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Mental health post-Covid-19: People reluctant to seek help

27 Jan 2021

By Ruwan Laknath Jayakody   Despite a probable increase in psychological distress, victimisation, and mental illness in the wake of the Covid-19 pandemic, it is likely that many people may not seek help owing to fears that the relevant services are overwhelmed and also that attending face-to-face appointments might put them at risk of contracting the virus, researchers noted. This, they reported, is also amidst concerning reports of staff re-deployment from psychiatric services to other health services in response to the pandemic, which may in turn also disrupt the continuity of the provision of care services, thus leading to a lack of consistent and assertive follow up, especially among those who depend on psychiatric services for safety and advocacy. These points were highlighted by S.R. Perera (attached to the Department of Psychiatry of the University of Peradeniya) and A. Wickramasinghe (attached to the Department of Psychiatry of the Rajarata University) in an article titled “Tragedies waiting to happen? Unravelling potential psychiatric repercussions during the Covid-19 pandemic”, which was published recently in the Sri Lanka Journal of Psychiatry, and was based on the systematic study of related research studies published in recognised journals. Among the well-documented adverse impacts and prognostic indicators of the Covid-19 pandemic on mental health, as demonstrated by recent studies, are: developing psychiatric disorders such as anxiety and depression within three months of testing positive for Covid-19 (according to the relevant study, one in five Covid-19 patients have been diagnosed with such); a comparatively high rate of the prevalence of adverse psychiatric symptoms of anxiety, depression, post-traumatic stress disorder (PTSD), and other forms of psychological distress; altered mental statuses such as new-onset psychosis, neuro-cognitive syndromes, and affective disorders which were also more common among younger patients; and addictive behaviours including substance-use disorders (opioid misuse and the resultant overdosing, respiratory depression, and hypoxemia [low levels of oxygen in the blood], smoking, and the resultant pulmonary infections, alcohol consumption, and methamphetamines which can cause lung injury, pulmonary hypertension [high blood pressure in the lungs], and cardiomyopathy [diseases of the heart muscle]) which can in turn lead to cardio-pulmonary and neurological complications that worsen the outcome of Covid-19. Suicide too is a concern in these times, the study notes. The authors also highlighted that those dependent on opiates are facing severe challenges at this time due to greater marginalisation, difficulty in accessing specific healthcare, imposed restrictions on drugs, the closure of rehabilitation centres, increased risk of life-threatening withdrawal, and the usage of illicit opiates. Since those in distress may take refuge in addictive substances to allay their negative feelings, this situation, the authors note, could potentially trigger the development of substance-use disorders in high-risk groups and a spike in the incidence of such among the general population. With regard to mental health problems such as depression, its features were found to be more common among females, younger persons (below 40 years) including students, children, and adolescents (the latter groups who are probably more likely to experience high rates of such). The same was the case with anxiety where in addition it was found that anxiety was also associated with other factors such as a lower level of education, poor self-rated levels of health, loneliness, quarantine status, worry about infection, and prior mental or physical health problems. Furthermore, the frequent exposure to news/information about Covid-19 and social media was also associated with increased symptoms of anxiety. In the case of children and adolescents, loneliness, which is reported to be associated with future mental health problems up to nine years later, and has a strong association with the development of depression, was found to be associated with elevated symptoms of depression in girls and elevated social anxiety in boys, with the length of the period of loneliness appearing to be a predictor of future mental health problems. The authors noted that this carries a special significance within the Covid-19 context, as policymakers debate the length of time that schools should remain closed and discuss the implementation of social distancing within schools. The researchers also pointed to the post-Covid-19-related incidence of info-demic and internet addiction including increase in the consumption of pornography and engaging in video gaming, especially during lockdowns. Amidst the pandemic and its travel restrictions-related lockdowns and imposed mandatory seclusion and resultant social isolation, exposure to economic and psychological stressors, increases in negative coping mechanisms such as alcohol misuse, and an inability to access the usual support, or escape abusive households, owing to quarantine or travel restrictions, domestic violence, the authors explain, too has reached epidemic proportions. Addressing domestic violence, they noted is a public health priority, given the prevalence of domestic violence and the associated psychological and physical morbidity and mortality. While previous research has suggested an association between mental illness and the perpetration of domestic violence, the researchers added that substance-use disorders carry the highest risk of domestic violence. Furthermore, people with severe mental illnesses are at increased risk of becoming victims of domestic violence, they explained. The review also identified a few studies that had examined factors that protected against psychological illness which included: the timely dissemination of updated and accurate information regarding the pandemic situation by the authorities and thereby minimising rumours and false information that perpetuates anxiety; actively carrying out measures to lower the risk of infection on the part of the individual (such as mask wearing and hand-washing); promoting positive coping styles; the prioritisation by policymakers of vulnerable groups for the purpose of the prevention of common mental disorders such depression, anxiety, as well as suicide; the provision of accessible mental healthcare, in particular for people from rural areas who face travel restrictions, as well as for those in quarantine; offering preventive support and early intervention where possible; preparing for an increase in mental health problems in children and adolescents; and prioritising the provision of treatment for substance use disorders, alongside any co-existing mental illness. It is therefore important that mental illness is recognised at the primary care level, the authors emphasised, adding that onward referrals should thereafter be made to specialist services.


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