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The Pandemic vs. Post Traumatic Stress Disorder: the impact of COVID-19 on Mental Health

At the beginning of this year, most of us were blissfully unaware of COVID-19. Since then, lives have turned upside down due to the introduction of this disease and the onslaught of a worldwide pandemic1.

"We are facing a global health crisis, unlike any in the 75-year history of the United Nations — one that is killing people, spreading human suffering, and upending people's lives. But this is much more than a health crisis. It is a human, economic, and social crisis."

United Nations Department of Economic and Social Affairs.

Outside of contracting the virus, the COVID-19 outbreak affects every individual. Whether it is worrying about job security and finances, experiencing social isolation, feeling insecure in housing, managing reduced health care access, or juggling schooling - every life is affected.

The Centers for Disease Control and Prevention (CDC) reports that more than two in five Americans are struggling with mental or behavioral health issues due to the pandemic, including; anxiety, depression, substance use, and suicidal thoughts. Plus, it's not just adults that are facing mental health problems. Statistics from the CDC also show that compared with 2019, the number of mental health-related visits to the Emergency Department (ED) for children has increased significantly. ED visits for children aged 5–11 have risen by 24%, and for children aged 12–17 years by 31% 2. Researchers discuss that the mental health concerns seen in children might be exacerbated by stress related to the pandemic. The abrupt disruptions to daily life, anxiety about illness, social isolation, and interrupted connectedness to school are all thought to be some of the main reasons for an increase in children’s mental health concerns.2.

In this uncertain time, mental health problems are growing in prevalence, and those who already have mental health concerns are finding that symptoms may worsen under the pandemic strain.


What Mental Health Stresses are people facing due to COVID-19?

Jonathan Ugalde, Licensed Professional Counsellor - Executive Director of Operations and Finance & Therapist at Calming Wind Counseling Services, discusses the challenges people currently face. "I believe that we, as a community, are facing traumatic stress. The pandemic has caused us to feel isolated from our families and friends, become even more concerned for our health and safety, and worried about the security of our finances and housing. We have found a lot of our community facing the difficulty of finding purpose and worth in a time of communal distress. This can lead to individuals having feelings of isolation, depression, and anxiety."

Research into disaster situations shows that emotional distress is prevalent in affected populations — a similar global trend is now manifesting within communities affected by the Covid-19 pandemic. In the aftermath of major disasters, the onset of post-traumatic stress disorder (PTSD) in those exposed to trauma is common-place3. So, are the mental health problems arising from the pandemic similar to PTSD?


Why are People Experiencing PTSD?

Ugalde explains that "PTSD is characterized in part by agitation, irritability, hostility, hypervigilance, social isolation, loss of interest in activities, loneliness, and emotional detachment. It tends to be caused by witnessing or experiencing trauma. As a worldwide community, we have been witnessing communal traumatic stress from COVID-19 restrictions, hypervigilance of hygiene and exposure, and found ourselves doing our best to keep mentally stable while enduring continued stress."

Those who suffer from COVID-19 may experience physical symptoms and discomfort, social isolation, and may be concerned about their survival. The need to self-quarantine then removes their immediate physical support network. All these components could increase the risk of developing PTSD 4.

When looking at the impact of lockdown, research conducted in China during the first month of the pandemic investigated the mental health of home-quarantined youths. Results showed that 12.8% had symptoms consistent with PTSD. The symptom levels were expected to increase as quarantine continued. This is important as a formal diagnosis of PTSD requires symptoms to persist for more than a month 5.

The central components of a traumatic experience include threat, helplessness, and disconnection. Many of these components are currently being experienced by the general population. This goes some way to explaining why an increase in PTSD symptoms is presently being experienced.


Long Term Mental Health Effects

Ugalde goes on to discuss the long-term impact of the pandemic. "With COVID-19, we have not been able to fully process it all because it is long term and complex traumatic stress. Other trauma lies underneath, such as homelessness, loss of work, loss of loved ones, and witnessing political unrest in the media."

In the British Medical Journal, scientists report that the pandemic's mental health impact is likely to last much longer than any physical impact 6. Also, the economic recession that will follow is expected to increase social inequalities that lead to an increased prevalence of mental health problems 7.

"There will be no vaccine for these mental health impacts of the covid-19 pandemic."

The BMJ Opinion, May 5th 2020 6


Challenges to Receiving Mental Health Support

With the uncertainty of the future and conflicting messages from public authorities, it is not surprising that mental health services are needed now more than ever. However, despite the growing need, the World Health Organisation reports that the COVID-19 pandemic has disrupted or stopped critical mental health services in 93% of countries worldwide 8.

Ugalde advises that there are challenges to accessing mental health support. "The greatest challenge at this time is making sure that people have the right insurance, are aware of the resources available, and acknowledge the need for support." Many people may not be aware that psychiatric support and counseling are available online or over the phone from many professionals.

When discussing these challenges, Ugalde goes on to stress that help is available. "Mental health professionals are doing everything we can to provide support. Whether it is through video calls, telephone sessions, or depending on the agency- in-person sessions following CDC guidelines." Online mental health support is an extremely effective way to access help from the comfort of your own home.


Focus on Family and Friends

Ugalde offers this advice on how to ease the mental health burden on families:

"Make sure you are focusing on what is in front of you; your family and friends. Whether they are in person or on the screen, you will only be able to ease your mental burden by appreciating those small pieces of positivity and holding on to them with everything you have. When we let our negativity engulf us, we can become narrow-focused. This holiday, do your best to keep an open mind. Use empathy and validation with your family members, encourage having fun however you can, and do not hold unrealistic expectations of yourself and others."

In this unprecedented time, every family will be facing stressful situations that they may not have experienced before. It is essential to support friends and loved ones. If you are concerned about someone, help them acknowledge that they may need support and assist them in accessing the mental health resources they need.



References:

1. Czeisler M, Lane R, Petrosky E et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1049-1057. doi:10.15585/mmwr.mm6932a1

2. Leeb R, Bitsko R, Radhakrishnan L, Martinez P, Njai R, Holland K. Mental Health-Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic — United States, January 1–October 17, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(45):1675-1680. doi:10.15585/mmwr.mm6945a3

3. Pfefferbaum B, North C. Mental Health and the Covid-19 Pandemic. New England Journal of Medicine. 2020;383(6):510-512. doi:10.1056/nejmp2008017

4. Post-traumatic Stress Disorder during COVID-19 | Psychiatry | Michigan Medicine. Psychiatry. https://medicine.umich.edu/dept/psychiatry/michigan-psychiatry-resources-covid-19/specific-mental-health-conditions/posttraumatic-stress-disorder-during-covid-19. Published 2020. Accessed November 25, 2020.

5. Liang L, Gao T, Ren H et al. Post-traumatic stress disorder and psychological distress in Chinese youths following the COVID-19 emergency. J Health Psychol. 2020;25(9):1164-1175. doi:10.1177/1359105320937057

6. The long term mental health impact of covid-19 must not be ignored - The BMJ. The BMJ. https://blogs.bmj.com/bmj/2020/05/05/the-long-term-mental-health-impact-of-covid-19-must-not-be-ignored/. Published 2020. Accessed November 25, 2020.

7. Recessions and health: The long-term health consequences of responses to coronavirus. Ifs.org.uk. https://www.ifs.org.uk/uploads/BN281-Recessions-and-health-The-long-term-health-consequences-of-responses-to-COVID-19-FINAL.pdf. Published 2020. Accessed November 25, 2020.

8. COVID-19 disrupting mental health services in most countries, WHO survey. Who.int. https://www.who.int/news/item/05-10-2020-covid-19-disrupting-mental-health-services-in-most-countries-who-survey. Published 2020. Accessed November 25, 2020.