Over the last ten months, the world has gone through unprecedented changes courtesy of the COVID-19 pandemic which took the global community by surprise, forcing us all to rethink the way we interact across all aspect of life.
Life as we knew it came to a halt, and with the introduction of restrictive measures and ‘lockdowns’, managing daily life became excruciatingly challenging for many. The ensuing financial and social isolation brought out a myriad of mental health challenges, including ‘lockdown fatigue’.
COVID-19 is having monumental effects on the mental health and wellbeing of populations worldwide, not just in First World Countries. With seemingly low capacity to respond, it is unclear how the world will deal with this looming mental health crisis. One thing is for sure, the COVID-19 crisis has shone a bright light on mental health and how massively it impacts a human being. As a result, mental health has begun to be discussed more openly.
In light of National Mental Health Month this October in Australia, GCT’s Lifestyle Writer Despina Karp sat down with Elena Mavromoustakos, Clinical Psychologist, in last Sunday’s weekly Orthodox Cafe to discuss the mental health impacts of
Thank you for taking the time to chat today Elena! Covid-19 has presented many challenges for a lot of people, what is the biggest impact mental health impact Covid-19 has had on people in your opinion?
COVID-19 has impacted global mental health profoundly, particularly increasing the prevalence of anxiety, depression and post-traumatic stress disorder across the globe. Following 2 weeks of official lockdown across the country, 65% of Spanish responders reported mild-severe anxiety and depressive symptoms (Fullana et al., 2020) and 75% of Chinese responders rated the psychological impact of the outbreak as mild to severe (Wang et al., 2020).
Contributing factors include disrupted travel plans, social isolation, media information overload and panic buying of necessity goods (e.g., toilet paper – who would have thought!). We saw the world go mad for a brief period! The impact of COVID-19 did not discriminate between those with/without a history of mental health difficulties, so that the outbreak triggered anxiety/depressive symptoms in people without a history of mental health, but also exacerbated these symptoms for those with pre-existing mental illness. There are many reasons for this. Put simply, novelty, unpredictability and uncertainty of COVID-19. The symptoms of COVID-19 are non-specific and difficult to distinguish from other viral illnesses. Unfortunately, during the pandemic, public health authorities and the media focused on the physical, bodily symptoms of COVID-19, instead of the increasing mental health burden it was causing.
Recently, we saw people across the world experience immense fear and anxiety of contracting the virus or dying from it, helplessness or blame towards people with COVID-19, grief towards the sudden loss of loved ones but also psychological distress caused by social isolation.
The media information overload was evident across the world and studies found that not reading the news/updates about the pandemic was one of the best predictors of lower levels of anxiety and depression.
Also, following a routine, such as a healthy/balanced diet, pursuing hobbies and staying outdoors were also predictors of lower levels of anxiety and depression (Fullana et al., 2020). Humans are social creatures and we require a feeling of closeness and connectiveness with others for overall well-being. During the third week of the National Emergency concerning COVID-19 and stay-at home orders in the US, a study found that 43% of responders scored highly on loneliness and that lonely individuals were significantly more depressed (Killgore et al., 2020).
Now that life is beginning to return to ‘normal’, what could people, in particular young people, do to help cope with the challenges that everyday life presents?
We aren’t out of the woods yet, so I think it is important we continue to take precautionary measures like hand hygiene, wearing a mask etc.
In terms of coping with challenges, we are in a unique situation at the moment where we are adjusting back to normal life. The adjustment is probably one of the biggest challenges following the pandemic. We all experience adjustments throughout our life e.g., moving out of home, going from primary to high school, having a new sibling, getting married etc. It is this ability to adjust to the circumstances that is pertinent to our wellbeing. Some of us have more difficulty adjusting than others and there are many reasons for this, particularly mental health struggles.
Depressive symptoms include a depressed mood for most of the day, diminished interest or pleasure in most activities, insomnia, fatigue, feelings of worthlessness, difficulty concentrating and these would make adjusting back to normal life very difficult after being in isolation. You can imagine that if someone is experiencing depression in response to social isolation/loneliness, it will be more difficult for them to start engaging with the world again. If you are finding yourself struggling to cope with the challenges of everyday life at any point in your life, don’t be afraid to ask for help.
For example, if you had started experiencing low energy and fatigue (due to a history of low iron) and this in turn affects how productive you are at work, you wouldn’t hesitate to go to the doctors to get your iron levels checked and begin on an iron supplement. Depression and anxiety are akin to this but unfortunately, there is still a lot of stigma and resistance to mental health. People experience shame, embarrassment and inappropriate guilt. Just because mental health is invisible, doesn’t mean it is not real. If someone breaks their leg, you can see their leg in a cast and therefore ascertain that they have hurt themselves.
Unfortunately, with mental health you can’t always see someone who has poor mental health. That is even more of a reason to encourage people to seek help because depression and anxiety can cause social withdrawal and isolation, when really the individual needs social support more than ever. If you notice a change in a friend, such as they are withdrawing more than normal, they seem down and they are not their normal selves, then reach out to them and show them that you care.
Pleasure, achievement, closeness/connection are three pertinent areas that improve overall wellbeing. Engage in activities that you can do just for pleasure and that bring you joy. For example, reading a book, watching a comedy, dancing, singing etc. Also, do things that give you a sense of achievement, no matter how big or small. These can include going for a walk, cooking something new, completing an exercise routine, life admin tasks etc. And lastly, engage in social activities that make you feel close and connected with others as humans are innately social creatures (Psychology Tools, 2020).
What advice could you give someone struggling with post-Covid-19 lockdown/isolation anxiety and social anxiety?
Avoidance is the biggest, most common strategy people with anxiety use. If someone is anxious, they tend to avoid the feared stimulus or situation in order to reduce distress. For example, if someone fears heights, then they will normally avoid any activities that involve high heights. If someone is socially anxious, then they typically avoid social situations. If someone fears injections, then they will typically avoid going to the doctors for a blood test. This helps in the short-term because it means that they are not being exposed to the stimulus or situation they fear. Unfortunately, in the long-term it maintains the anxiety, it doesn’t give the individual the chance to learn that the feared outcome either doesn’t happen or that even if it does happen, they manage to get through it. For example, someone with a fear of flying manages to get onto a flight but they are preoccupied with anxious thoughts that the plane will crash.
Typically, they will be hyper-vigilant for any signs of this occurring e.g., some turbulence. However, by not avoiding planes, they now learn that the plane didn’t crash (evidence against anxious thought) and that they managed to get through the flight (improves self-efficacy). So my advice to lockdown/isolation anxiety and social anxiety is to expose yourselves more and more to the thing you fear. Avoidance is not helpful for the long-term; it only maintains the fear because you are depriving yourself of a positive learning experience that disconfirms your catastrophic predictions. You should try and gradually confront the feared stimulus/situation. Start with situations that are easier for you to handle and gradually work your way up to more challenging tasks. This allows you to build your confidence slowly that you can handle the feared situation and that the feared outcome doesn’t actually occur. Depending on the severity of the symptoms, sometimes you may need help from a psychologist.
Time Magazine recently reported that ‘women are almost three times as likely as men to report suffering from significant mental health consequences (27% compared to 10%), including anxiety, loss of appetite, inability to sleep and trouble completing everyday tasks’. What are your thoughts on this? What advice can you give young women who may be reading GCT and may feel like they need some guidance during this period of uncertainty?
Research suggests that being a woman does increase risk for symptoms of depression, anxiety, insomnia, high perceived stress and adjustment disorder in response to COVID-19. This was demonstrated in an Italian sample (Rossi et al., 2020), a Chinese sample of respondents (Liu et al., 2020) and Australian participants (Pieh et al., 2020). This does not mean that men did not experience depression, anxiety and stress in response to COVID-19; this just suggests that being female increases risk. However, a past history of mental illness, history of a chronic illness, foreigners quarantined in hospitals, being a student and also being uneducated were also risk factors (Wang et al., 2020), in addition to people with no work and low income (Pieh, Budimar, & Probst, 2020).
The gender difference may be due to the fact that women are more likely to hold positions in high-risk fields such as working as teachers, nurses, crowded factory work, hospitality, housekeeping etc. Health care workers have previously been found to experience chronic stress, depression, anxiety and PTSD in response to SARS (McAlonan et al., 2007). Women are also more likely to be at home in quarantine and socially isolated with their children and experience other stressful events (i.e., working, financial, relationship or housing problems) due to pandemic or lockdown measures (Rossi et al., 2020). Previous research has found that after traumatic events, acute psychological disorders characterised by intrusive memories are more prevalent in women than men (Kendler et al., 2001).
Therefore, if you are noticing that you are not feeling quite like your normal self, in terms of mood or anxiety or stress then seek help because you matter! You can’t take care of anyone else well, if you are uncared for.
Some things that have been found to help amidst global uncertainty include setting a routine, stay mentally and physically active, practice gratitude, notice and limit worry triggers and relying on reputable news sources.
- (URL: https://www.psychologytools.com/resource/living-with-worry-and-anxiety-amidst-global-uncertaintyPsychology Tools, 2020). If you are a parent, you may not have as much time for yourself, so adapt to include your own self-care.
- Free 24/7 Coronavirus Mental Wellbeing Support Service on 1800 512 348 or https://coronavirus.beyondblue.org.au/. This is available in other languages too.
- The Australian Government is providing 10 additional Medicare-subsidised psychological therapy session for Australians affected by the COVID-19 pandemic restrictions. Speak to your GP about accessing these services.
- Digital and telephone support – “Head to Health” provides access to free, low-cost phone and online mental health services and supports e.g., coping with stress course.
Lastly, what made you want to be a Clinical Psychologist and what is the best thing about your job?
I have long thought about my answer to this question and over the years the answer has become more simplified and clearer. Put simply, two things: empathy and compassion. Empathy is a more emotional response, whereby you feel with another, whereas compassion is a more cognitive approach, whereby you feel for another. Neuroscientists have found empathy linked to part of the brain responsible for emotion and self-awareness, whereas compassion was linked to part of the brain called the medial orbitofrontal cortex, responsible for learning and reward in decision-making. Empathy provokes a deep understanding for another’s feelings, whereas compassion promotes a desire to help the other. Together, these 2 things encourage understanding of another’s pain but also a willingness to help. Additionally, the field of mental health is ever-growing, we don’t have all the answers and it’s unlikely we will ever get to a point of having all the answers. This is extremely humbling and exciting as I enjoy discovering and learning.
The Orthodox Cafe continues every Sunday at 11am in the hall underneath the Parish of St Stylianos in Gymea, follow their social media pages and website for updates and more information!
For more information on National Mental Health Month in Australia click here
For International Mental Health Day information click here:
ABOUT ELENA MAVROMOUSTAKOS
Elena is currently completing her PhD at the Western Sydney University (WSU) in neuropsychology, looking at cognitive strategies people can use to improve memory for everyday tasks. She also lectures and tutors subjects relevant to clinical psychology at WSU. Additionally, she is in the process of opening a practice that conducts neuropsychological assessments, so therefore intelligence tests, academic achievement (learning ability) tests, memory tests etc, and providing counselling for both children and adults.
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