The covid-19 has significantly increased our anxiety levels and experts have warned that a good number of us could suffer more seriously due to the mental health implications going forward and after the pandemic.

Dining out at restaurants with friends and relatives and attending book clubs, it is revealing that Susan Kemp has had a perfect social life before the Coronavirus. Since April when the lockdown began, she’s moved out of her apartment near Stockholm only five times after struggling with sudden social anxiety symptoms and germaphobia from obsessive compulsive behaviours due to the pandemic.

In her experience, “It’s like this stress makes me pass a breaking point where I was able to regulate better.” Kemp is in her 30’s and she’s a copywriter and also a part-time student. She frequently gets afraid thinking of public transport, the cleanliness of cutlery and glass at the restaurants and imagines the images of virus cells lingering around the materials.

The main symptom I experience is that I will start crying because I think I’m going to die. My kind of cry makes my body and lungs feel sore. This is not just a problem because her feelings are repressed and the fears could take many years before her normal feeling is back on track.

While a lot of people have become more anxious during covid-19 lockdown, Kemp’s story highlights that for some of us, the pandemic has sparked or rather amplified severe mental health problems. Psychologists are, however, raising concerns that these effects may linger in a longer term.

 And author of Psychology of Pandemics and professor of psychiatry, Steven Taylor, University of British Columbia, has argued that for a sizable number of people, around 10 – 15 per cent, life will not return to normal because of the impact of the covid19 on mental health. An independent mental health institute, Australia’s Black Dog Institute, also raised concerns about the increased minority who will be affected by severe anxiety over a long period. In the UK also, British Medical Journal has also published that the mental health effect of the pandemic will likely be longer than its physical impact.

From historical standpoint

One of the concerns of people with the issue surrounding the long term effect of coronavirus stems from previous existing insights from history experiences from pandemics and national exigencies.

In 2003, the SARS global outbreak was associated with at least 30% higher suicide rates among people above 65 years of age. Quarantine as a strategy necessary to mitigate the spread of the virus can significantly have negative psychological effect on people such as PTSD, anxiety, insomnia and depression. In fact, job loss and other financial struggles during global economic recession have been associated with decrease in the quality of mental health.

“From history standpoint, the negative mental health effects of disasters affect people more and can last even longer than the health implications” – according to Joshua Morganstein (Centre for the Study of Traumatic Stress in Maryland, US). “If history is our predictor right now, then, we should anticipate “a tail of mental health needs the proceeds long after the COVID-19 is resolved.”

Citing a key research, 25-year retrospective review of the impact of Chernobyl nuclear disaster in Ukraine, it was discovered that two decades post event, first responders to the event had higher increased depression rates and PTSD. Researchers also concluded that mental health effects were the most significant consequences of the disaster that resulted in the death of thousands and damaging of the region’s economy.

Likewise, the research suggests mental health crises, such as PTSD and stress, which is an issue for people who lost their properties during the New Orleans Hurricane Katrina when assessed five year later after the sad event. This report was exacerbated among the people with poor mental health or low income before the hurricane struck.

What are the long term problems that will be linked to covid-19?

Among many mental health issues associated with covid-19 pandemic long lasting effects, psychologists have found obsessive compulsive behaviour to be one of the top problems.

Taylor explains OCD could have a lasting impact because it arises from interaction between genes and environmental factors. People with a genetic predisposition towards OCD such as obsessive cleaning, are likely going to be triggered by the COVID-19 pandemic. Some of those people will develop chronic germaphobes except they begin to receive adequate treatment.

In line with OCD resulting from anxiety, general anxiety is also a very key issue needing attention – said Yuko Nippoda, psychotherapist and spokesperson for the UK Council of Psychotherapy. “There are people suffering from anxiety already and the people tending towards feeling anxious will do so more easily and at the end, the situation might get worse.” “Even when pandemic ends, some people will still be overly-anxious due to the threat of variant strain.”

The chronic loneliness caused by social isolation or hopelessness during the pandemic is another concern, says Nippoda. Some individuals have involuntarily found themselves with fewer social relationships due to social distancing and may even find it really difficult rebuilding their existing networks. Others deliberately withdraw themselves from the outside world because they want to feel safe and as a result become reluctant to increase their social interactions in the near future – Nippola. When people are experiencing stress, they tend to detach themselves from the stressful world. And once they are detached, getting out into the world to socialize becomes very difficult.

Meanwhile, the stress impact of living with covid19 may have a greater mental health impact on people with painful life experience in the past. It may trigger the memory surrounding the trauma consciously and unconsciously. In this present situation, mental health conditions can become a long term thing and can become the doorway to previous traumatic experiences.

I just have this constant fear of losing someone again” – according to Lindsey Higgins, a 35-year old from New York, who has lost her partner to suicide in 2014 and has, since, experienced resurging episodes of PTSD since the pandemic began. After many years of counselling, she believed that “life was about moving forward,” but now gets very nervous each time her current partner leaves the house to engage in his routine. “Obviously, you know, he’s not going to die when he’s out. But there’s still the fear that something bad might happen like getting COVID-19 and get very ill.”

An ongoing unemployment and other financial struggles due to the global lockdown due to the pandemic may impact the persistence of people’s mental wellbeing too. Several former studies link to depression, suicidal ideation/thoughts, and stress have been conducted. A recent data polling from the US revealed that more than 50% of the unemployed or low income earners have reported having negative mental health. And this is the same who had income cuts due to pandemic as well.

Psychologists emphasize that the unforeseen nature and scale of covid-19 crisis adds more layers of uncertainty compared to global financial crises. Until vaccines are provided, it remains devastating if industries and businesses which have been badly hit by the pandemic will recover.

Nippoda explains that this presents a challenging situation for individuals who cannot deal with uncertainty or are struggling to handle uncontrollable situations. We live in uncertain times presently. Some people are fearful towards uncertainty and the unknown and this fear is prolonged.

What do we need to learn?

History can judge the truth of the predictions and expectations. Various organizations and schemes have created guidelines to tackle the issue. Earlier this year, the World Health Organization, published recommendation for safeguarding mental health. Similarly, another guideline has been published by UK and US governments as well as governments of other countries. This month, the American Psychological Association released their report on the lasting impact of the pandemic on stress and how people can cope with a period of uncertainty like this.

Researchers are also gathering empirical evidence with the hope that the data provides a better grasp of the long-term side effects of mental health during a time like this and how to manage it. Major studies in the UK are also looking specifically at the mental health of hospitalized patients with COVID19. and the nurses working on the frontline. In Sweden, some researchers from the Centre for Psychiatric Research in Stockholm are also conducting a year project involving more than 3000 people participants with pre-existing mental health conditions involving depression, OCD, and anxiety. An Australian national survey by the Matilda Centre for Research in Mental Health in Sydney is also assessing the impact of the pandemic on the continuous mental health and wellbeing of the population.

There are concerns that mental health problems may arise but the rising nature needs to be understood – Nitya Jayaram-Lindstom, operations manager for the Stockholm project. According to her, the Swedish research focuses on how much covid19 may have exacerbated the already existing inequality of mental health, how patients’ symptoms develop or change over the next years, and which groups are most affected. “We are also investigating the factors contributing to resilience, which is an important risk factor.

Joshua Morganstein, from the Centre for the Study of Traumatic Stress in Maryland, argues that these projects will be essential resources for both the healthcare providers and the government. “Health surveillance of different populations to understand these aspects of risks is important so that we can provide interventions and plan for subsequent pandemic waves as well as the future public health emergencies” – he said. Stress can be likened to a toxin like lead or radon.” In order to understand it and how it’s affecting a society, it is pertinent to know who is exposed, when was the exposure, how much was exposed, and what effects were caused by the exposure.” Although there is little data so far, Morganstein predicts that long-term studies are more likely to further reveal the wellbeing differences across race, gender, and income, all of which have been highlighted during the pandemic and they need to be taken into cognizance when developing future responses.

The Benefit of resiliance and hope

Despite global concerns about the issues surrounding mental health challenges caused by the covid19 impact, psychiatrists have come out to say there are some positive benefits to it.

Taylor argues that while a large minority may experience long-term struggle, the pandemic has taught a high level of resilience to stress in the general population. And this is alongside humans’ capacity to “recover” after catastrophic events. For example, in Wuhan where the pandemic broke out and cases brought under control after a 76-day lockdown including mass testing, the city stated a “loud” water park music festival in August. Thousands of people gathered together, shoulder-to-shoulder with no masks or social distancing rules. Also, large gigs returned to New Zealand after community transmission of the virus was controlled. We see that these events have taken place despite the fatal mood in January, 2020 when many people were unsure if life would return to normal while some speculated about a Dickensian post-pandemic world. Similar events and gathering will occur in every other part of the world as soon as the pandemic is over – Taylor noted.

Psychotherapist Nippoda suggests that for some individuals, the adverse circumstances of the pandemic have really had a positive impact on their mental health which may be lasting, The lockdown experience has helped people to reduce anxiety levels and stop panic attacks among people with high level of stress associated with daily engagement before the pandemic. This is because to them they have a greater sense of freedom and safety by spending more hours at home. Although social isolation and loneliness are risk factors for those who retreat too much, she opines that the enforced lockdown has helped strive for a better work-life balance in the future and has enabled them to do things at their own pace in life when it comes to socializing – e.g., finding their comfort zone within indoors and outdoors boundaries.

Others have also used the period of social distancing to declutter their houses and the new space within the houses has been thought about positively with the mind as something they can clean up if their heads were the same – says Nippoda. The pandemic has helped increase time for some people to find and develop their hobbies. For instance, making and doing things from the beginning is thought to provide in a person a sense of fulfilment, satisfaction and stress-relief.
But these experiences only ring hollow in the ears of people like Susan Kemp who is still struggling to picture her end to her chronic mental health challenge caused by the pandemic. Obviously, there is a need to have some balancing between being cautious and total hermit that I am not able to achieve – she says. “But I irrationally can’t overcome my fears. These days, it’s hard to choose when I’m being rational or irrational. “

“I find it very tough to rebalance and reintegrate myself,” – Lindsey Higgins, who posited that she’s unsure if her symptoms will subside and improve even if vaccines are created.” “Vaccine distribution will take time and it will be longer convincing other people to also take the vaccine. Truly, I am uncertain if I’ll ever feel secure again.