It is 2021-And the world’s mental health has changed. It is important to reflect on how the last 2 years have reshaped, the field of mental health. None of us have seen a pandemic affecting all nations and people. The many deaths, disruptions, and incessant political battle lines have never been starker. But there have been advances, rethinking of mental health care and indeed reimagining of mental well-being itself. We summarized some of the key findings in the evolving picture of mental health, as new data keeps accumulating.
The pandemic and the mental health of the population
A systematic review of 71 studies showed that anxiety and insomnia are possibly the biggest problems followed by depression and PTSD during the pandemic. Interestingly repeated analyses show that the prevalence of mental health problems is higher outside of China and higher outside of Asia. Suicidal thinking and attempts have increased across the board but it is unclear if the actual rates of suicide have increased. In the general population, mental health problems were highest in those who had COVID-19, followed by healthcare professionals, and then the rest of the population. Across the world, the risk factors for mental health issues are previous mental health history, youth, and low or middle social economic status.
Children and Youth
This group is affected by the pandemic restrictions, but the effect is greater in adolescence. This is also the time when peer relationships are important. Social isolation affects young people’s mental health. The duration of the isolation has a bigger effect than the intensity. Parental stress also increased. Changes in schooling have led to increased stress in teachers, with those from Asia reporting higher anxiety.
Women’s mental health
There are increased demands on women, particularly in their home management roles. Intimate partner violence has also risen across the world. Depression and anxiety have increased in the perinatal period compared to the time before Covid-19.
Loneliness has long been held to be a risk factor for mental health and the pandemic has given us further insights that this applies across age groups. These cuts across all age groups, and are prompting more research in the area. Reduction in social connection affects both mental and physical health.
Addictive behaviours during the pandemic
The use of alcohol and addictive substances is on the rise across the world. Social isolation, economic hardships, impact on mental health are important factors as also the decreased availability of services for people with addictions.
Internet Use and Mental Health
Excessive use of social media was associated with an increased risk of mental health problems. Internet addiction with behaviours such as social media use, online gaming and pornography have also increased during the pandemic period.
The inequity of mental health care
Living in an area with lower income and having poor access to the internet does reduce the chances of receiving mental health care in the Asia-Pacific region. Canada has one of the highest cell phone and internet costs, which surprisingly, has not been a talking point during the pandemic either in the popular press or scientific publications. Such costs would clearly disadvantage many with mental health adversity in both metropolitan and remote areas from access to appropriate treatments.
Work & mental health
Workplaces have changed forever and so should human resource management. The work environments would change and many people would either work remotely or do a hybrid of remote and in-person work. These changes were stressful but now we have to come to agreements on the new normal. This would require redefining work, personal life, functioning as a team, organizational citizenship and new human resource thinking.
The spectre of post-Covid-19 syndromes
After recovery from Covid-19, sufferers may continue to have physical health and mental health problems.
The rate is particularly higher if they have received inpatient hospital care, indicating that the severity of the infection matters. Depression and anxiety are noted, but even the physical health symptoms such as fatigue and loss of smell or taste made an impact on the mental health. Our own study of fatigue shows persistence up to 12 months after recovery from COVID-19. The treatment of all these conditions is improved by adding a psychological approach.
And now the silver linings
Delivery of mental health interventions, changed overnight despite the long-standing concerns of the practitioners to use existing technology. Randomized controlled trials of Internet-based psychological treatments (predominantly CBT) for mental health conditions are reasonably effective. We now have good studies on managing and alleviating loneliness. Several approaches work, but the majority of the studies used cognitive behavioural therapy. Both group and personalized individual treatments work. Positive communication and parenting make a difference in the lives of children and adolescents who are trying to make sense of the unexpected changes in the sensitive years of their lives. The most common technologies for mental health care were video, zoom and WhatsApp. The possibility of access to mental health care has improved dramatically, cutting the cost of inconveniences such as travel, arrangement for child care and the costs around these. We have several effective vaccines for COVID-19 developed in record time. Studies show that having COVID-19 vaccination is linked with a reduction in mental distress. And finally, we do have an answer if government actions matter with regard to mental health. Those countries which implemented strict public health rules based on science have less anxiety and depression compared to countries that followed less rigour.
Opportunities and challenges to better training in evidence-based psychological treatments
Psychological interventions are now recognized as a key force to improve health care across the world. This has created an increased demand for training, supervision and consultation to deliver the therapies with expertise and consistent with the recommendations for evidence-basedtreatments. The dramatic improvement in digital technology has made it possible to have such training available right at students’ and therapists’ homes through video conferencing, webinars, webcasts and app-based approaches. In all this, we must remember that it is not just hours before the screen which shapes the therapist but ongoing practice, supervision, mentorship, coaching and delivery of measurement-based care which eventually makes the difference for them and the people who reach out to them for help.
About the Author:
Dr Sanjay Rao is an experienced teacher and Associate Professor of Psychiatry at the University of Ottawa. In 2018, he was awarded a Fellowship of the Canadian Association of Cognitive Behavioural Therapy for his contribution to CBT in Canada. He has received an award from the Department of Health, UK for CBT development. He is the Director of Unified CBT Academy and the Medical Director at the Center for Mental & Psychological Health.