic instability many countries will face. In the article, Petsanis touched on unemployment during and after the Great Depression, and how it led to a greater incidence of heart disease.
UN Secretary-General Antonio Guterres also stressed the cumulative impact of stress, grief, and anxiety in a recently published opinion piece in Time Magazine, saying: “Unless we act now to address the mental health needs associated with the pandemic, there will be enormous long-term consequences for families, communities and societies.”
The UN has urged governments around the world to take the mental health consequences of the pandemic seriously, and to ensure that mental health support is available.
SARS outbreak referred to as ‘mental health catastrophe’
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 being led by Stellenbosch University researchers, Professor Soraya Seedat and Dr Georgina Spies.
In the article, Spies told Health24 that the SARS 2003 outbreak has been referred to as a mental health catastrophe, and that research shows that 30 months after the outbreak, post-traumatic stress disorder (PTSD) was the most prevalent long-term psychiatric condition, followed by depressive disorders.
The COH-FIT study aims to collect information from over 100 000 participants from more than 40 countries and six continents. To help the research team gather data, please take the survey at www.coh-fit.com.
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.
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