Aug. 2022

Special Edition: Coronavirus  5 min COVID-19 and Its Toll on Mental Health

Mental Health
Mental Health © Canva

Humans are social beings – as if we had not known that already, the COVID-19 pandemic serves as a painful reminder. To self-isolate, to socially distance, to refrain from the human touch, to be unable to see people’s faces goes against human nature. It is understandable that “extraordinary times call for extraordinary measures.” Yet, when these measures become everyday life with little to no support offered, they can cost us more than a little self-discipline. They may cost us our mental health.

The pandemic is a textbook case of so-called “collective trauma” or “mass trauma”: the traumatisation of a whole group of people at once caused by a disturbing event. In this case, we are talking about the whole of humanity. The World Health Organization (WHO) reported until now a total infection rate of over 588 million cases of which over six million were deaths (as at August 2022). The actual numbers are probably higher, since the data collection quality varies between countries. Currently, almost all of us know someone who has or had COVID-19 (if not ourselves), and many people know someone who died of its complications. Some of them have lost loved ones.

Loss is nothing new in our lives, however, the circumstances of the pandemic have been exceptional. Usually, people who suffered complications from COVID-19 needed to be hospitalized within few days of their infection and were isolated in special units, with no visitors allowed. Those who passed could not say their goodbyes and neither could their families. Funerals, important ceremonies not for the dead but for the living, were not permitted, and families were denied the consolation and closure these ceremonies provide.

The psychological burden weighs exceptionally heavy on those who brought the infection home to their parents or grandparents and recovered, but their older family members did not. They might feel responsible for the demise of their relatives. They might even feel guilty for being alive, a syndrome known as “survivor guilt.” 

NGOs all over the world have started free psychological helplines to support those who lost their loved ones during the pandemic. The Egyptian NGO Mersal, for example, launched a programme offering free therapy sessions for people facing psychological crises, be it due to loss or for other reasons.

Moreover, the pandemic has put medical staff under severe pressure, from high risks of infection to insane working hours to watching patients and colleagues die on a regular basis. Healthcare professionals witness death all the time, especially in emergency and intensive care units, yet not on the scale of a pandemic. Medical personnel in developing countries work under even more difficult circumstances, facing shortages of hospital equipment and medical supplies. They must make do with whatever they can get and risk their lives for pittances. A hotline was launched by the Egyptian General Secretariat of Mental Health which provides psychological counselling sessions for medical staff.

Economic and social repercussions

The impact of the pandemic does not stop at loss and burnout, it also has economic and social repercussions. According to the International Labour Organization (ILO), “8.8 per cent of global working hours were lost” in 2020 (relative to the fourth quarter of 2019), which equalled “255 million full-time jobs […], hitting 114 million people, […] [and resulting] in an 8.3 per cent decline in global labour income (before support measures are included), equivalent to US$3.7 trillion or 4.4 per cent of global Gross Domestic Product (GDP).” As for 2021, the ILO estimated that global hours worked in 2021 are 4.3 per cent below pre-pandemic levels, wich is the equivalent of 125 million full-time jobs. More importantly, it warns of “a great divergence” in employment recovery trends between developed and developing countries: “Europe and Central Asia experienced the smallest loss of hours worked, compared to pre-pandemic levels (2.5 per cent). This was followed by Asia and the Pacific at 4.6 per cent. Africa, the Americas and Arab States showed declines of 5.6, 5.4 and 6.5 per cent respectively.”

NGOs in Arab countries are breaking their backs to assist those affected by the pandemic, above all day labourers. In Algeria, the initiatives Le cœur sur la main and SOS Kabylie have been providing struggling families with food, clothing or school supplies until they can support themselves again. However, the statistics of the ILO for Arab countries show that more state involvement is needed in order to overcome the economic crisis triggered by the pandemic.

Even people who have not lost their loved ones or jobs to the pandemic can be victims of this collective trauma, as, once more, uncertainty and panic have proven to be more contagious than any microbe. The media have played a significant role in creating this anxious climate, especially at the beginning of the pandemic, when even reliable sources remained indecisive about crucial things, such as whether to wear a face mask or not. This situation fuelled a great deal of “fake news”, spreading fear with information that was not scientifically backed.

The psychological effect of lockdowns

When there finally was enough empirical evidence of the lethality of the virus and death tolls were rising exponentially, countries went into complete lockdown one by one. The lockdowns alone had a profound psychological effect on people. Children could not go to school and many of them, above all those with behavioural problems, began to show clear signs of psychological disturbance. Paediatrician and child psychotherapist Dr Amal Nofal summarised their plight as follows:

“[Due to COVID restrictions,] children were left only with mobile phones and computers as sources of entertainment. Many children spent the whole day playing games (fighting and aggressive games), watching Youtubers or cartoons. This impacted their social skills, made them very aggressive towards other children, and reluctant to go back to school or trainings, to study or share in family chores. Other children were affected by high levels of anxiety at home, for instance due to the loss of family members and acquaintances to COVID. I have observed an increase in the incidence of children suffering from OCD or depression.”

The social isolation also significantly impacted adolescents and young adults. Activities with friends are just as vital for the healthy social development of these age groups as for children. Dr. Nofal adds,

“Adolescents, as well, had nothing but social media and electronics to turn to, which affected them deeply and in many different ways, including alienation from their families, as their ideas and thoughts were shaped more decisively by social apps and virtual friends. Game and internet addictions became more common, as did depression and anxiety due to a poor social life and fear of the future.”

Furthermore, many young people were unable to experience – fully or at all – some of life’s most important events due to COVID restrictions, such as their first year in college, graduation, or weddings. A meta-analysis of 48 studies covering 204 countries published by The Lancet in octobre 2021 compares the prevalence of major depressive disorder and anxiety disorders before and during the Pandemic. The results indicate an increase of 27.6 per cent in major depression and 25.6 per cent in anxiety disorders due to COVID-19. Countries hit worst by the pandemic showed the highest rates, including Egypt, Iraq, and Saudi Arabia in the Middle East. The study also showed that women and young people were more susceptible to pandemic-related depression and anxiety. No matter the age, however, the lockdown situation was fraught with stress, especially for the most vulnerable, be it socioeconomically or psychologically.

Rules, newly gained freedom and adaption

At the beginning of the pandemic, panic gripped everyone, and the survival instinct kicked in. This manifested itself very clearly in supermarkets, of all places. The positive side to this panic was that people became more compliant with the rules. In 2020, people were much more willing to wear face masks and use antiseptics than now, simply because the situation was still new and perceived as dangerous. In unprecedented emergencies, we tend to follow others, especially those who we consider experts, a psychological phenomenon known as “informative social influence”. Yet now, even though the pandemic is not over, the number of people rebelling against COVID measures, including vaccination, is on the rise. An increasing number of people perceive measures no longer as protection but as restriction to their freedom.

Thanks to several mitigations, such as working from home and online classes, and loosening of measures, including the reopening of non-essential stores and return to travel, a degree of adaptation to the situation has occurred, even without us noticing. Humans are masters of adaptation. The question is: Can we really adapt to a traumatic event? The answer is: Yes, it is possible. Adapting to traumatic events is what is known as “resilience”. According to the Lancet study, the pandemic left millions of people clinically depressed and anxious. Those people need to be treated first, as only then can they start the processes of adapting to the new reality. A person who is depressed because they lost their partner or job is in no condition to adapt.

Now, the real question is this: Governments have imposed lockdowns and all those strict measures to prevent the collapse of healthcare systems. But who is going to pay the price for this collective trauma? Will it at the end not affect the same healthcare systems?

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