COVID19's Third Wave: Mental Health

By Jesse Howell, PhD. & Gina Uppal

| Nov 03, 2020

TLDR: Critical mental health services have been disrupted in 93% of countries worldwide while the demand for mental health is increasing. This blog dives into how COVID19 has impacted our mental health and presents an urgent need for innovations in population health.

As doctors fight the second wave of COVID-19 on the front-lines, experts are starting to worry about the silent third wave that is building as critical mental health services remain disrupted and preventative cancer screenings reach an all time low.

In Canada, hospitals are already seeing more people presenting with advanced cancers since non-urgent services including screenings were shut down in the spring. This supports a national population-based modelling study using NHS data in the UK that predicted substantial increases in the number of avoidable cancer deaths as a result of diagnostic delays due to the pandemic.

As we treat COVID-19, we cannot forget about prevention and population health. This is especially a concern as the global burden of mental illness has been steadily rising. Between 76% and 85% of people with severe mental disorders receive no treatment for their disorder in low-income and middle-income countries; the corresponding range for high income countries is also high: between 35% and 50%. A further compounding problem is the poor quality of care for those receiving treatment according to the WHO 2013-2020 Mental Health Action Plan.

As the pressure builds, could tech be a release valve? While public health struggles to deliver traditional health promotion strategies, patients and providers are crossing the digital divide faster than ever.

The impact of COVID on global mental health

In Italy, one of the first epicenters of the pandemic, people were already experiencing mental health problems related to COVID-19 even within the first few weeks of shut downs. Specifically, around 40% of people were experiencing post-traumatic stress symptoms, and around 20% were experiencing symptoms of depression, anxiety, and overall stress related to the lockdown (Frontiers in Psychiatry, 2020). Around 7% were experiencing insomnia, which may work to exacerbate symptoms later on. When looking at the stats for the rest of the world on how they responded mentally to the pandemic, this more or less captures the same trends (depression and anxiety are fairly consistent, and usually go hand in hand).

According to a new WHO survey of 130 countries, the pandemic has disrupted or halted critical mental health services in 93% of countries worldwide while the demand for mental health is increasing. Over 60% reported disruptions to mental health services for vulnerable people, including children and adolescents (72%), older adults (70%), and women requiring antenatal or postnatal services (61%). This survey provides the first global data showing the devastating impact of COVID-19 on mental health that will only worsen without intervention.

Who is at risk?

Although most people are feeling the negative effects of this pandemic, some people may be more at risk than others. Specifically, research shows that females, younger age groups (under 40), individuals with chronic illnesses, the unemployed, students, and individuals who frequently consume social media/news concerning COVID-19, might be more at risk (Journal of Affective Disorders).

Not surprisingly, people with pre-existing mental health conditions/anxiety or mood disorders are experiencing more stress during this pandemic. Worse yet, it creates a vicious cycle, as those with anxiety or mood disorders are more likely to self-isolate than those without any mental illness (Journal of Anxiety Disorders). This article also suggests that those with pre-existing conditions should have tailored interventions for COVID-19 related stress. These experiences are further exacerbated in BIPOC and lower income communities who are already marginalized and have increased risk of contracting and dying from COVID19, as health equity remains a core challenge in the pandemic response.

Mental health on the frontline

Health care workers have been on the front lines of the pandemic for over 7 months, and we have at least another 12-18 months before a vaccine relieves the pressure on the system. Not surprisingly, the vast majority of them are experiencing symptoms of mental illness. For instance, in a study conducted in China among frontline healthcare workers exposed to Coronavirus, it was reported that more than 50% were experiencing symptoms of depression, 45% were experiencing anxiety, and 72% were experiencing distress. Of course there are a couple of caveats, as women may be more at risk than men for generalized anxiety disorder, and frontline workers are more likely to experience insomnia than second-line workers (JAMA Network Open Access). These signs are important, because if left unchecked, they will likely develop into something more chronic and severe.

Despite this, like true heroes, 60% of frontline workers report an increase in meaning and purpose since the beginning of the pandemic (General Hospital Psychiatry). Evidence suggests that even in these high stress jobs and unpredictable times, the simple things like a healthy diet, regular exercise, proper sleep patterns, and mindfulness-based programs can have a benefit on their mental well-being (Journal of Head & Neck Sciences).

How might we use digital tools to support these workers in managing their mental health? How do we ensure these reach the groups that need this help most? Could wearables and mindfulness apps be included in benefit plans or provided to workers?

Can tech help bridge the gap?

Almost half the world's population lives in countries where, on average, there is one psychiatrist to serve 200 000 or more people; other mental health care providers who are trained in the use of psychosocial interventions are even more scarce (WHO Mental Health Atlas, 2017). While technology cannot replace doctors and widespread systems change, could it help bridge this massive gap in care?

How can we leverage our smartphones for health? If we get this right, this ubiquitous technology can drive behaviour change at scale in ways we’ve never been able to. Dive into our last blog for peer-reviewed research on wearables and health apps and understand their current efficacy in managing mental illness.

Population health 2.0 is here

Digital therapeutics, or DTx, are a growing class of clinically proven interventions driven by software programs that treat, manage or prevent a medical disorder or disease. These tools have been proven especially effective in managing mental health and chronic conditions. Looking ahead, these tools can help support difficult population based research into experimental interventions like psilocybin that have been believed to have curative properties. With access to these powerful technologies, scientists are pushing the boundaries of medicine to not only treat sickness, but help heal and transform our collective global health.