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Mental health and people who have had COVID-19: Drawing on reliable information

Dr. Jonathan Rogers explains the evidence on mental health conditions associated with previous coronavirus infections
Well, I think the first thing to say is that actually most people will be OK. Most people won’t have mental illness after experiencing Covid, and most people will get back to living the lives they were living before. There will be a significant minority who will have mental health problems after Covid and some of those might be related to being infected with the virus. I think we need to be aware that those people who had delirium when they were severely unwell with Covid, and were admitted to hospital, might have some difficulties with their memory afterwards. Particularly those people who have memory problems before Covid. I think we can expect that more people will have anxiety and depression in the coming months.
There are lots of reasons for that, including the effects of a lock down and the difficulty that people have had seeing friends and family, doing their normal activities, actually having a routine structure to their day. But also having a severe illness for those who’ve been admitted to hospital is a stressful experience in itself and can make people very anxious. What we saw with previous epidemics of coronaviruses was that there were high rates of post traumatic stress disorder afterwards. Now these were particularly people who are severely unwell and were in hospital or even in intensive care units. Being in intensive care is very distressing. I think there’s something about having an infectious illness which makes it more difficult.
You’ve only been communicating with friends and family via video link, at best. Members of staff are in full PPA making it quite hard to establish a relationship with  them and so we could see people experiencing post traumatic stress disorder, or PTSD, over the next few months and that might look like people avoiding certain situations. People feeling constantly on edge. We’ve been getting flashbacks to what they have had before. What we saw with previous coronavirus outbreaks is that there are also high rates of fatigue. That’s people feeling tired for a prolonged period of time beyond the effects of the initial illness. Now, fatigue is at is a distressing symptom, and it stops you doing what it wants.
What you want to do, but it also effects people going back to work. Now with previous coronavirus outbreaks, about one in five experience persistent fatigue even after it looked like they were over the infection itself. So I think all these things together will have big consequences for peoples lives, both in terms of relationships, hobbies and crucially for our country, for employment as well. About 3/4 of people who had a coronavirus severe infection in the past and got back to work in the next few months, but there were a quarter who really struggled with that. So who might be more risk and what can we do about it?
Well, there are a few risk factors, people who are…who are more likely to to suffer mental ill health after coronaviruses. One was healthcare workers. Patients who been exposed to the virus in the course of their work. They experience being patients themselves and they found it very difficult getting back to normal. The second group is people with more severe illnesses. Patients who’ve been admitted to hospital, and particularly those who’ve been admitted to an intensive care unit, are likely to find it harder  to get over that experience.
And finally we found quite interestingly, that those people who spent a long time thinking about their experiences and had frequent memories about being unwell actually found it harder to get on with their lives and were more likely to become mentally unwell. So what I’d encourage you to do as hopefully things get back to normal, is to go back to those things you were doing to keep yourself mentally healthy before. That’s exercise, seeing friends and family, getting a routine back in your day. And try to move on from what’s happened and don’t just stay the past. Let’s look to the future together.

Here, Dr. Rogers is drawing on a systematic review. When thinking about engaging in meaningful action, we need to first ask whether we are drawing on reliable information. Many of you have commented on wanting to watch fewer news feeds, and being careful where you get your information from.

In scientific research, we draw on what are called Levels of evidence.

For example, researchers can study one person in a single case study, a large group of people in cohort studies, or we can compare two different groups under experimental conditions in what’s called a randomised control trial (RCT). The RCT is used widely in medication research, and any potential COVID-19 vaccine will be trialed in such a way – one group will be given the vaccine, and another will be given a potentially beneficial alternative or a placebo.

In psychotherapy research, however, we aren’t always aware of the “active ingredients” of the therapy:

  • Was it that piece of goal-setting that worked?
  • Was it when the therapist validated the patient’s fear?
  • Was it the therapy relationship overall?

In psychotherapy research, there is an important place for smaller, more detailed studies to understand what works in therapy. While a range of therapies, including CBT and psychodynamic therapy, have been evidenced in larger trials, researchers are still working on what exactly it is about that different therapies that work for people like Kevin.

Now, with the coronavirus epidemic, we can’t put people in a group and randomly give them coronavirus or a placebo, as this is highly unethical! But we can follow large cohorts and compare them to unaffected areas.

Importantly, there is a big difference between “my friend says the pandemic is good for our health” and a review like the one that Dr. Rogers draws upon. Importantly, this review still has limits in its reliance on previous coronavirus epidemics.

We are currently facing this particular disease at a particular time, with a particular socioeconomic and political situation, access to particular news and information, and populations with particular health conditions. This is why we say that research guides our understanding, rather than dogmatically prescribes how we should act – there are lots of factors to consider.

And, even when we use reliable information, it can become distorted, amended, and altered to fit different narratives. This often happens in the media, for instance, when some research is ignored entirely, and other research makes the headlines.

So, if we are thinking about informed action that draws on new information, the first step is to reflect on where we draw our information from:

  • Are we looking at first-hand data?
  • Is it reliable and valid?
  • Do the authors have any competing motives?

And, when we are taking in the information we can also reflect:

  • Am I looking for and finding information that confirms what I already think?
  • Is this information making me uncomfortable so that I would prefer to discount it?

Let’s now take a closer look at Kevin’s story, and how psychotherapies have approached the task of engaging in meaningful action.

This article is from the free online

COVID-19: Psychological Impact, Wellbeing and Mental Health

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