'Mental health pandemic': A coronavirus side effect
HEALTH AFFAIRS: Are depression, stress and an expected rise in suicides more severe than the COVID-19 disease?
By MAAYAN JAFFE-HOFFMANNEW STUDIES are starting to show that the combination of economic hardship and loneliness is pushing people in Israel and internationally over the edge.(photo credit: CREATIVE COMMONS CC0)
Nearly five months since the novel coronavirus crisis knocked the world askew, another phenomenon has started to converge on society: a mental health pandemic of depression, substance abuse, post-traumatic stress and even suicide.“Mental health and psychological issues will have much harder and much longer-term effects than the disease,” said Irina Nevzlin, author of The Impact of Identity: The Power of Knowing Who You Are. “Pandemics pass eventually, but the aftershock and the post-trauma can be quite dramatic.”In March and April, when the government sent the people of Israel into lockdown, two things could have been predicted, said Dr. Daniel Orenstein: an economic crash and extreme psychological impact from people being scared, alone or not being in physical contact with one another.Orenstein, the principal investigator of the Socio-Ecological Research Group at the Technion-Israel Institute of Technology, explained, “We had two predictable side effects, and in some cases the side effects are turning out to be more severe than the disease itself,” he said.New studies are starting to show that the combination of economic hardship and loneliness is pushing people in Israel and internationally over the edge.A Kaiser Family Foundation poll taken in the US found that nearly half of Americans reported that the coronavirus crisis had harmed their mental health. A similar study published last month by Beth Israel Deaconess Medical Center found that 90% of respondents reported experiencing emotional distress related to the pandemic.The latter study, which surveyed 1,500 American adults during the second half of May, also found that nearly 80% of respondents were frustrated on some level with not being able to do what they normally enjoy doing. Around the same number were worried about their own health, and nearly 90% were more worried about the health of loved ones than before the COVID-19 pandemic.In Israel, almost three-fourths (73.3%) of Israelis feared catching the virus, among them 26.5% of Jews and 46.9% of Arabs who “greatly feared” getting sick, according to a survey published earlier this month by the Israel Democracy Institute.Moreover, already in May, a study published by the Central Bureau of Statistics showed that one-third of Israelis over the age of 21 were stressed and anxious as a result of the coronavirus crisis.One-quarter of parents said their children’s emotional state had deteriorated during the course of the pandemic. Twenty-six percent of people over the age of 65 described themselves as being in a negative mental state, the statistics bureau reported.Furthermore, some 18% of the population described themselves as lonely and 16% as depressed, the report said.ERAN, Israel’s emotional first aid service, has reported a sharp increase in call volume.And finally, mental health professionals in Israel and abroad are saying they expect the number of suicides to increase as a result of the pandemic.“When diseases strike, experts say, they cast a shadow pandemic of psychological and societal injuries,” an article published in May by The Washington Post reads.“The shadow often trails the disease by weeks, months, even years. And it receives scant attention compared with the disease, even though it, too, wreaks carnage, devastated families, harms and kills.”LOOKING AT data collected after other national traumas, such as natural disasters, terrorist attacks and economic downturns, researchers have created models that show this likely increase in suicides and attempted suicides.For example, a team of scientists modeled the effect of unemployment on suicide on the basis of global public data from 63 countries.“We observed that suicide risk was elevated by 20% to 30% when associated with unemployment during 2000–11 (including the 2008 economic crisis),” authors Wolfram Kawohl and Carlos Nordt wrote in their report, which was published by The Lancet. “We have now used this model to predict the effects of the currently expected rise in the unemployment rate on suicide rates.”Close to 800,000 people die by suicide every year, according to the World Health Organization (WHO). In the worst-case scenario of the worldwide unemployment rate increasing to 5.6%, Kawohl and Nordt found there would be an increase of as many as 9,570 suicides per year. In the lower scenario, if unemployment would increase to 5.1%, the world could expect to see an additional 2,135 suicides.However, according to the WHO, each suicide in a population is accompanied by more than 20 suicide attempts. Thus, the study said, the number of mentally distressed people who might seek help from mental health services can be expected to increase in the context of the pandemic, and countries should expect an extra burden on their mental health systems.“Whether this increase will be in the short- or long-term (or both) remains unclear,” The Lancet study reads.A separate study published in World Psychiatry by Roger S. McIntyre and Yena Lee yielded similar results. “The foregoing rapid rise in unemployment and associated economic insecurity is likely to significantly increase the risk for suicide.”According to their data, during the most recent economic recession of 2008, a 1% rise in unemployment was associated with a rise in the suicide rate of 0.99% in the United States. Similarly, each percentage point increase in unemployment was accompanied by a 0.79% rise in suicide in individuals 65 years of age or younger in Europe.Until now, suicide in Israel has generally not been an acute problem and, in fact, has declined in recent years.A report by Macrotrends showed that Israel’s suicide mortality rate was 7.6 per 100,000 people in 2005 and dropped to 5.4 per 100,000 in 2016.In an interview with Media Line, Mark Weiser, head of the division of psychiatry at Sheba Medical Center, said, “In the entire country of Israel, we have about 300-400 suicides a year, in a population of nine million. Even if the rates go up to 1,200 [due to the coronavirus], this is a negligible number of cases.”However, as Golan Shahar, a professor of clinical health psychology at Ben-Gurion University of the Negev and an adjunct professor at Yale University, noted, suicide hides depression, and anxiety and depression always come together. Moreover, the coronavirus crisis has resulted in an increase in “externalized trauma” such as domestic violence and martial problems – psychological and psychiatric outcomes that are summoned by stress.“I don’t know if the ramifications of the virus are worse than the virus,” he said.DR. TALYA MIRON-SHATZ, founding director of the Center for Medical Decision Making at Ono Academic College, added that a German study showed that periods of prolonged unemployment for men could have a long-lasting emotional impact.“The study found that even two years after some unemployed people found work, their level of happiness was lower than others in the same job,” Miron-Shatz said, noting that the shift came because the individuals said they had lost trust in their abilities to provide for their families.She also noted that the world’s obsession with reviewing the number of people dead from the pandemic, something she said has become a “national sport” in Israel, serves as a constant and unhealthy reminder “of our morbidity.”Experts in Israel say the public’s resilience has declined dramatically between the first and second wave, and one of the reasons is an acute loss of trust not only in their ability to manage their own lives, but in the government.“Trust is this fundamental component of all sustainability and resilience,” Orenstein said.He said that in the last month, the lack of trust has become so tremendous that he is seeing even colleagues and friends struggling to trust mainstream information sources.“Anti-vaxxers, climate-change denialists, conspiracy theorists, they are having a heyday with the coronavirus,” he said. “Anyone susceptible to conspiratorial thinking, who does not understand the science or cannot differentiate real and fake news or scientific and folk knowledge, is going to be particularly sensitive in this era.“Some of my colleagues are beginning to doubt official sources of news and wonder if there is something behind all of this that we don’t know,” he continued. “This makes us completely ineffective to create rational policies that deal with all of these conflicting objectives.”The Israel Democracy Institute’s July survey demonstrated what Orenstein described: The public’s trust in the government’s handling of the coronavirus crisis has plunged.Only 40.5% of respondents said they had trust in government medical experts, 29.5% in Prime Minister Benjamin Netanyahu, and 27% in Health Minister Yuli Edelstein.IDI’S Guttman Center for Public Opinion and Policy Research has been asking Israelis these same questions since the early spring, when the pandemic was first hitting the country. During the “first wave,” the prime minister enjoyed trust ratings as high as 57.5% ,and an average rating of 51.5% between the March 29 and June 9 surveys. This newest ranking is his lowest since the start of the outbreak.Some 59.4% of Arabs said they have “no trust at all” in Netanyahu.Similarly, trust in the government’s health experts has declined steadily, from 63% in March to this month’s 40.5% rating. Some 19.6% of Jews and 31.2% of Arabs reported that they “have no trust at all.”For the first time in this most recent survey, IDI measured the intensity of feelings – as opposed to attitudes – toward the government.Some 45% of respondents said they felt disappointed, the survey showed, and 22.5% angry.SHAHAR SAID that in the first wave there was a marked manifestation of resilience on the part of the public. He assessed a representative sample of Israeli adult Jews two days prior to the entry of the virus into Israel, and then six times weekly during the first part of the pandemic. He found that the levels of anxiety increased, but only moderately, and then reached a plateau, finally decreasing in a way that was proportional to the threat.“The public was neither complacent as in Italy nor panicked as many people in the media had predicted,” Shahar said of Israelis during the first wave.But something changed.“I believe the after-shock or the stress of the public is manifesting now in the second wave,” he said.Shahar said he believes that in general Israelis are resilient and have learned to cope with mass stressors. But, he said, Israelis were under the impression that the country’s efforts against coronavirus would be short-term and then would subside.“The fact that the measures implemented were effective, as shown by our success in flattening the curve, was very uplifting, and people sort of put the entire thing behind them, only to find out that the virus is not only here to stay, but in fact, the spread is growing very rapidly,” Shahar said. Moreover, he said the impression that the government did not prepare for the second wave and made mistakes was “demoralizing.”Additionally, said Miron-Shatz, “The coronavirus became to a degree politicized,” which further eroded public trust. “Things went AWOL.”Earlier this week, new coronavirus commissioner Dr. Ronni Gamzu relaunched organized efforts against that coronavirus. The basis of his address to the public was the need for a new social contract.It is time for a new contract between the citizens of Israel and those who are managing the coronavirus crisis, he said, adding, “We have seen a decline in confidence in recent days, and as such, the virus has spread. The new contract: The government does everything logically, quickly and confidently. The citizens obey and cooperate.”Nevzlin said that despite the need for social distancing, this time of crisis and change is ripe for connection.She said that many people are involved in Facebook or other social media groups, but have failed to connect to their families, core community and roots.“The level of disruption is outstanding,” Nevzlin said. “Even someone who is very strong is going to have a tough time going through this.” She recommended using the time to reflect, hold deep conversations with family members and strengthen one’s roots.“Your family should be a comfort zone,” she said. “You might as well make lemonade out of lemons.”At the same time, health experts said that while the government is equipping the medical community with more doctors, nurses and ventilators, it must provide mental health support and suicide prevention interventions, as well.“That is a very complex, stressful situation that threatens to be chronic,” Shahar said.Added Orenstein, “What the government should be doing is focusing all of its attention on resilience – strengthening the weakest sectors of society, finding alternatives for social interactions and education. Everything else is just a distraction.”
