Fear of Pandemics 2019 and the rise of Suicide
By Fayaz Ahmad Paul
The pandemic began at the end of 2019 in China and has quickly spread globally. Currently 25 Crore of people around the world are infected and almost 50 Lakhs have died. The clinical manifestations of pandemic vary from asymptomatic forms to severe clinical conditions characterized by respiratory failure, sepsis, septic shock and multiple organ dysfunction syndromes. Understandably, medical professionals and public health specialists are focused on taking care of individuals who are very sick, while containing the coronavirus spread in the general population. Less attention is given to the psychiatric consequences of the Covid-19 crisis.
The Covid-19 pandemic has profound psychological and social effects. There is a pervasive awareness of uncertainty over the future and an understanding that the pandemic is far from over. It is possible that there will be economic privation and political upheaval. The psychological sequelae of the pandemic will probably persist for months and years to come. Pandemics may increase the prevalence of psychiatric disorders and suicide rates during and after the pandemic. The last comparable crisis was the pandemic of Spanish Flu in 1918-1919 caused by H1N1 viruses with genes of avian origin. About 500 million people of the world’s population were infected with the Spanish Flu viruses and at least 50 million people perished around the world. The Spanish Flu epidemic was associated with an increase in death by suicide. It has been proposed that a decrease in social integration and interaction during the epidemic and the fears caused by the epidemic likely increased suicide. It is important to note that social isolation and fears are common during the current Covid-19 epidemic.
Increase in suicides can be attributed to fears of contracting the illness, fears of being a burden to the family, general anxiety, social isolation and psychological distress. It was observed that anxiety was associated with stress and reduced sleep quality, and the combination of anxiety and stress reduced the positive effects of social capital on sleep quality. Worries about their physical health, anger, impulsivity and suicidal ideation were significantly higher in psychiatric patients than in normal population. Multiple cases of Covid-19 -related suicides in the India and other countries have been reported in mass media. Pandemic is associated with distress, anxiety, fear of contagion, depression and insomnia in the general population.
Social isolation, anxiety, fear of contagion, uncertainty, chronic stress and economic difficulties may lead to the development or exacerbation of stress-related disorders and suicidality in vulnerable populations including individuals with pre-existing psychiatric disorders, low-resilient persons, individuals who reside in high Covid-19 prevalence areas and people who have a family member or a friend who has died of Pandemics-19. Social isolation contributes to the path physiology of psychiatric disorders and suicidal behavior.
In the famous book on suicide, Emile Durkheim emphasized that social connectedness is a critical factor in emotional health and social stability. From a suicide prevention perspective, it is troubling that the most important public health approach for the Covid-19 epidemic is social distancing. Anxiety and fear of contagion during the Covid-19 crisis may be related to uncertainty, fear of unknown and Panic inducing stories in traditional and social media. Worries and fears cause various mental and physical symptoms and may lead to the development of anxiety disorders, depression and sleep disorders. Sleep disturbances are a stand-alone risk factor for suicidal behavior. Uncertainty, especially economic uncertainty is associated with stress-related disorders and suicide. It has been shown that uncertainty is a more stressful state to be in than really knowing something bad will happen. Uncertainty is associated with depression and anxiety. A spike in daily economic uncertainty lead to an immediate impact on suicides which suggest that economic uncertainty may lead to an increase in the risk of suicide.
Historically, economic downturns were associated with mental health disorders and suicides. Increases in the unemployment rate were associated with higher prevalence of depression, alcohol and other substance use disorders and suicide deaths. To reduce suicides during the Covid-19 crisis it is imperative to decrease stress, anxiety, fears and loneliness in the general population. There should be traditional and social media campaigns to promote mental health and reduce distress. People need to be encouraged to stay connected and maintain relationships by telephone or videos get enough sleep, eat healthy food and exercise. It is important to deliver community support for those living alone and to encourage families and friends to check in. Screenings for anxiety, depression and suicidal feelings ought to be employed. Transparent, timely and responsible media reporting is absolutely necessary. Suicide prevention helplines should be available and may be very useful in preventing suicides. Whenever possible, governments and (NGOs) should provide financial support for people in needs.
People with psychiatric disorders should be advised to continue their treatment regimens and to stay in touch with their mental health professionals especially Psychiatrists, Psychiatric social workers and clinical or rehabilitation psychologists. Some psychiatric patients may need adjustments in their treatment and increased frequency of contact with their mental health clinicians. Telemedicine can improve accessibility of mental health care. Patients should be advised to limit watching, reading or listening to traditional and social media news stories. Individuals in suicidal crises need special attention. Some suicidal persons might not seek help because of fear that attending face-to-face appointments with a health care professional might put them at risk of contracting Covid-19 or because of other reasons.
Therefore, individuals with a recent suicide attempt history need a follow up. Clinicians should have well-defined guidelines on how to deal with suicidal individuals. Suicide prevention in the Covid-19 era is an important and difficult issue. It is to be hoped that the efforts of clinicians, Psychiatric social workers, researchers and policy makers will reduce Covid-19 related suicides.
Fayaz Ahmad Paul is a Research Scholar and can be reached at [email protected]