Maintaining Mental Sanity In The COVID-19 Pandemic

As part of efforts to contain the spread and devastation of the novel coronavirus (COVID-19) in Nigeria, President Muhammadu Buhari, had on Sunday, March 29, 2020, ordered a total shutdown of Lagos, Abuja, and Ogun states.

Total shut down of nations and cities and the concomitant social distancing, it is meant to achieve, has shown to be very effective in China, South Korea, Singapore and other nations in reducing the spread of the virus.

But the drastic measure comes at a huge cost. It is feared that some people are particularly vulnerable to loneliness, social isolation and other mental health problems that may arise from long-term social distancing during the coronavirus pandemic.

Also, all over the world, some people are losing their jobs. There have been rising cases of suicide due to the raging COVID-19 pandemic. Mental health experts are warning that losing everyday social connections comes with psychological costs. And those costs could go up the longer such measures drag on.

In response to the accelerating pandemic, besides Lagos, Ogun, and Abuja, a growing number of states have banned all nonessential activities and asked residents to stay home. Across the country, colleges and offices have gone entirely online; schools and restaurants are closed and nursing homes are barring visitors. Such social distancing can stop, or at least slow, the spread of COVID-19.

Several studies have shown that the most vulnerable are the elderly and health workers including doctors, nurses and other allied health professionals.

According to the World Health Organisation (WHO), as the coronavirus pandemic rapidly sweeps across the world, it is inducing a considerable degree of fear, worry, and concern in the population at large and among certain groups in particular, such as older adults, care providers and people with underlying health conditions.

The WHO noted that in public mental health terms, the main psychological impact to date is elevated rates of stress or anxiety. But as new measures and impacts are introduced – especially quarantine and its effects on many people’s usual activities, routines or livelihoods – levels of loneliness, depression, harmful alcohol and drug use, and self-harm or suicidal behaviour are also expected to rise.

Healthcare Workers At Risk Of Mental Health Problems

Although there are no statistics available yet to prove mental health issues and suicides are increasing, the discussions with health workers and others clearly point in that direction.

On March 26, 2020, an Italian nurse had committed suicide just days after testing positive for COVID-19 because she feared she had spread the disease to others.

READ MORE: Coronavirus: How Do I Get Tested In Nigeria?

Also, the finance minister of Germany’s Hesse state, Thomas Schaefer has committed suicide apparently after becoming “deeply worried” over how to cope with the economic fallout from the coronavirus.

Director-General of the Nigeria Centre for Disease Control (NCDC), Dr Chikwe Ihekweazu, told The Guardian that frontline health workers are going through a lot of stress and psychological trauma and Nigerians should support not criticise them.

The epidemiologist said: “Everybody should support healthcare workers. Stop criticising us in the middle of a war. You don’t do that to soldiers during a war. Help the health workers, encourage them and buy them food if possible, be kind to them. We need them now more than ever. They are the ones in the middle of everything.”

President Muhammadu Buhari in his address on Sunday said: “I will take this opportunity to thank all our public health workforce, health care workers, port health authorities and other essential staff on the frontlines of the response for their dedication and commitment. You are true heroes.”

Meanwhile, a new study has examined the mental health of nearly 1,300 healthcare workers in China who dealt with COVID-19 patients. The research looked at symptoms of depression, anxiety, insomnia, and distress.

Chikwe Ihekweazu. Photo: NCDC

New research offers insights into the mental health of healthcare workers who are directly engaged in treating COVID-19. Jianbo Lai, from the department of psychiatry at the First Affiliated Hospital of Zhejiang University School of Medicine in Hangzhou, China, is the first author of the study, which was published in the journal JAMA Network Open. Lai and colleagues set out to examine the mental health outcomes of healthcare professionals who treated patients with COVID-19 in China.

Namely, they looked at healthcare professionals who worked in 34 hospitals that had fever clinics or wards for COVID-19 patients. Frontline healthcare professionals “who are directly involved in the diagnosis, treatment and care” of people with COVID-19 were at the
heart of the researchers’ interest.

These workers may be at a heightened risk of psychological distress and other mental health problems, wrote the authors, due to the ever-increasing number of COVID-19 cases, the overwhelming workload, an information overload, and insufficient personal protective equipment and drugs. Furthermore, the authors note, existing studies show that in similar situations, healthcare workers experience stigmatization, as well as fear of infection for themselves and their families.

Lai and the team “collected demographic data and mental health measurements from 1,257 healthcare workers in 34 hospitals from January 29, 2020, to February 3, 2020.” Only hospitals with COVID-19 wards and fever clinics were eligible.

To assess the severity of symptoms of depression, anxiety, insomnia, and distress, the researchers used the Chinese versions of the “nine-item Patient Health Questionnaire, the seven-item Generalized Anxiety Disorder scale, the seven-item Insomnia Severity Index, and the 22-item Impact of Event Scale-Revised.”

The researchers applied multivariable logistic regression analysis to find the factors that are associated with mental health problems. The participation rate for the survey was 68.7 percent. More than 64 percent of the respondents were between the ages of 26 and 40 years, and over 76 percent of them were women.

More than 60 per cent of the respondents were nurses, while physicians accounted for just over 39 per cent. Frontline healthcare workers made up 41.5 per cent of the respondents.

Overall, the study found that:
* 50.4 percent of respondents had symptoms of depression, 44.6 per cent had symptoms of anxiety, 34.0 per cent reported symptoms of insomnia, and 71.5 per cent reported feelings of distress.
* “Nurses, women, frontline healthcare workers, and those working in Wuhan, China, reported more severe degrees of all measurements of mental health symptoms than other healthcare workers.”
* Frontline healthcare workers who directly engaged in the diagnosis, treatment and care of COVID-19 patients had a higher risk of depression symptoms.

Specifically, frontline healthcare workers were 52.0 per cent more likely to have symptoms of depression, 57.0 per cent more likely to have symptoms of anxiety, 60.0 per cent more likely to experience distress, and almost three times as likely to have insomnia than those who were not on the frontline.

Furthermore, 18.0 per cent of frontline healthcare workers who experienced depression had a severe form of the condition, compared with 12.9 per cent of second-line workers.

Also, 34.7 per cent of frontline workers who experienced anxiety had severe symptoms compared with 25.0 per cent of second-line workers. Similarly, 12.3 per cent had severe insomnia compared with 4.5 per cent of second-line workers, and 42.1 per cent of frontline specialists who had psychological distress experienced severe symptoms, compared with 29.9 per cent of second-line workers.

Lai and colleagues conclude, “Compared with working in second-line positions, working in the frontline directly treating patients with COVID-19 appeared to be an independent risk factor for all psychiatric symptoms after adjustment for confounders.”

“Protecting healthcare workers is an important component of public health measures for addressing the COVID-19 epidemic,” they continued.

“Special interventions to promote mental well-being in healthcare workers exposed to COVID-19 need to be immediately implemented, with women, nurses, and frontline workers requiring particular attention.”

Mental Health And Psychological Resilience

According to the WHO Regional Director for Europe, Dr Hans Henri P. Kluge, as COVID-19 pandemic sweeps across the world, it is causing widespread concern, fear and stress, all of which are natural and normal reactions to the changing and uncertain situation that everyone finds themselves in.

“The issue facing each and every one of us is how we manage and react to the stressful situation unfolding so rapidly in our lives and communities. Here we can draw on the remarkable powers of strength and cooperation that we also, fortunately, possess as humans. And that is what we must try to focus on to respond most effectively to this crisis as individuals, family and community members, friends and colleagues,” said Kluge.

WHO takes the impact of the crisis on people’s mental health very seriously and is monitoring the situation together with national authorities, while providing information and guidance to governments and the public.

At a press briefing held on March 26, 2020, Kluge, together with Dr Aiysha Malik, Technical Officer, Department of Mental Health and Substance Abuse, WHO Headquarters and Dr Dorit Nitzan, Acting Director of Emergencies, WHO/Europe, answered questions on mental health issues in the context of COVID-19 and offered insights on tools, techniques and interventions to address them.

“With the disruptive effects of COVID-19 – including social distancing – currently dominating our daily lives, it is important that we check on each other, call and video-chat, and are mindful of and sensitive to the unique mental health needs of those we care for. Our anxiety and fears should be acknowledged and not be ignored, but better understood and addressed by individuals, communities and governments,” Kluge noted.

The COVID-19 Crisis On Children’s Mental Health

This is indeed an unprecedented time for all of us, especially for children who face an enormous disruption to their lives. Children are likely to be experiencing worry, anxiety and fear, and this can include the types of fears that are very similar to those experienced by adults, such as a fear of dying, a fear of their relatives dying, or a fear of what it means to receive medical treatment. If schools have closed as part of necessary measures, then children may no longer have that sense of structure and stimulation that is provided by that environment, and now they have less opportunity to be with their friends and get that social support that is essential for good mental well being.

Being at home can place some children at increased risk of, or increased exposure to, child protection incidents or make them witness to interpersonal violence if their home is not a safe place. This is very concerning.

Although all children are perceptive to change, young children may find the changes that have taken place difficult to understand and both young and older children may express irritability and anger. Children may find that they want to be closer to their parents, make more demands on them, and, in turn, some parents or caregivers may be under undue pressure themselves.

Simple strategies that can address this can include giving young people the love and attention that they need to resolve their fears, and being honest with children, explaining what is happening in a way that they can understand, even if they are young. Children are very perceptive and will model how to respond from their carers. Parents also need to be supported in managing their stressors so that they can be models for their children.
Helping children to find ways to express themselves through creative activities, and providing structure in the day – if that is possible – through establishing routines, particularly if they are not going to school anymore, can be beneficial.

Mental health and psychosocial support services should be in place, and child protection services need to adapt to ensure that the care is still available for the children of families who need it.

The Psychological Impact On The Elderly

Regarding older people and also those with underlying health conditions, having been identified as more vulnerable to COVID-19, and to be told that you are very vulnerable, can be extremely frightening and very fear-inducing. The psychological impacts of these populations can include anxiety and feelings of stress or anger. Its impacts can be particularly difficult for older people who may be experiencing cognitive decline or dementia. And some older people may already be socially isolated and experiencing loneliness, which can worsen mental health.

On a positive note, there are many things that older people can initiate themselves or with the support of a carer, if needed, to protect their mental health at this time. These include many of the strategies that we are advocating across the entire population, such as undertaking physical activity, keeping to routines or creating new ones, and engaging in activities, which give a sense of achievement.

Maintaining social connections is also important. Some older people may be familiar with digital methods and others may need guidance on how to use them. Once again, the mental health and psychosocial support services and other services that are relevant to this population must remain available at this time.