Pandemic’s impact on mental health, a sting in the tail

Dr Ryan Noach, CEO of Discovery Health

To many of us, it feels like we’ve returned to pre-COVID normality. This brings a welcome sense of some relief. However, in the healthcare world, we remain quite concerned about the potential for variant-driven flare-ups of COVID-19 acute infections. We are seeing an uptick in positive testing rates and many anecdotal cases of COVID-19 right now.

Importantly, we are also spending time getting to grips with the pandemic’s second order effects. Not only are we seeing the widespread impact of people living with Long-COVID, but it is also increasingly evident that there’s a sting in the pandemic’s tail – widespread declining mental health.

Loss, grief, isolation, economic hardship, job uncertainty and unemployment levels feed general concerns about the future. For the employed, the change to work modes – hybrid, or at-home – and reorganisation of team dynamics present unique stressors that are driving burnout and mental illness in ways that we don’t yet fully understand. For people who’ve recovered from COVID-19, Long-COVID symptoms bring additional stress, with widespread complaints of cognitive slowing and symptoms of mental illness.

I am deeply concerned about this landscape, supported by what I am seeing in our Discovery Health data. October is South African and global Mental Health Awareness Month and the right time to reflect on how best to reposition for the future.

Depressive and anxiety disorders drive global burden of disease

Pre-COVID data indicate that 16.5% of people[1] in our country were living with a mental health disorder. Globally depressive and anxiety disorders were among the leading causes of burden of disease too. In 2020, there was an astounding 25% rise in the global prevalence of these conditions[2].

A year ago, the Lancet[3] looked at the impact of the pandemic on major depressive and anxiety disorders across 204 countries. The prevalence of major depressive disorder increased 27.6% and anxiety disorders 25.6% (percentages refer to hundreds of millions of people) – 36.4% and 38.7% in South Africa.

Filling 7.5 Ellis Park stadiums with people requiring mental health care

Discovery Health is a data-driven organisation. We carefully track trends emerging from the landscape of our 3.7 million medical scheme members from 19 administered medical schemes.

In the Discovery Health Medical Scheme (DHMS) we’ve seen a steep rise (2017-2021) with around a 4% compound annual growth rate (CAGR) in mental illness prevalence – from 10.5% to 12.5% of the Scheme’s 2.7 million members. The 450 000 members now in need of mental health support are enough to fill seven and a half Ellis Park stadiums.

Depression is the primary condition driving the increase, affecting 58% – around 250 000 people – of affected scheme members, followed by anxiety disorder (CAGR or 5.0%).

The highest CAGR we have seen in mental health conditions (2018 – 2021) is in those aged 20 to 34, in women, and in people who also have another chronic condition (along with mental illness), especially where they have diabetes or cardiovascular disease. Mental illness as a comorbidity changes the severity of underlying disease even on a risk-adjusted basis.

It’s interesting to note that more people are accessing care (psychotherapy and medicine) out-of-hospital. Rates of accessing care virtually are rising fast too (up by 29% from 2020 to 2021) with promising scope for growth.

Contracting COVID-19 can affect mental illness (and vice versa)

Earlier this year Discovery Health surveyed[4] around 7000 administered medical scheme members to understand if they were living with any enduring symptoms after acute COVID-19 infection. It was frightening to identify that a high proportion were, reporting headaches (31%), breathlessness (14%), problems sleeping (14%), lack of concentration (11%), muscle weakness (11%), a deterioration in their ability to concentrate (30%), walk (20%), see (16%), communicate (7%) and more.

Separately, Discovery Health data show that having had COVID-19 increases the likelihood of developing depression and anxiety with up to a 4% increased prevalence for up to six months after recovery from COVID-19.

Interestingly, a study[5] published in August in the Lancet Psychiatry found an increased incidence of mood and anxiety disorders (subsiding within 2 months) and increased risk of psychotic disorders, cognitive deficit, dementia and seizures for up to two years following COVID-19 infection.

The jury is out on a definite COVID-19-brain link. Possible causes[6] include COVID-19’s direct effects on the brain and immune system and also the trauma of serious disease and stress around persistent symptoms.

A solutions-driven approach is key, and there’s value in structured support

Data from the DHMS Mental Health Care Programme (launched in 2020) show the benefits of structured mental health screening and treatment. General practitioners and psychologists are prompted to screen their patients for depression. Where required they enrol them onto the Mental Health Care Programme to access cover for consultations, psychotherapy, and medication. We’ve seen a 17-fold increase in enrolments since June 2020. Six months into participation we see a drop in hospital admissions, with a 6.7% reduction in cost. While these are emerging outcomes, they show the importance of screening, providing cover for outpatient care and the value to be derived from being part of a structured programme. Early intervention also allows for far better management, which improves patient outcomes.

Healthy living is key to warding off and managing mental illness

To boost mental health and resilience (especially under stress) we need good sleep quality and quantity, habits such as mindfulness meditation for stress relief, ensuring healthy eating[7] and regular exercise.

The recently released Science of Vitality journal[8] shares that physical activity and good nutrition are associated with up to four times lower psychological distress. Also, Discovery Vitality has just announced the findings of a landmark South African study[9] published in the International Journal of Physical Medicine & Rehabilitation (in collaboration with the Harvard T.H. Chan School of Public Health and the University of Cape Town). The research is a global-first because it focuses on an African data set of nearly 50 000 people over a three-year period. The results show that increasing physical activity from ‘low to moderate’ could prevent 1 in 5 cases of depression in women. Also, a relatively small increase in physical activity – say from 5,000 steps one day a week to 10,000 steps one day a week can significantly reduce depression incidence. (For maximum health benefits, the WHO recommends at least 150–300 minutes of exercise per week).

There is so much to be investigated and solved for in the current mental health space

For now, if I can leave you with anything, let it be, we’re all in this together. Those struggling with mental health issues, or a diagnosed illness are not alone. And, for those yet to reach out for help, there’s no better time to do so than now.

ENDS

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698554/
[2] https://www.who.int/news/item/02-03-2022-COVID-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide
[3] https://www.thelancet.com/article/S0140-6736(21)02143-7/fulltext
[4] https://www.discovery.co.za/corporate/health-insights-impact-of-a-long-COVID-19-symptoms
[5] https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00260-7/fulltext
[6] https://psychiatry.ucsf.edu/copingresources/longCovid
[7] https://pubmed.ncbi.nlm.nih.gov/28431261/ and https://pubmed.ncbi.nlm.nih.gov/26317148/
[8] chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.discovery.co.za/site/binaries/content/documents/managedcontent/discoverycoza/assets/vitality/science-of-vitality/the-science-of-vitality-journal.pdf/the-science-of-vitality-journal.pdf/contentdelivery%3Abinary
[9] https://www.longdom.org/open-access/physical-activity-and-the-prevention-of-depression-a-longitudinal-analysis-of-a-south-african-database.pdf

This article was first published in Business Day on 20 October 2022