As the pandemic unfolds it is timely to talk with Associate Professor Mythily Subramaniam and reflect on the phases of the pandemic in relation to mental well-being.
Mythily has worked in mental health research for over 15 years and is also Director of the Research Division and Lead Investigator of the Programme of Mental Health Policy Studies at the Institute of Mental Health. She also teaches and mentors students at the Saw Swee Hock School of Public Health.
Talk us through some of the mental health concerns related to the COVID-19 pandemic.
It is important to remember that even before the pandemic, one in four adults and one in 10 children experience mental illness, and many more of us know and care for people who do.[i] That data is from the UK — in Singapore, the Mental Health Study 2016 reported the prevalence as being one in seven adults, possibly an under-report because of the local stigma of mental illness that discourages people from seeking support.
The initial phase of the pandemic saw fear, alarm and anxiety, which was a normal reaction to an unknown situation. There was fear of falling ill, fear of health facilities and becoming infected there, fear of being separated from family and friends in quarantine, fear of job losses and financial hardship, to name but a few.[iii]
Indeed, up to a third of us may have symptoms of anxiety and depression as a result of the pandemic, with many having difficulty sleeping.[iv] Social media and rolling news coverage has also led to intense feelings of anxiety and the spread of false information has increased stress.[v]
There has been increasing awareness of the importance of mental well-being in Singapore; this has increased further during the pandemic. Singapore has put in place support through helplines and referrals to specialists, and increased access to services through online platforms.
Are there some groups that are more vulnerable to mental well-being impacts during the pandemic?
The front-line workers, such as health workers, would have increased stress and anxiety, as well as possible flashbacks to SARS in 2003. Anecdotally, they reported concerns about being a risk of infecting their families.
The pandemic led to far greater social isolation. While some were with wider family during the circuit breaker period, many were alone. Social isolation and loneliness increase the risks of premature mortality, and the magnitude of the risk exceeds that of many leading health indicators (e.g., obesity, substance abuse, physical inactivity and so on).[vi]
Social isolation is more strongly associated with poor health conditions and behaviours in younger adults compared to older age groups.[vii],[viii] However, each country’s context is different. Within Singapore there is concern that older adults who live alone and are unable to connect in the online space may be confused over rules and increasingly vulnerable to feeling displaced and lonely.[ix]
The pandemic has also led to job losses, under-employment, businesses closing and uncertainty going forward. Job losses and financial hardship disproportionally affect lower income and younger groups and can cause anxiety, depression and suicide.[x],[xi]
International studies also found that working women who were mothers took on the greater share of domestic responsibilities, resulting in increased stress to manage the household and children, and yet maintain work productivity.
The age groups in transitions are a particular concern as their next steps towards adulthood have been disrupted, such as those graduating and seeking employment, those going to college and university, and those taking exams. Added uncertainty at this age can be incredibly detrimental to well-being.
International data also found that there was an uptick in domestic abuse, violence and increased use of alcohol during lockdowns. All of which will impact on the mental well-being of those in abusive relationships.
Singapore’s migrant workers would also have anxiety about what the pandemic would mean for them — from being infected and at risk of job losses, to how the pandemic was playing out in their home countries and how their family was impacted. In addition, there has been the stress of prolonged confinement in the dormitories due to ongoing infections and the need to impose quarantines.
The pandemic has brought to the fore longstanding concerns about our most vulnerable populations and resulted in positive changes within weeks. Taking our valued migrant population alone, there is more open dialogue and a clearer path to improve their healthcare, well-being and living environments, and to hear their concerns. These are positive steps and in time can hopefully be viewed as silver linings to this challenging time.
The pandemic has shown just how much mental health is at the heart of public health and the pandemic. Recognising the substantial impact of the pandemic on mental health, the United Nations recommends a set of mental health and psychosocial support actions that should be implemented as part of the response to the COVID-19 pandemic.[xii]
How do we track mental health trends in Singapore?
Within Singapore it is difficult to understand the prevalence of mental well-being in the population and population subsets. Data is not regularly centrally collated and analysed. There would be real value in collecting this, as well as identification of needs through a cohort approach, so that we can proactively plan and implement services to meet population needs.
During the circuit breaker period we re-established contact with over 400 individuals from a previous study on mental well-being who had previously agreed to future contact, who provided a window into mental health concerns during the pandemic. There was an increase in prevalence of mental health issues. Interestingly there was a great deal of support from participants to talk with us.
Tell us something surprising about yourself.
I’m an avid fan of K-dramas, total escapism!
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[i] NHS Mental Health. Available at: https://www.england.nhs.uk/mental-health/ (accessed 5.5.2020)
[iii] UN IASC (2020) Interim Briefing Note Addressing Mental Health and Psychosocial Aspects of COVID-19 Outbreak. Available at: https://interagencystandingcommittee.org/iasc-reference-group-mental-health-and-psychosocial-support-emergency-settings/interim-briefing (accessed 24.4.2020)
[iv] Rajkumar RP (2020) COVID-19 and mental health: A review of the existing literature Asian J Psychiatr. 2020 Aug; 52: 102066. Published online 2020 Apr 10. doi: 10.1016/j.ajp.2020.102066. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151415/ (accessed 24.4.2020)
[v] Quartz (2020) The psychology of coronavirus fear—and how to manage it. March 10, 2020. Available at https://qz.com/1812664/the-psychology-of-coronavirus-fear-and-how-to-overcome-it/ (accessed 09.04.2020)
[vi] Holt-Lunstad J et al (2015) Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015 Mar;10(2):227-37. doi: 10.1177/1745691614568352. Available at: https://journals.sagepub.com/doi/10.1177/1745691614568352 (accessed 30.4.2020)
[vii] Engadget (2020). The psychological impact of COVID-19 isolation, as explained by scientists. March 27, 2020. Available at: https://www.engadget.com/2020-03-27-pyschological-impact-covid-19-isolation.html (accessed 13.04.2020)
[viii] Hämmig O et al (2020) Health risks associated with social isolation in general and in young, middle and old age PLoS One. 2019; 14(7): e0219663. Published online 2019 Jul 18. doi: 10.1371/journal.pone.0219663 PMCID: PMC6638933 PMID: 31318898. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6638933/ (accessed 30.4.2020)
[ix] Today (2020) The Big Read in short: Why some seniors find it hard to stay at home. Available at: https://www.todayonline.com/big-read-short-why-some-seniors-find-it-hard-stay-home (accessed 5.5.2020)
[x] McKinsey (2020) How to rebuild and reimagine jobs amid the coronavirus crisis. April. Available at: https://www.mckinsey.com/industries/public-sector/our-insights/how-to-rebuild-and-reimagine-jobs-amid-the-coronavirus-crisis (accessed 24.4.2020)
[xi] Pew Research Center (2020) People financially affected by COVID-19 outbreak are experiencing more psychological distress than others. March 30, 2020. Available at https://www.pewresearch.org/fact-tank/2020/03/30/people-financially-affected-by-covid-19-outbreak-are-experiencing-more-psychological-distress-than-others/ (accessed 01.04.2020)
[xii] UN IASC (2020) Interim Briefing Note Addressing Mental Health and Psychosocial Aspects of COVID-19 Outbreak. Available at: https://interagencystandingcommittee.org/iasc-reference-group-mental-health-and-psychosocial-support-emergency-settings/interim-briefing (accessed 24.4.2020)