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The uneven impact of the pandemic on mental health
Healthcare professionals found themselves in the eye of the storm, with a sense of powerlessness as they were forced to witness many more patients than usual die in difficult circumstances. Many have been traumatised.
pandemic The uneven impact of the on mental health
Our lives have been marked by the pandemic for well over a year now. While there was an initial fear that restrictions would lead to a rash of suicides and mental illness, thus far researchers have not seen any signs of this. That said, some have clearly fared very badly.
text ÅSA MALMBERG photo ISTOCKPHOTO, MIKAEL WALLERSTEDT
“It
Filip Arnberg, Programme Director at the National Centre for Disaster Psychiatry. is very important to bear in mind that this pandemic means so many different things to different people,” says Filip Arnberg, Programme Director at Uppsala University’s National Centre for Disaster Psychiatry.
Arnberg has long researched how people handle crises and disasters and one group that he points to as having taken particular punishment during the coronavirus pandemic is healthcare workers. They have found themselves in the eye of the storm and many of them have experienced a psychological state known as moral stress.
“This is common among those working in disaster medicine. They travel to disaster zones with limited resources where they are forced to make decisions that are difficult on a personal level and are unable to offer the care they would like,” says Arnberg.
THE PRELIMINARY RESULTS of a study led by Arnberg show that Swedish healthcare workers have been faced with exactly this dilemma during the pandemic. The main reason for this is the lack of both materials and staff.
“They find themselves in situations in which, for various reasons, they are unable to follow their moral compass. I would say that it is normal for four out of five people working on COVID wards to feel moral stress. This problem was especially severe during the first wave,” says Arnberg.
That the situation in the healthcare service has at times resembled a disaster zone is a view shared by Emily Holmes, Professor of Psychology at Uppsala University. Hospital staff caring for the most severely ill COVID patients have been overworked, without adequate time for recovery, with a sense of powerlessness as they were forced to witness many more patients than usual die in difficult circumstances.
Many have been traumatised. According to a study of British healthcare professionals, as many as 40% of intensive care staff working with COVID patients suffered from post-traumatic stress disorder (PTSD). Other studies have suggested that the corresponding figure for British military personnel stationed in war zones is 10%.
PROFESSOR HOLMES’S RESEARCH group is currently working on a project to study whether completing simple, structured tasks on a mobile app can help traumatised healthcare workers haunted by recurring, distressing memories.
“These intrusive memories are incredibly brief, only half a second, but in that flashback they relive a moment, perhaps a patient’s face. It can even be a fraction of a moment, maybe a curtain or an empty bed.
According to a study of British healthcare professionals, as many as 40% of intensive care staff working with COVID patients suffered from post-traumatic stress disorder (PTSD).
The brain is attempting to pick up some warning signal. It returns both visually and emotionally,” explains Holmes.
With the correct treatment, however, the prognosis for recovery is very good. But more knowledge is still required about how PTSD can be prevented. The method developed by Holmes’s research group has delivered very promising results in terms of preventing the development of PTSD.
“We’re trying to find a way to recompose the brain so that it doesn’t store these dreadful images as recurring, intrusive memories. Unlike other forms of psychotherapy, there’s no need to talk about trauma in any detail,” says Holmes.
Reactions from research subjects have thus far been positive, with many expressing a significant need for simple methods such as this that can be accomplished alone and that both prevent and help them to cope with recurring, distressing memories.
IN SOME CASES, those who have fallen ill with COVID-19 have also found it difficult to recover, both physically and mentally. Although long COVID has not yet been well researched, there are several studies underway. One form of psychotherapy that may help to improve the quality of life of this group is acceptance and commitment therapy (ACT). At least, that is the hope of Karin Brocki, Professor of Psychology at Uppsala University, who is examining the matter more closely.
In brief, ACT, which has been proven to work against chronic pain, involves teaching the patient strategies to deal with their symptoms so that they do not dominate their life. This improves the individual’s psychological flexibility.
Professor Karin Brocki of the Department of Psychology.
Professor Emily Holmes of the Department of Psychology.
“This is all about the ability to adapt your behaviour, emotions and thoughts to the situation at hand while retaining the things that make you feel good. Mastering this ability will make you somewhat more resistant to developing mental illness. If you like going to the gym, find other ways to work out,” says Brocki.
Brocki was one of the first to study how the mental health of Swedes has been affected by the pandemic.
“The first study we conducted demonstrated that, despite the fact that we were largely able to live as normal, the level of mental illness increased significantly during the early phase of the pandemic. We could see that it was young people who were suffering the most. Those who had previously experienced mental illness were at greatest risk of feeling unwell during the pandemic,” says Brocki.
THAT YOUNG PEOPLE in general felt worse than their elders might be explained by the major changes that take place in early adulthood, which are associated with anxiety. Perhaps they have moved to another city to study, have an unstable economy and are generally uncertain about the future. Existential questions may be amplified by a protracted crisis like the pandemic.
Professor Brocki has also studied how the pandemic has affected families with young children. With colleagues from the University of Cambridge, among others, she has conducted a large international study of families with children in the age group 4–7 years in six countries: China, the United Kingdom, the United States, Sweden, Italy and Australia. The level of restrictions has varied greatly between these countries.
“We measured the wellbeing of parents, conflicts between parents and between parents and children, the ability to maintain routines during the pandemic and the wellbeing and functioning of children in dayto-day life. Regardless of country, we saw a correlation between deteriorating mental health in parents during the pandemic and the children’s wellbeing. In those families where parents reported increased mental stress during the pandemic, children also functioned less well, showing increased hyperactivity, disobedience and emotional problems,” says Brocki.
Many people are suffering mental ill health due to the pandemic. But according to Professors of Psychology Karin Brocki and Emily Holmes, help is at hand.
THE RESEARCHERS WERE unable to discern any obvious correlation between the severity of restrictions in a country and the mental wellbeing of the families.
“One explanation for the observed correlation between parents’ and children’s wellbeing during the pandemic may be that the parents’ ability to support their children’s emotional and behavioural self-regulation was disrupted. In the preschool years, children need support from their parents to regulate their behaviour, as their self-regulation skills are still developing. If the interplay between parents and child is disrupted, this will have obvious effects on the child’s wellbeing because, as we know, self-regulation is intimately connected to mental wellbeing and various types of behavioural problems. One vital aspect that has a bearing on the child-parent
relationship is precisely this ability on the part of the parent to adapt emotionally and in everyday life,” she explains.
The ability to maintain routines and to do the things that support our wellbeing, such as exercising and nurturing social contacts, is generally important if we are to cope with crises such as the ongoing pandemic.
“The exceptional thing about the pandemic is that its stresses are so protracted. It has been going on for over a year now and placing considerable restrictions on wellness factors that influence our health,” explains Filip Arnberg.
AS PROGRAMME DIRECTOR for the National Centre for Disaster Psychiatry, Arnberg has studied many crises, yet finds the pandemic difficult to compare to other events, such as the 2004 tsunami or the sinking of the Estonia. Its distinguishing feature is its protracted nature.
The National Centre for Disaster Psychiatry was established at Uppsala University in 2002 on behalf of the National Board of Health and Welfare. In the wake of the Estonia disaster, it became apparent that, given society’s tendency to forget, Sweden needed to gather knowledge of traumatic events so that society would not need to start from scratch with each new crisis. The National Centre for Disaster Psychiatry is one of several knowledge centres at Swedish universities related to disaster medicine.
“Our mission can be summarised as creating, gathering and disseminating new knowledge about the psychiatric and psychosocial aspects of highly stressful events. Our mission is somewhat broader than a normal research group in as much as we also contribute expertise to the National Board of Health and Welfare. With contributions from other government agencies and organisations, we also try to disseminate knowledge to the public in various ways, ” he says.
One thing that has struck him in the course of his research is that most people seem to cope well in a crisis.
“More often than not it takes an existing burden or a particularly large stressor to make us feel that we are completely unable to deal with an event. Some people might think this sounds optimistic but, after studying bus crashes, the Estonia disaster, the tsunami, Scandinavian Airlines Flight 751, the Scandinavian Star fire, the Västmanland forest fire and now the pandemic, I am convinced that this is the case,” says Arnberg. ●
