Psychological impact of covid 19
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Psychological impact of covid 19 on Patients, Public and Health Care Workers
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Psychological impact of covid 19
- 1. Psychological Impact of COVID-19 Dr. Aziz Mohammad FCPS Asstt: Professor Psychiatry KMC/KTH
- 2. Learning Objectives… • Understand the human response to Stress like the COVID-19 Pandemic. • Understand Psychological Impact of the pandemic in public and HCWs. • Why rumors spread so quick even if there is no Internet. • Know about some neuropsychiatric presentations in patients severely infected and those recovered from severe COVID-19. • Understand the vulnerability and protective factors related to psychological comorbidities in COVID-19. • Measures that can be taken to minimize these morbidities.
- 3. Stress & Human Response “Stress is the reaction people have toward excessive pressures or other types of demand placed upon them. It arises when they worry that they can’t cope (Rubenstein, 1999)” Our body’s response to circumstances or events that frighten, irritate, confuse, endanger, or excite us.
- 4. STRESS Behavioural Sleep disturbance Use of alcohol/drugs Absenteeism Aggression Emotional Depression/anxiety Irritability Crying Suicide Loss of humour Worrying Cognitive Lack of concentration Negative thoughts Poor Memory Biochemical Increased metabolic rate Altered hormone and Neurotransmitters levels Physiological Higher blood pressure Rapid breathing Increased heart rate Dilation of pupils Muscle tension Dry mouth
- 6. Implications of COVID-19 • Global Threat to human life. • State of Uncertainty • Social Distancing • Disrupted Life • Loss to the Economy: Individual, National and International • Stigma • Workload of HCWs • Effects of Quarantine
- 7. Reaction to Stress: ICD-10
- 8. What is a Rumor?? • A currently circulating story or report of uncertain or doubtful truth.
- 10. Why Rumours Spread So Quick…. • Make sense of something which is unclear • People spread Rumors when they feel Anxiety* • People spread Rumors when the information is Important • People spread Rumors when they believe the Information • People spread Rumors when it helps their Self-Image *Walker, Charles & Beckerle, Carol. (1987). The effect of anxiety on rumor transmission. Journal of Social Behavior & Personality. 2. 353-360.
- 11. Impact of COVID-19 pandemic on mental health in the general population (19 Studies, n=93,569 participants)* • Xiong J, Lipsitz O, Nasri F, Lui LMW, Gill H, Phan L, et al. Impact of COVID-19 pandemic on mental health in the general population: A systematic review. J Affect Disord. 2020;277:55-64. Clinical Condition Prevalence Symptoms of anxiety 6.33% to 50.9% Symptoms of Depression 14.6% to 48.3% Post Traumatic Stress Disorder 7% to 53.8% Psychological distress 34.43% to 38%
- 12. Risk Factors (19 Studies, n=93,569 participants)* • Xiong J, Lipsitz O, Nasri F, Lui LMW, Gill H, Phan L, et al. Impact of COVID-19 pandemic on mental health in the general population: A systematic review. J Affect Disord. 2020;277:55-64. Risk Factors Female Single Age <40 Yrs Excessive S. Media Exposure Students Past Psychiatric History Quarantine Status Chronic Medical Condition Low Socioeconomic Status Acquaintance with infected
- 13. Post COVID-19 Psychiatric Morbidity: 2 months • PTSD, Depression and Anxiety: 34.5% • Clinical Significant Post Traumatic Stress Disorder: 25.4% • One or more protracted symptoms: 44.3% Main Predictors of PTSD Symptoms: • Females • Past Hx of Trauma • Protracted Symptoms • Poor Stress Coping *Poyraz BÇ, et al. Psychiatric morbidity and protracted symptoms after COVID-19. Psychiatry Res. 2021 Jan;295:113604.
- 14. Post COVID-19 Morbidity: 4 months • Post Traumatic Stress Disorder Symptoms: (Avg: 20%) • Mild: 25.6% • Moderate: 11.3% • Severe: 5.9% • Loss of Taste and Smell: 17% • Residual Aches and Pains: (8%) *Bellan M, et al. Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four Months After Hospital Discharge. JAMA Netw Open. 2021;4(1)
- 15. Impact of COVID-19 on HCWs (Wuhan, n=1257)* • Distress: 71.5% • Symptoms of Depression: 50.4% • Symptoms of Anxiety: 44.6% • Insomnia: 34.0% *Lai J, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020 Mar 2;3(3).
- 16. Impact of COVID-19 on HCWs (55 Studies, n=68,295)1 • Major common theme of Anxiety=70%1 • Work Stress: 53%2 • Depression in ED nurses=43.61%3 • Severe Mental Disturbance with Suicidal Ideations: 6.5%4 1. Cabarkapa, Sonja et al. “The psychological impact of COVID-19 and other viral epidemics on frontline healthcare workers and ways to address it: A rapid systematic review.” (2020) Brain, behavior, & immunity-health vol. 8. 2. Juan Y. Psychological distress surveillance and related impact analysis of hospital staff during the COVID-19 epidemic in Chongqing, China. Compr. Psychiatr. 2020:152198. 3. An Y, et al. Prevalence of depression and its impact on quality of life among frontline nurses in emergency departments during the COVID-19 outbreak. J Affect Disord. 2020 Nov 1;276:312-315 4. Zhang W.R. Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychother. Psychosom. 2020:1–9.
- 17. The Brain is actually affected directly in certain cases. + • Neurological Manifestations=(36.4%)1 • Encephalopathy: 93 reported cases, including • 7% of 214 hospitalized patients with COVID-19 in Wuhan, China • 69% of 58 patients in intensive care with COVID-19 in France. • Manic Episodes: 21 reported cases, 17 were on Steroids. • Cerebrovascular Diseases=(5.7%)2 • Reactive psychoses: 4 Cases reported in Spain2 1. Mao L, Jin H, Wang M, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683–690. 2. Valdés-Florido, et al. “Reactive psychoses in the context of the COVID-19 pandemic: Clinical perspectives from a case series.” Revista de psiquiatria y salud mental vol. 13,2 (2020): 90-94.
- 18. Moriguchi T, et al.. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis. 2020 May;94:55-58. COVID Encephalitis
- 19. Strategies known to Work…
- 20. Strategies known to Work (Cont…)
- 21. Strategies known to Work (Cont…) • Self coping strategies: (Active Coping)1 • Correct dissemination of information. • Provision of adequate training and resources. • Successful Vaccination. 1. Babore A. Psychological effects of the COVID-2019 pandemic: perceived stress and coping strategies among healthcare professionals. Psychiatr. Res. 2020;293:113366
- 22. WHO Survey: (Changes to Mental, Neurological and Substance use services due to COVID-19)* • June to Aug 2020 • 130 Countries across 6 WHO’s regions Findings: • Disruptions to Mental Health services: 67% Countries • Although 89% of countries reported that mental health is part of their National COVID-19 response plans, only 17% of these countries have additional funding for covering these activities. *https://www.who.int/news/item/05-10-2020-covid-19-disrupting- mental-health-services-in-most-countries-who-survey
Notas do Editor
- F43.1 Post-traumatic stress disorder This arises as a delayed and/or protracted response to a stressful event or situation (either short- or long-lasting) of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone (e.g. natural or man-made disaster, combat, serious accident, witnessing the violent death of others, or being the victim of torture, terrorism, rape, or other crime). Predisposing factors such as personality traits (e.g. compulsive, asthenic) or previous history of neurotic illness may lower the threshold for the development of the syndrome or aggravate its course, but they are neither necessary nor sufficient to explain its occurrence. Typical symptoms include episodes of repeated reliving of the trauma in intrusive memories ("flashbacks") or dreams, occurring against the persisting background of a sense of "numbness" and emotional blunting, detachment from other people, unresponsiveness to surroundings, anhedonia, and avoidance of activities and situations reminiscent of the trauma. Commonly there is fear and avoidance of cues that remind the sufferer of the original trauma. Rarely, there may be dramatic, acute bursts of fear, panic or aggression, triggered by stimuli arousing a sudden recollection and/or re-enactment of the trauma or of the original reaction to it.
- 1. People Spread Rumors When There’s Uncertainty It’s when we don’t already have a firm grasp on how or why things are happening in the world that rumors start to spread. If you can imagine being in middle school again, imagine what would happen if one day, out of the blue, one of your classmates stopped coming to school. There’s a ton of uncertainty there, so people would probably develop and spread rumors as a way to get a handle on what happened. In fact, a field experiment in 1955 did just that: the researchers strategically withdrew a student from a grade school class without explanation. Not surprisingly, rumors started to fly as students tried to make sense of the situation. 2. People Spread Rumors When They Feel Anxiety Oftentimes uncertainty breeds anxiety—we like to have a clear sense of the world, and we get anxious when we feel uncertainty—and anxiety on its own has been linked to rumor spreading. Some research has shown that more anxious people tend to be the ones who are more likely to spread rumors. Another fascinating experiment made some students feel especially anxious about an upcoming interview. The students who were made to feel more anxious spread rumors more quickly than the less anxious students in the control group. Research has also shown that “dread” rumors (i.e., rumors that something bad is going to happen) spread more than “wish” rumors (i.e., rumors that something good is going to happen). This is the case both for rumors spread online and for rumors spread in person. 3. People Spread Rumors When the Information is Important As much as you might be dying to talk about the rumor you heard about the company you work for, I probably don’t care a ton. The reason is that it’s just not that relevant to me. I, on the other hand, would be itching to talk about some other rumor that’s more important to me. In fact, Allport and Postman’s “basic law of rumor” that they developed in 1947 was that spreading rumors depends on both the ambiguity of the situation and the importance of the rumor. Across a whole bunch of studies, people are more likely to spread rumors when the information is more important to them. 4. People Spread Rumors When They Believe the Information Let’s face it—if you hear a rumor that you think is completely ridiculous, you probably won’t find yourself on a mission to spread that information far and wide. For example, one study looked at the spread of rumors during a university strike. It was the rumors that were more believable that ended up spreading the most. 5. People Spread Rumors When it Helps Their Self-Image Plenty of research has shown that people often want to feel good about themselves, but one way people can do that is through rumor spreading. There are a couple reasons this can happen. One is that spreading a rumor positions you as someone who is clued into what’s going on in the world. People might then come to you as the one who’s especially informed. Another way rumor spreading can boost self-esteem is when the rumor is about another group. Other research has shown that putting down other groups can boost people’s self-esteem. Lots of rumors, it turns out, are about a group’s “opposing” group. These have been called “wedge rumors” and serve to reinforce intergroup differences. Clearly, these can boost self-regard by elevating one’s own group about a rival other group. 6. People Spread Rumors When it Helps Their Social Status This might sound like reason #5, but there’s a subtle difference. Reason #5 was that people feel better about themselves when they help spread rumors. There’s a little more to it, though, which is that people can use rumors to strengthen their social ties. Want to be accepted by a group? Pass along some rumors about their rival group. The evidence for this can be seen in studies where people tell different rumors depending on the person they’re telling them to. Specifically, the question was whether people would pass along a rumor that one school group’s ranking had decreased or whether they’d pass along a rumor that the group’s ranking increased. The results showed that it depended on who would be receiving the rumor. If it was someone who was part of that group, people were more likely to spread a positive rumor about them. If it was someone who was part of a rival group, then people were more likely to spread the negative rumor. The point is that people spread rumors strategically, to gain the respect of others.
- After a mean of almost 50 days following the diagnosis, 98 patients (34.5%) reported clinically significant PTSD, anxiety, and/or depression, with PTSD being the most common condition reported (25.4%). One hundred and eighteen patients (44.3%) reported one or more protracted symptom(s). Predictors of PTSD symptom severity were the female gender, past traumatic events, protracted symptoms, stigmatization, and a negative view on the COVID-19 pandemic. PTSD symptom severity was the sole independent predictor of the protracted symptoms.
- It is important to note that professional recognition and ethics can positively reinforce hard work but the value of these are diminished when they are applied in a punitive way that stereotypes HCWs. The emphasis on their self-sacrifice while providing essential and life-saving services becomes magnified in the midst of an epidemic and often HCWs are portrayed as heroes. This in turn can impose certain expectations on them, to demonstrate personal strength and resilience, both emotionally and professionally. However, this can also impede their ability to recognise vulnerabilities or share traumatic experiences, similar in some aspects to military personnel. This may inadvertently increase their mental health risks and stigmatising beliefs, thus prevent them from seeking psychological help (Jones et al., 2018). As such, HCWs must feel free to express their emotions and share experiences, both positive and negative, even when society portrays them as faceless masked agents, and hails them as heroes.
- It is important to note that professional recognition and ethics can positively reinforce hard work but the value of these are diminished when they are applied in a punitive way that stereotypes HCWs. The emphasis on their self-sacrifice while providing essential and life-saving services becomes magnified in the midst of an epidemic and often HCWs are portrayed as heroes. This in turn can impose certain expectations on them, to demonstrate personal strength and resilience, both emotionally and professionally. However, this can also impede their ability to recognise vulnerabilities or share traumatic experiences, similar in some aspects to military personnel. This may inadvertently increase their mental health risks and stigmatising beliefs, thus prevent them from seeking psychological help (Jones et al., 2018). As such, HCWs must feel free to express their emotions and share experiences, both positive and negative, even when society portrays them as faceless masked agents, and hails them as heroes.
- It is important to note that professional recognition and ethics can positively reinforce hard work but the value of these are diminished when they are applied in a punitive way that stereotypes HCWs. The emphasis on their self-sacrifice while providing essential and life-saving services becomes magnified in the midst of an epidemic and often HCWs are portrayed as heroes. This in turn can impose certain expectations on them, to demonstrate personal strength and resilience, both emotionally and professionally. However, this can also impede their ability to recognise vulnerabilities or share traumatic experiences, similar in some aspects to military personnel. This may inadvertently increase their mental health risks and stigmatising beliefs, thus prevent them from seeking psychological help (Jones et al., 2018). As such, HCWs must feel free to express their emotions and share experiences, both positive and negative, even when society portrays them as faceless masked agents, and hails them as heroes.