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Reflections on the collective mental health trauma of Covid-19

As we emerge from the pandemic, many people will suffer psychological problems for years to come

'The information we have now about the impact of Covid-19 on the world’s mental health is just the tip of the iceberg,' says WHO chief. Photograph: DonkeyWorx

June Shannon
Wed Jan 11 2023 - 05:31

It is Health Season in The Irish Times

It is now more than three years since the emergence of Covid-19 which led to a long period of uncertainty and interrupted lives.

In January 2020, human-to-human transmission was confirmed by the World Health Organisation (WHO), and the following month the first case of the disease was confirmed in Ireland.

Three years ago, life, as we knew it, was put on hold, livelihoods were lost and childhoods suspended.

Words that once seemed alien, such as social distancing and variants, have become all too familiar over the past 36 months.

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It is hard to imagine that we have lost almost three years of our lives to a pandemic; harder still that, to date, according to the WHO, more than 6.6 million people have died.

Speaking in March 2021, WHO director general Dr Tedros Adhanom Ghebreyesus said the mass mental health trauma of the Covid pandemic exceeded that of the second World War and could last “for many, many years to come”.

WHO director general Tedros Adhanom Ghebreyesus.

“Now, even with this Covid pandemic, with bigger magnitude, more lives have been affected; almost the whole world is affected, each and every individual on the surface of the world actually has been affected. That means mass trauma, which is beyond proportion, even bigger than what the world experienced after the second World War and when there is mass trauma it affects communities for many years to come. So, the mental health problem is not an issue of just current, during the pandemic but even for many, many years to come and countries have to see it as such and prepare for that.”

In a country like Ireland, this is the first time that this generation has seen the raw force of nature shake the foundations of our way of life

—  Prof Brendan Kelly, professor of psychiatry at Trinity College Dublin

According to the WHO, in the first year of the pandemic, global prevalence of anxiety and depression increased by 25 per cent.

A scientific brief released in March this year by the WHO shows that the pandemic has affected the mental health of young people and that they are disproportionally at risk of suicidal and self-harming behaviours. It also indicates that women have been more severely impacted than men and that people with pre-existing physical health conditions – such as asthma, cancer and heart disease – were more likely to develop symptoms of mental disorders.

“The information we have now about the impact of Covid-19 on the world’s mental health is just the tip of the iceberg,” said Dr Ghebreyesus. “This is a wake-up call to all countries to pay more attention to mental health and do a better job of supporting their populations’ mental health.”

Commenting on the impact of the pandemic on our collective mental health, Prof Brendan Kelly, author and professor of psychiatry at Trinity College Dublin, said we have all been affected by the pandemic to greater or lesser degrees and its psychological effects have been “widespread and significant”.

“A collective experience like Covid-19 affects our shared understanding of our place in the world, and how predictable that world is. For many, the world feels more uncertain now, or perhaps we realise how fragile it was all along,” Prof Kelly said.

According to Prof Kelly, two main issues are at play as we emerge from the pandemic. Firstly, people with pre-existing mental illness are having particular difficulty due to relapses of illness and the lingering effects of difficulties they had accessing care throughout the pandemic.

Secondly, he said that many people are “struggling to return to life with the same vigour as before”.

“These are re-entry problems, characterised by reluctance to resume certain activities such as socialising or going to the movies, and free-floating anxiety or unease, which can be difficult to name in your life, but can be very real. Becoming aware of these feelings is the first step towards overcoming them.”

In a December 2020 research paper published in the Irish Medical Journal, entitled The Impact of Covid-19 on Mental Health in Ireland: Evidence to Date, Prof Kelly wrote: “Evidence to date shows that the combined effect of the Covid-19 pandemic and associated restrictions is that approximately one person in every five in the general population in Ireland (and elsewhere) has significantly increased psychological distress (eg anxiety, depression). Risk factors include being female and living alone.”

Two years on from this article, Prof Kelly said that while things were improving, they were doing so slowly and gradually. “That high level of stress and anxiety will subside over time, rather than disappear quickly. Also, people affected by long Covid often have substantial problems with emotional issues, psychological symptoms, and, for some, clinical depression. Treatment and support can be provided, but we need to remain aware of this condition into the future. The situation is certainly improving, but gradually.”

Brendan Kelly is a professor of psychiatry.

Asked if our mental health was currently suffering from a pandemic “hangover” and how that might manifest, Prof Kelly said that “we see lingering problems in a reluctance to emerge fully from our Covid shells, in a generalised anxiety that is hard to put a finger on, but is very real, and in a deepened sense of uncertainty about the world, for many”.

“In a country like Ireland, this is the first time that this generation has seen the raw force of nature shake the foundations of our way of life. Other countries experience tsunamis, floods, volcanoes, famines and epidemics more frequently than we do. For many Irish people, this was the first time the brutal forces of nature struck so hard and so close to home.

“That has impacted our sense of safety in the world, our misplaced confidence about our place in the order of things. But it is just a hint of what lies ahead if we do not address the climate emergency with all the focus and vigour we marshalled for Covid. The pandemic proved that we are more capable of this kind of response than we had previously imagined.”

While populations the world over were affected by the global pandemic, it was clear from early on that the mental wellbeing of some sections of society were more negatively impacted than others. Certain groups such as healthcare workers and people with pre-existing mental health conditions, for example, were particularly vulnerable.

Prof Kelly explained that during the pandemic, approximately one in five people in the general population had more levels of stress, anxiety or depressive symptoms than they could manage using their usual resources, while the number of healthcare workers affected in this way was double that or two in every five.

It is important, then, to remember that just as the impacts of the pandemic were more challenging for some, so too will be their recovery. “For people with pre-existing mental illness, services were difficult to access, and many were at increased risk of Covid-19 itself. During the pandemic, the odds of infection with Covid-19 were over seven times greater in people with depression or schizophrenia compared to the general population. These are shocking statistics that made a diagnosis of mental illness one of the largest single risk factors for contracting Covid-19. People with mental illness have always suffered systematic discrimination in health and social care in every country around the world. Health emergencies exacerbate that problem, as we saw with Covid-19, so recovery, although very possible, will be more challenging,” Prof Kelly said.

Older people were another sector of society whose mental wellbeing was at increased risk during the pandemic due to factors such as fear of infection, loneliness and social isolation. According to experts at the Faculty of Psychiatry of Old Age at the College of Psychiatrists of Ireland, long periods of isolation and dependency on others was “detrimental” to older people’s confidence.

“People under our care have shared their experiences of their changed perceptions about themselves. ‘I never thought of myself as a vulnerable person before this,’ was the experience of some people. The forced isolation forced a change in the opposite direction to what was persistently advised and fostered as part of healthy ageing before Covid. This caused a major disconnect in families. Elderly relatives living alone received fewer visits, people could not do their own shopping because of the fear of infection, and this increased dependency on others was quite detrimental to people’s confidence. News, conversations on the media were dominated by deaths and infection rates, so even in their isolation, there was an element of fear and not being able to escape the emotional impact of the pandemic.”

People who are still hesitant about crowds or large events should not force themselves too hard but should make lots of little efforts to move out that little bit further

—  Prof Brendan Kelly, professor of psychiatry at Trinity College Dublin

The introduction of vaccines and the easing of restrictions in particular brought with it a hope of restoration of normality for older people, the faculty said. It advised that in order to maintain good mental health over the coming months, older people should try to remain as active as possible. “Stay active, look after your cardiovascular health, eat well, don’t smoke, if you drink, do so in moderation, and stay connected. Loneliness is very bad for your physical and mental health.”

We have learned as a society the negative impact of social isolation and we hope that we can plan for a more socially engaged and connected society in the future, it added.

According to Prof Kelly, the pandemic increased emotional distress across the population in general, led to relapses among some people with pre-existing mental illness, and increased mental health needs for certain groups. However, he said this “should be balanced against plentiful evidence of strength, resilience and adaptation seen during the pandemic”.

“If prior to Covid-19, someone had told me there would be a global pandemic, millions would die, societies would lock down, economies would grind to a virtual halt, schools would close and international travel would cease, I would have imagined that nobody could cope with such a situation. I would have been wrong. Our resilience and coping mechanisms proved stronger than I thought. Many people had psychological problems, and some still do, but an equal number – or more – did not. We are stronger than we think. We were always stronger, but we never realised it until now.”

Looking to the future, Prof Kelly said the best way to look after our mental health in the coming months was to remember that it and our physical health are closely intertwined. “The best advice is to take some exercise, keep an eye on your diet and take active steps to reintegrate into society at your own pace. People who are still hesitant about crowds or large events should not force themselves too hard but should make lots of little efforts to move out that little bit further, stay out that little bit longer and take small, steady steps back to enjoying the social activities they enjoyed before Covid. It’s time, but it will take time.”

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