COVID-19 collateral – strained mental health a global concern

Physical health has come under great scrutiny during the COVID-19 crisis, but related mental health factors may have a longer-lasting, further-reaching, and more significant impact on societal norms and demands on health-care systems.

A review of studies conducted during the COVID-19 pandemic, mostly in China but including the United States, Canada, and European countries, has highlighted alarming trends regarding mental health markers associated with elevated suicide rates. It is important to keep in mind that mental health surveys often rely on self-reporting, which are historically susceptible to response bias.¹ However, surveying a large number of respondents over a broad area can offer a statistically significant trend.

Asia

Traditionally, the population in Asian countries tends to be more susceptible to mental health distress that leads to potentially fatal self-harm. Be it familial and/or societal pressures, stressful work environments, or health-related measures such as vitamin D deficiency, mental health on the Asian continent is a chronic problem and has been the focus of many studies over the last two decades.²

Almost 54% of 1,210 survey respondents in China reported the psychological impact of the COVID-19 outbreak as moderate or severe.³In another study, out of 7,236 Chinese citizens surveyed, more than 35% reported many hallmark symptoms of generalized anxiety disorder.⁴Not all effects on mental health are clinical, but are still important as they affect general societal disposition. An analysis of 17,865 online posts by social media users before and after the declaration of the COVID-19 pandemic in China illustrated a clear negative sentiment, representing a general shift in societal expression to negative emotions including anxiety, depression, and anger.⁵

Canada

A survey of 3,000 Canadians⁶ reported that the pandemic has caused stress and anxiety for most people in Canada, leading to many mental health concerns overall, and increased negative indicators for specific subgroups. In 2019, 2.5% of the general population reported having had thoughts of suicide. In May of 2020, this number more than doubled to 6%.

Certain subgroups showed higher frequency for thoughts of fatal self-harm:

• 18% of those who were already contending with mental illness or mental health issues
• 16% of Indigenous people
• 15% of those with a disability
• 14% of those who identify as LGBTQ+
• 9% of parents of kids under age 18

Even though public health messages indicate that children are less likely to be affected by the virus, 24% of parents of kids under 18 say their children’s mental health is deteriorating due to the societal effects and measures being taken in response to COVID-19. The survey also included positive elements; 66% of parents indicated increased quality time with their children (the extent of parental involvement in children’s lives is positively correlated with their children’s positive mental health),⁷and 59% of respondents indicated they are managing mental health using physical exercise. Pre-COVID, just 22% of Canadians incorporated exercise as a significant part of their lives, even though studies show that regular exercise can reduce the risk for certain conditions by 50%.⁸

United States

A June 2020 web-based survey of 5,470 Americans⁹yielded the following results:

• Almost 31% reported symptoms of anxiety disorder or depressive disorder
• 10.7% reported having seriously considered suicide in the preceding 30 days

At least one adverse mental or behavioural health symptom was reported by:

• Almost 75% of respondents age 18-24 and almost 52% age 25-44
• 66.2% of those who in education hold less than a high school diploma
• 54% of those who are essential workers
• 72.7% of those who were treated for diagnosed anxiety, 68.8% of those who were treated for depression, and 88.8% of those who were treated for post-traumatic stress disorder (PTSD)

This survey, which examined mental health responses in the same month of 2019 to set a baseline, indicates that mental health issues are disproportionately affecting young adults, Hispanic persons, black persons, essential workers, unpaid caregivers for adults, and those receiving treatment for pre-existing psychiatric conditions.

Is Japan a harbinger for projected increase in suicide numbers?

Japan reported its first positive result on a COVID-19 test on January 16, 2020. Researchers in Japan, which ranks fifth highest in the world for suicide rates, found that suicides were down 13.5% January through April of 2020 compared to the same period a year earlier. This trend reversed in July and by August 2020 suicides were up by 7.7% from 2019.¹⁰Data suggests that students and homemakers were in the highest-risk category, and that young women (under age 40) had the greatest spike in cases, reporting a 63% increase from August of 2019.¹¹ Early modelling by researchers in Canada predict a similar overall trend, but monthly totals will be unknown until later this year at the earliest.¹²

A question of self-medication

Across almost all industries, sales have suffered in North America.^{13  14} The trend, however, does not apply to cannabis. Cannabis sales in Canada have increased by more than 75% when comparing April to August of 2020 to the same period in 2019.¹⁵ In the United States, the industry saw a 40% increase in sales over the year prior.¹⁶ Alcohol sales in Canada and the U.S. also appear to be COVID proof, although not so in the rest of the world. In the U.S., there is a 13.3% increase in those who reported having started or increased substance use to cope with stress or emotions related to COVID-19,¹⁷In Canada, 19%¹⁸of survey respondents reported increased alcohol consumption. Globally, however, IWSR “2020 Drinks Market Analysis”¹⁹indicates that alcoholic beverage sales dropped 12% in 2020 compared to 2019.

Is the boon in cannabis and alcohol sales in North America due to customers trying to stave off COVID-19 boredom? Has it been fuelled by generous government unemployment benefits and stimulus cheques? Are attempts at self-medication due to increased anxiety and stress surrounding potential COVID exposure? Is it because of relaxed government regulations and enforcement or limited access to black-market cannabis products that come with border closures? Regardless of cause, the effect is clear. Unlike in the case of most North American sectors suffering the effect of lockdowns and limitations, COVID has been good for the cannabis and alcohol industries.

The COVID-19 pandemic has certainly put its stamp on world history. How we work, interact socially, educate, and even manage our health, have morphed into something almost unrecognizable, and seemingly overnight. Some countries battened down the hatches while others conducted business almost as usual. Economic effects have been mostly negative, but forced adaptation has given birth to collateral social and environmental effects, not the least of which is increased strain on mental health. Time will tell if the effects are long term or if they will fizzle with the virus. In the meantime, we might as well do our best to show compassion for our friends and neighbours who could be on the brink of giving up.

1.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4224297/
2.     https://academic.oup.com/epirev/article/34/1/129/498617
3.      https://academic.oup.com/qjmed/article/113/10/707/5857612
4.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152913/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7111105/
6. https://cmha.ca/wp-content/uploads/2020/06/EN_UBC-CMHA-COVID19-Report-FINAL.pdf
7.      https://acamh.onlinelibrary.wiley.com/doi/10.1111/jcpp.12600
8.      https://www150.statcan.gc.ca/n1/pub/82-625-x/2015001/article/14135-eng.htm
9.     https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm
10.     https://www.medrxiv.org/content/10.1101/2020.10.06.20207530v3.full-text
11.      https://www.medrxiv.org/content/10.1101/2020.10.06.20207530v3.full-text
12.     https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236718/
13.     https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=2010000802&pickMembers%5B0%5D=1.1&cubeTimeFrame.startMonth=03&cubeTimeFrame.startYear=2019&cubeTimeFrame.endMonth=11&cubeTimeFrame.endYear=2020&referencePeriods=20190301%2C20201101
14.      https://www.census.gov/retail/mrts/www/nadjusts.txt
15.     https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=2010000802&pickMembers%5B0%5D=1.1&cubeTimeFrame.startMonth=03&cubeTimeFrame.startYear=2019&cubeTimeFrame.endMonth=11&cubeTimeFrame.endYear=2020&referencePeriods=20190301%2C20201101
16.    https://www.stateofthecannabisindustry.com/
17.      https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm
18.     https://cmha.ca/wp-content/uploads/2020/06/EN_UBC-CMHA-COVID19-Report-FINAL.pdf
19.      https://www.theiwsr.com/global-beverage-alcohol-is-not-expected-to-rebound-until-2024/