Mental Health & Wellbeing
Adverse mental health consequences of Covid-19 have been widely predicted but not yet accurately measured. However, previous SARS based research demonstrates that respiratory viral diseases are particularly associated with acute and long-standing psychopathological consequences in survivors (Bohmwald et al., 2018). A review of mental-health post-SARS concludes that during onset of the virus there is a fear for survival and fear of infecting others followed in the latter stage by concerns around stigmatization, reduced quality of life and psychological distress following illness (Gardner & Moallef, 2015).
Pandemics can overwhelm psychological and emotional tolerance (Wade, 2020), and distress associated with fear of illness and uncertainty of the future can result in direct and vicarious traumatisation (Li et al., 2020). Gabor Maté (Youtube, 2020) discussed the impact of the fear response in highly traumatised populations, acknowledging that trauma changes the brains trajectory during developmental years. The amygdala, hippocampus and orbitofrontal cortex all mediate intense states of fear, anger and aggression which intensify or dampen responses. Therefore, populations with developmental trauma may experience a heightened fear response towards a pandemic. This is an under-researched area but one that should be considered when working from a trauma sensitive approach.
Longitudinal research (Daly & Robinson, 2020) found that perceived health risks play a key role in explaining the rising and falling levels of psychological distress. Those perceiving personal risk of infection as high, were shown to experience increased levels of anxiety and reduced psychological wellbeing in the early stages of the pandemic (Karatzias et al., 2020). This is compatible with health belief models that suggest those perceiving higher susceptibility to a severe disease, perceive the risk as particularly threatening which is likely to generate negative affective responses (Mukhtar, 2020).
Early indications suggest a bi-directional association between Covid-19 and psychiatric disorder (Taquet et al.,2020) with survivors at increased risk of psychiatric sequalae, and prior psychiatric diagnosis an independent risk factor for Covid-19. Biologically, the immune response to the virus itself may impact the Central Nervous System (CNS) by precipitating virus-induced psychopathological sequalae with research indicating that psychosocial stress can substantially reduce immune defences leading to levels of inflammatory responses resulting in tissue damage (Rohleder, 2012).
Researchers warn that the virus’s effects on the brain, manifesting as loss of taste (ageusia) and loss of smell (anosmia), could be a harbinger of more serious impacts such as confusion, delirium and even psychosis (Pantelis, 2020). Research indicates that ‘cytokine storms’ involved in the immune response could cause psychiatric symptoms by precipitating neuroinflammation (Dantzer, 2018) as the virus infiltrates the brain directly, via the olfactory nerve, and this impacts areas that regulate emotions and memory.
Meta-analysis from Rogers et al., (2020) of the neuropsychiatric manifestations of SARS revealed that in the post-illness stage, depression (10.5%), insomnia (12.1%), anxiety (12.3%), irritability (12.8%), memory impairment (18.9%), fatigue (19.3%), traumatic memories (30.4%) and sleep disorder (100%) were frequently reported. These findings are supported by preliminary data suggesting that post Covid-19 patients experience confusion, memory loss, depression, anxiety, and insomnia (NIHR, 2020). These conditions are all high-burden non-communicable conditions associated with reduced health and wellbeing and treatment plans should aim to treat individuals holistically (Mazza et al., 2020).