Covid19 & Mental Health

Until the coronavirus pandemic broke out, many health experts believed that mental illness would become the epidemic of the 21st century.  In 2001 the World Health Organization had created its World Program of Action on Mental Health to face this challenge. Mental disorders compromised the health of millions of people and the economic and social development of countries. It was necessary to establish a clear and coherent strategy to correct the gap between the needs and the real possibilities of action countries had.

However, during the first two decades of the century, the number of people affected by mental disorders has not decreased but increased, and at an astonishing rate, accelerated by socioeconomic and labour factors linked to the many changes the world is undergoing. In October 2017, coinciding with the World Mental Health Day, that year dedicated to mental health in the workplace, the WHO estimated that more than 300 million people suffered from depression and more than 260 million experienced anxiety disorders on the planet.

Who would have thought then how the situation was going to be three years later.

At the time of this writing, ten months after the Director-General of the World Health Organization Tedros Adhanom Ghebreyesus announced that Covid19 reached the level of a pandemic, more than 1.8 million people worldwide have died from this disease. It is very likely that if we now asked those health experts about what will become the epidemic of the 21st century, many would no longer say mental illness but Covid19.

However, it is not that mental health problems are over. On the contrary, people’s mental health is suffering a lot the consequences of the pandemic. 

Many people are afraid of being infected, of death, of infecting others, of the possibility of losing friends and family. Others suffer the loss of loved ones without being able to say goodbye to them. Some lose their job or their income or are afraid of losing them. Some suffer isolation, loneliness. The avalanche of information and disinformation in which we live does not help either. Therefore, the Covid19 pandemic becomes a stressor that can contribute to the development, relapse, or worsening of various mental illnesses.

Besides, there is evidence that Covid19 itself can bring with it neurological and mental complications, such as delirium, encephalopathy, agitation, stroke, insomnia, loss of the sense of taste and smell, anxiety, depression, and Guillain-Barré syndrome. We also know that certain pre-existing mental disorders can increase the risk of complications if you contract the virus. For example, there is evidence that people with dementia have a higher susceptibility to Covid19 and higher death rates associated with the disease.

And all this happens just at a time of saturation of health systems that, on occasions, causes the interruption of the care services received by people suffering from these types of disorders, which can worsen their diseases. (Although we must also recognise the incredible capacity of reaction and imagination that many institutions and professionals have shown to find alternative ways to continue assisting their patients amid the crisis).

For all those reasons, from the first moments of the epidemic, the scientific community understood that it was necessary to explore the impact the health crisis could have on people’s mental health. The first study we are aware of is one authored by Al-Rabiaah et al. (January 2020), where they analysed the prevalence of anxiety among the Chinese population exposed to the disease. Since then, researchers have written thousands of articles on the subject, including systematic reviews and meta-analyses, such as one authored by Pappa et al., which revealed high rates of anxiety, depression, and insomnia among health personnel in Asian countries. Or another one (Xiong et al., 2020) providing evidence of relatively high rates of anxiety, depression, post-traumatic stress disorder PTSD, and psychological distress among the population affected by Covid19 in different countries.

Nanos gigantum humeris insidentes

Following this research line, the January issue of the scientific journal Psychiatry Research will publish what is for the time being the largest-scale study on the impact of Covid19 on the mental health of citizens, which is already available in an online version. This study has been carried out by a team of Canadian experts led by Jude Mary Cénat, professor of clinical psychology at the University of Ottawa, to understand the impact of the Covid19 pandemic on the mental health of affected populations and help design and implement evidence-based mental health programs.

More specifically, researchers have directed their efforts to analyse: (1) the combined prevalence of depression, anxiety, insomnia, post-traumatic stress disorder, and psychological distress in the general population; (2) the differences in the combined prevalence of these problems among healthcare workers compared to the general population; (3) gender differences in the combined prevalence of the investigated mental health problems; 4) possible differences in the impact of the pandemic on mental health problems across geographic regions.

To produce this meta-analysis, the researchers identified 2,189 articles on the subject, of which only 130 passed the first filter, and 46 passed the final quality check. At a later stage, they would add four articles published after their initial scanning, and five more they found in the list of references from a previous meta-analysis. As a result, the study finally encompassed 55 articles written between January and May 2020 that, through 68 independent samples, analyse the impact of Covid19 on the mental health of almost 190,000 people around the world. The majority of those studies came from China (45 out of 68 samples), although there were also studies from Italy, the United States, Peru, Spain, Iran, among other countries. In terms of their subjects, 41 of the studies focused on the mental health of health workers, while 27 analysed the consequences of the pandemic on the mental health of the general population.

What have they found?

In my opinion, three findings are important to highlight:

First, the meta-analysis confirms that depression, anxiety, insomnia, post-traumatic stress disorder, and psychological distress are significantly more frequent disorders among populations affected by the pandemic.

Compared to the data reported in the latest WHO study on common mental health disorders, the prevalence of depression in populations affected by Covid19 is more than three times higher (15.97% compared to 4.4%), that of anxiety is four times higher (15.15% compared to 3.6%), and that of post-traumatic stress disorder is five times higher (21.94% versus 4%).

Second, data show that, in general, health workers suffer the same or even fewer mental health problems than the rest of the population, which is consistent with what studies conducted in previous health crises (SARS, Ebola) revealed. Nonetheless, the authors point out the need for longitudinal studies to determine whether this finding is related to temporary coping strategies associated with these professionals being in the front line of the fight against the pandemic. If so, once the pandemic subsides, health workers may develop more serious mental health problems. The researchers highlight the prevalence of insomnia, which is significantly higher among healthcare workers and is a predictor of depression and suicidal ideation.

Third, studies show that men and women experience the stressors derived from the pandemic similarly. However, the authors wonder if these results may be related to differences in gender roles across cultures. Because, while studies carried out in China evidence no gender differences, other studies carried out in the West and the Middle East (Mazza et al., 2020; Moccia et al., 2020; Moghanibashi-Mansourieh, 2020) do show that women have a higher risk than men of developing mental health problems during Covid19. Hence, they point to the need to carry out more research on this topic.

Of course, this meta-analysis, like practically any scientific investigation, is subject to limitations the authors admit in their article. First, the pandemic is not over yet, and many researchers carry out their studies in the rush of the emergency we are experiencing. Second, from a geographic perspective, we must keep in mind that the vast majority of research refers to a single country: China. Third, there are very few studies on the mental health of Covid19 survivors who have developed the most severe symptoms of the disease.

In any case, it is a giant leap (or at least a leap on the shoulders of giants) that deserves recognition, as these early findings can guide further research and facilitate the development of more effective mental health programs both during and after the pandemic.

Reference

Cénat, J. M., Blais-Rochette, C., Kokou-Kpolou, C. K., Noorishad, P. G., Mukunzi, J. N., McIntee, S. E., Dalexis, R. D., Goulet, M. A., & Labelle, P. R. (2020). Prevalence of symptoms of depression, anxiety, insomnia, posttraumatic stress disorder, and psychological distress among populations affected by the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry research, 295