Motivated

Coronavirus Can Cause Mental Health Crises


by Natasha Tracy - March 18, 2020


Photo Credit: by arbyreed, flickr.com
Photo Credit: by arbyreed, flickr.com

Coronavirus is scary. A virus that spreads the way this virus has and has caused quarantines of cruise ships, cities and, indeed, even a whole country would cause anyone to be concerned. But can feelings around coronavirus move beyond mere fear? Can the effects of coronavirus actually extend to mental health crises? And if so, how can be mitigate mental health crises caused by coronavirus?

Why Is Coronavirus So Scary?

The outbreak of coronavirus was first reported in Wuhan China on December 31, 2019. The disease caused by coronavirus, is known as COVID-19.

By March 11, 2020, less than two-and-a-half months after COVID-19 was first reported, it was declared a pandemic by the World Health Organization (WHO).

“. . . WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction. WHO therefore have made the assessment that COVID-19 can be characterized as a pandemic.”

The WHO loosely defines a pandemic as a worldwide spread of a new disease for which there is no immunity.

As of this writing, March 17, 2020, the Center for Disease Control and Prevention (CDC) reports 4,226 cases of COVID-19, and 75 deaths in the United States. The highest rates of COVID-19 are being reported in Washington and New York States. These are followed by California, Florida, Georgia, Louisiana and Colorado. There are currently 569 confirmed cases of COVID-19 in Canada and 8 deaths.

Globally there are 179,111 cases of COVID-19 with 11,525 new cases having been reported in the last 24 hours. There have been 7,426 deaths with 475 new deaths having been reported in the last 24 hours. That equates to a fatality rate of about 4.2 percent. And while, initially, cases of COVID-19 could be tracked to the epicenter of the outbreak in China (spread through travel), community spread cases with no known link to the epicenter are now cropping up all over the world, including in Canada.

While some people would argue a survival rate of over 95 percent is very high, it’s worth noting that the flu – which kills hundreds of thousands of people a year, only has a fatality rate of 0.1%. That means that the COVID-19 is about 42 times as deadly as the flu.

Coronavirus Mental Health Crisis – Anxiety

Of course, coronavirus is causing anxiety and even panic for many. You can see this globally in the way people are panic-buying water and toilet paper in spite of the fact that the WHO and the CDC do not consider this appropriate. The level of anxiety is such that people simply aren’t making rational decisions. A large part of this is the uncertainty around COVID-19 as uncertainty is a major driver of anxiety.

Consider, for a moment though, how hard it is for those who already had an anxiety disorder before the COVID-19 outbreak. Any anxiety disorder can certainly be exacerbated by this situation with those with obsessive-compulsive disorder (OCD) often fairing the worst and developing a fixation on the illness.

According to a piece in The Guardian, for those experiencing coronavirus-related anxiety, reactions could be:

* Feeling overwhelmed, fearful, sad, angry or helpless

* Difficulty sleeping or concentrating

* Fear of contact with others

* Fear of traveling on public transportation

* Fear of public spaces

* Physical symptoms like increased heartrate or an upset stomach

All of the above symptoms can negatively impact how a person is dealing with a pre-existing anxiety disorder. Some with an anxiety disorder are having to increase their anti-anxiety medication just to stay functional.

Additionally, some people are experiencing full-on panic attacks because of COVID-19. These panic attacks can last up to 30 minutes, be very debilitating and cause shortness of breath, tingling and other symptoms.

Quarantine Mental Health Effects and Crises

Quarantine can magnify the negative impact of a pandemic. Quarantine has been shown to have many negative mental health effects, some during quarantine and some after quarantine. These include:

* Anger

* Confusion

* Posttraumatic stress symptoms (at least 6 months after the quarantine has ended)

* Anxiety

Having a history of a psychiatric illness is associated with anxiety and anger even four-six months after quarantine.

Specifically, in a group of hospital staff that were quarantined for nine days after exposure to the severe acute respiratory syndrome (SARS) virus; after the quarantine was ended, the following were found:

* Anxiety at work

* Irritability

* Exhaustion

* Detachment from others

* Acute stress disorder symptoms

* Insomnia

* Poor concentration

* Indecisiveness

* Poor work performance

* Reluctance to work/consideration of resignation

Quarantine symptoms are made worse by:

* Longer quarantine duration

* Infection fears

* Frustration

* Boredom

* Inadequate supplies

* Inadequate information

* Financial loss

* Stigma

Unfortunately, those factors are found in many quarantine areas around the world.

Coronavirus Mental Health Crises – Depression

In China, where the outbreak has been going on the longest, 14,000 people were evaluated, and 16.6 percent of people were found to have moderate-to-severe depression. In fact, hundreds of 24-hour helplines have been launched since the coronavirus began spreading. One Shanghai-based psychologist who answered calls told Reuters that one caller who lived with chronic depression reported suicidal thoughts due to the "barrage of bad news."

A review published in The Lancet, found that even three years after quarantine, high depressive symptoms were found more in hospital staff who were quarantined compared to those who were not. When many studies were looked at in review, symptoms of low mood were highly prevalent.

After the severe acute respiratory syndrome (SARS) epidemic, the following was learned:

“ . . . with other relevant factors controlled for, being single, having been quarantined during the outbreak, having been exposed to other traumatic events before SARS, and perceived SARS-related risk level during the outbreak were found to increase the odds of having a high level of depressive symptoms 3 years later. Altruistic acceptance of risk during the outbreak was found to decrease the odds of high post-outbreak depressive symptom levels.”

Those with a household income of less than $40,000 (CAN) showed much greater levels of posttraumatic stress disorder and depression after quarantine.

While two of the antidepressants we commonly see prescribed at Canada Pharmacy Online include vortioxetine (Brintellix) and tranylcypromine (Parnate), always check with your doctor to see what the right choice is for you.

Coronavirus Mental Health Crisis – Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is unlikely to develop from the pandemic itself. It is more likely to develop due to the quarantine associated with an illness like COVID-19. Interestingly, quarantine itself doesn’t qualify as a trauma according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Nonetheless, many studies have measured the presence of PTSD after a quarantine.

One study found that in hospital employees, quarantine was found to be a major predictor of PTSD, even three years later. Both children and their parents have shown a greatly increased chance of having PTSD after quarantine – even four times more than those who are not quarantined.

Healthcare workers may be at an elevated risk for PTSD as after quarantine as they have shown more severe symptoms of posttraumatic stress than the general

public who has also been quarantined.

Healthcare workers also:

* Feel greater stigmatization than the general public

* Exhibit more avoidance behaviors after quarantine

* Report greater lost income

* Report substantially more anger, annoyance, fear, frustration, guilt, helplessness, isolation, loneliness, nervousness, sadness, worry and less happiness

The length of quarantine is associated with poorer mental health and specifically avoidance behaviors, anger and posttraumatic stress disorder. It appears that those quarantined over 10 days experience more posttraumatic stress disorder than those quarantined under 10 days. Additionally, if those in quarantine perceive difficulties in complying with quarantine protocols, that, too is a predictor of posttraumatic stress disorder.

Preventing Mental Health Crises Due to Coronavirus Quarantine

There are ways to mitigate the mental health crises risks associated with quarantine because of COVID-19. According to the review in The Lancet, these include:

* Keeping the quarantine as short as possible

* Give people as much accurate information as possible

* Ensuring adequate supplies

* Reducing boredom

* Improving communication

After quarantine, it has been shown that people find support groups specifically for previously quarantined individuals helpful.

Outside of quarantine, any method that takes care of a person’s mental health can be useful during times of extreme stress such as during the coronavirus pandemic. These can include things like:

* Self-care

* Limiting time spend accessing social media and other sources of news that may be misleading or fear-provoking

* Working to feel less isolated such as through online calls with loved ones

* Getting outside, when allow and safe to do so

* Exercising

* Therapy

* Psychiatric care

* Actively participating in mitigating the spread of COVID-19 using the following section’s tips

Ways to Mitigate the Spread of COVID-19

The good news is that everyone can help stop the spread of COVID-19.

The first step is to be aware of what is happening with the outbreak through trustworthy sources like the WHO and the CDC. It’s important to remember that sometimes the media is sensationalistic and this characteristic can worsen mental health crises associated with COVID-19.

The WHO says people should also:

1. Regularly and thoroughly clean your hands with an alcohol-based hand rub (at least 60% alcohol) or wash them with soap and water (for at least 20 seconds).

2. Maintain at least three feet of distance between yourself and anyone who is coughing or sneezing.

3. Avoid touching your eyes, nose and mouth.

4. Make sure you, and the people around you, follow good respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.

5. Stay home if you feel unwell. If you have a fever, cough and difficulty breathing, seek medical attention and call in advance. Follow the directions of your local health authority.

6. Keep up to date on the latest COVID-19 hotspots (cities or local areas where COVID-19 is spreading widely). If possible, avoid traveling to places – especially if you are an older person or have diabetes, heart or lung disease.

While this is a challenging time for everyone affected, pandemics have come and gone before and by us all doing our best, we can lessen the amount of time this one is causing such devastating effects.

References

Brooks, S, PhD, et al, “ The Psychological Impact of Quarantine and How to Reduce It: Rapid Review of the Evidence .” The Lancet, Feb. 26, 2020

Center for Disease Control and Prevention (CDC), Coronavirus Disease (COVID-19) Cases in U.S. March 18, 2020.

Government of Canada, Coronavirus Disease (COVID-19): Outbreak Update. March 17, 2020.

Murray, J and Sherwood, H, “Anxiety on the Rise Due to Coronavirus, Say Mental Health Charities.” The Guardian, March 13, 2020.

World Health Organization (WHO), Coronavirus Disease 2019 (COVID-19) – Situation Report 57. March 18, 2020.

World Health Organization (WHO), Q & A on Coronaviruses (COVID-19). March 18, 2020


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