Michael Abrahams | The complex relationship between COVID-19 and mental health

If the COVID-19 pandemic is having a negative effect on your mental health, you are not alone. In fact, you have a lot of company. Globally, there have been reports of increased incidences of mental health issues in all age groups and across a spectrum of ethnicities.

For example, a recent report from the Pan American Health Organization (PAHO) shared data showing that during the pandemic, more than four in 10 Brazilians have been living with anxiety, depression symptoms increased fivefold in Peru, and the proportion of Canadians reporting high levels of anxiety quadrupled.

A study recently published in the journal Nature Aging reported that a team of researchers in Canada found 43 per cent of adults age 50 or older experienced moderate or high levels of depressive symptoms at the beginning of the COVID-19 pandemic, and that this increased over time.

According to The State of the World’s Children 2021; On My Mind: promoting, protecting and caring for children’s mental health – UNICEF’s most comprehensive look at the mental health of children, adolescents and caregivers, at least one in seven children have been directly affected by lockdowns, and more than 1.6 billion children have suffered some loss of education.

CASES SPIRALLING

Social isolation, disruption of routines and recreational activities, fear of getting sick, the trauma of losing loved ones or having them being hospitalised, job insecurity and unemployment, food insecurity, poverty, and an increased incidence of domestic violence resulting from lockdowns and stress have sent mental illness cases spiralling upwards.

And the mental health issues come not only from the stressful social environment that the pandemic has brought, but also from directly being infected with SARS-CoV-2, the virus that causes COVID-19. Being ill and knowing that death or long-term morbidity is possible because of the illness is enough to lead to clinical depression or anxiety. But being admitted to a COVID-19 ward or intensive care unit – and not being able to see family or friends – and witnessing people dying around you and their bodies being taken away can be severely traumatic, even leading to post-traumatic stress disorder.

But it goes way beyond that. Researchers have linked COVID-19 infection with damage to the brain. In addition to anosmia, the loss of smell reported by some COVID-19 patients, other neuropsychiatric symptoms have been observed that have been directly attributed to changes in the brain caused by the virus, such as cognitive and attention deficits (brain fog), anxiety, depression, psychosis, seizures and suicidal behaviour.

And it gets even worse. Not only can COVID-19 lead directly or indirectly to neuropsychiatric pathology, but a growing number of studies have linked mental health disorders with not only a higher risk of contracting COVID-19, but also an increased likelihood of poor outcomes. For example, an analysis of data from five hospitals in the Yale New Haven Health System in Connecticut, USA, found a higher level of mortality for COVID-19 patients who had a prior psychiatric history, with the risk of death going up by 50 per cent for those with a history of mental illness, compared with those with no such history. Another study found that if someone had a history of a mental disorder, not only were they were more likely to get infected, but are also at greater risk of having a poor outcome, such as hospitalisation or death, should infection occur.

MULTIPLE REASONS

The likely reasons for these correlations are multiple. For example, people with certain mental illnesses may behave in ways that place them in harm’s way, such as refusing to wear masks or follow physical-distancing protocols. Persons with mental illnesses are also more likely to have other comorbidities, or neglect their overall health, increasing their vulnerability to infection. The stress that accompanies many mental illnesses can also weaken the immune system, making such persons less able to mount an effective immune response to ward off the infection.

Mental health management must be a priority during this pandemic. SARS-CoV-2 is a virus that primarily attacks the respiratory system, but our brains and our minds have become prime targets for collateral damage. From influencing vulnerability to infection, to appearing as a result of it, mental illness and COVID-19 maintain a close relationship. Health authorities must strategise how to deal with the growing number of mental health issues that are now being manifested, as the neurological, psychological and psychiatric sequelae of the pandemic, and the resulting morbidity, will likely persist long after it is over.

Michael Abrahams is an obstetrician and gynaecologist, social commentator and human-rights advocate. Send feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or follow him on Twitter @mikeyabrahams.