Isolation, quarantine: Impact of COVID-19 loneliness on mental health

This week, the  world  celebrates Mental Health Awareness Week  and amid the global pandemic of COVID-19, it means that individuals with pre-existing mental health conditions such as anxiety, mood and substance abuse disorders are likely to have their symptoms worsen on account of the pandemic.

Since the outbreak of the pandemic, national lockdowns and physical distancing preventive measures directed across the world coupled with the multiple uncertainties confronting people, have spurred an observed increase in addictive coping strategies, such as the abuse of alcohol, drugs, tobacco, and online gaming. According to the United Nations , “Many people who previously coped well, are now less able to cope because of the multiple stressors generated by the pandemic”.

In Canada, there have been reports that 20% of the population aged 15-49 have increased their alcohol consumption during the pandemic, and the UN Women early on in the pandemic highlighted heightened cases of physical and mental risk experienced by women and children as a result of increased domestic violence and abuse.  To mitigate acts of violence such as these, several Southern African countries including Botswana, Lesotho, Madagascar, Malawi,Namibia, South Africa, Zambia and Zimbabwe have in addition to other preventive measures, resorted to placing restrictions on the sale of alcohol  during the pandemic.

The uncertainties surrounding the widely spreading infection include but are not limited to fears of infection, fears of death and fears of losing loved ones. Coupled to these, for millions around the world, there are additional fears over sustenance and survival as many have lost their means of livelihood following the pandemic and preventive measures implemented to curb its spread.

At the same time, widely spreading misinformation about the virus and prevention measures, conspiracy theories, in addition to uncertainties about the future, are major sources of distress, whilst prospects of losing loved ones without having a chance to say goodbye or hold funerals for them are other sources of angst. Global reports appear to show that no continent is spared ,with details of high levels of psychological distress from China, United States, Iran and Ethiopia emerging.

According to MatshidisoMoeti  , the World Health Organisation (WHO) Regional Director for Africa, about50% of people with depression do not receive treatment, and barriers such as lack of information, stigma and cultural issues, prevent many people from seeking help for psychological disturbances. The relationship between escalating mental health disorders and infectious diseases is not new, and previous research has shown parallels between the mental health impact of COVID-19 and what was observed during the 2014 – 2016 outbreak of Ebola in West Africa, where it was reported that up to half of individuals infected with Ebola experienced fear, depression, post-traumatic stress (PTSD), and stigmatisation in their communities.

WithCOVID-19 preventive measures such as lockdowns, physical distancing, and social isolation, it is little wonder that there have been reports of widespread loneliness worldwide. Health insurance data released in January reported that about 60% of American adults felt some degree of loneliness and this was even before the pandemic hit, and from adults to teenagers ,the number of those who have admitted to feelings of increased loneliness has substantially increased since COVID-19.

Research has shown that quarantines lasting 10 days or more increase the risk of PTSD  afterwards, and additionally, research following the SARS epidemic revealed that quarantined healthcare workers were significantly more likely to experience alcohol or substance abuse than the general population and global reports of suicides among frontline health workers hint at the looming mental health crisis.

The WHO, together with her partners, has since the declaration of a pandemic of COVID-19regularly provided guidance on mental and psychological healthcare for health workers, people in isolation, and the general public. While it is reassuring that these guidelines are included in the management of infected individuals in many treatment centers including in Nigeria, the road to mental health and wellbeing during this pandemic and whenever it ends will be a long and arduous one. So, several steps will need to be taken to protect the health and wellbeing of Nigerians going forward.

First, mental health needs to be properly integrated into primary healthcare with increased distribution of trained health workers, coordinated care, and systems referral when more specialist care is required and should also be considered a healthcare priority for national and state governments. According to the WHO, the treatment gap for severe mental disorders in low and middle-income countries can be as huge as 75%.

In Nigeria, as is common in many sub-Saharan African countries, there is a large inadequacy of mental health specialist services. Nigeria has approximately one psychiatrist to every one million people, the majority of whom work in a few urban centers leaving the vast majority of the country’s communities with no specialist service.

A recent study in several countries (including Nigeria) revealed that only about 20% of persons with common but serious mental disorders (such as depression with suicidal risk) had received any treatment in the previous one year, with only 10% receiving minimally adequate treatment. The widespread provision of mental health care services at the primary care level will help close this gap.