Almost overnight, the daily lives of millions were rearranged as governments worldwide scrambled to contain the novel coronavirus.
The changes, however necessary, have drawn concern from mental health experts who worry about how self-isolation, financial insecurity and barriers to care could affect those already struggling — particularly individuals with thoughts of suicide.
Loneliness has the capacity to fray people, and can provoke feelings like anxiety and depression, said Mark Sinyor, a psychiatrist at Sunnybrook Health Sciences Centre and associate professor of psychiatry at the University of Toronto.
But there’s another way to look at it.
“There is a feeling of collective purpose in this,” he said.
“One of the key issues in mental health, and in suicide specifically, is a feeling that one doesn’t belong… These kinds of global catastrophes and emergencies can foster meaning and belonging. I think we’re going to see mixed impacts on mental health specific to this outbreak.”
The global COVID-19 pandemic has infected at least 800,000 people and killed more than 39,000 worldwide. It has also paralyzed economies and forced governments to impose strict controls in an effort to stop the virus from spreading further and overwhelming already burdened health-care systems.
That has led to adjustments to everyone’s lifestyle, Canadians included.
“Isolation, in general, is really bad for people’s mental health,” said Ritika Goel, a physician in Toronto. “We often prescribe for people to get out into the community and to regularly go and have social contact.”
The data on past outbreaks and suicide is conflicting, but experts agree that the dramatic lifestyle changes, along with the potential for financial issues in any time of crisis, can worsen a person’s mental health.
“People die of other health conditions at a higher rate than they would have at a non-outbreak time. That can be due to a number of issues, from not seeking appropriate care to the barriers to care that emerge during these times,” Goel said.
“Unfortunately, our health-care system’s approach to mental health and illness at baseline is not always the most responsive. Add on a pandemic situation, where a mental health crisis may not be viewed as a medically urgent thing, when of course it can be… That can be collateral damage of COVID.”
After SARS in 2003, researchers tried to understand and measure the psychological effects of the global epidemic.
In Hong Kong, where the virus spread widely, one study found an increase in suicides during the outbreak, particularly among those above age 65. The researchers believed the deaths were associated with fears of getting the disease, fears of disconnection and, for the elderly, “fears of being a burden to their families” during the epidemic.
SARS, like COVID-19, was considered more deadly for older people, though not exclusively to them.
While it “seems plausible” that social disconnection could result in negative mental health outcomes, Sinyor was quick to point out that it’s not the same world it was in 2003.
Our vast means of staying connected online — particularly via video, where you can see someone on a screen — is a powerful tool. It’s one he’s also employing to see his patients.
“That’s going to be very important in mitigating some of that social disconnection that we’re worried about,” he said.
As many health services downsize and go digital to abide by physical distancing guidelines, urgent in-person mental health care is still available.
Juveria Zaheer, a psychiatrist and researcher with the Centre for Addiction and Mental Health in Toronto (CAMH), works in the emergency department. She said the hospital saw a drop in visits at the beginning of March — the “calm before the storm,” she called it.
She acknowledged that it’s difficult to know what could come next, but said resources are still available during these “unprecedented times” for people who need them.
“Having suicidal thoughts in the face of only feeling alone, or only because of COVID-19, they’re not usual. It’s not a normal response and you deserve care and you deserve to reach out and get support,” she said.
Suicidal thoughts are “always a psychiatric emergency,” Zaheer said.
“It’s is a consequence of really significant emotional suffering.”
Niko Stratis, who lives in Toronto, knows the feelings of emotional suffering well.
Like many Canadians, Stratis is coping with the changes but has found somewhat of an appreciation for the “uncertain future” the world is facing.
Having wrestled with loss, trauma and gender identity since being a teenager, it took years for Stratis to feel freed from thoughts of self-harm and suicide.
“Imagine never seeing yourself for who you are. If every time you looked in the mirror and a lie was looking back at you, even if it was a good lie, it’s distressing,” said Stratis. “I just didn’t want to live that life, as that person.”
The pandemic has led them to choose to live “more than ever before.”
“I see us all fighting for a future,” Stratis said, “and I think I want to have space in there, too.”
It’s too soon to say how far the impacts will go, Sinyor said, and even then, the “mix” of impacts people may encounter will be complicated.
In the meantime, mitigating the effects of the pandemic come down to a number of things, he said, including keeping connected, maintaining mental health care, encouraging health coping strategies, and ensuring people have accurate information about the outbreak.
The “collective purpose” and “shared adversity” is something all Canadians can hold onto, Sinyor noted.
“By all the efforts we’re making, we’re protecting hundreds of thousands of vulnerable Canadians from death. In that way, all the efforts are really very meaningful,” he said.
“So if there are people out there who are contemplating suicide, we need to make sure to communicate that we’re all working hard for a really important and meaningful purpose.”
How to get help
If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911 for immediate help. The Canadian Association for Suicide Prevention, Depression Hurts and Kids Help Phone 1-800-668-6868 all offer ways of getting help if you, or someone you know, may be suffering from mental health issues.
— with files from the Associated Press