WOW—another article about this CORONA virus. If I am being honest, I have been waffling between wanting to consume every piece of information available on it to wanting to go hide in my closet and pretend that none of this was happening. So, for me to be writing anything about it and further contributing anything out there for anyone to read, really is quite shocking, even to me.
So, why am I, then?
Well, I have been sitting here, like all of you, watching everything unfold and change so fast that I have barely had time to really take it all in and digest any of it. It seems like yesterday that I was listening to the news and we were being informed about the virus being contained to Wuhan, China. Then, one airplane with “some” passengers who had been to that area were being flown into LAX, but they were going to be quarantined. At that point, I had some slight doubts that this virus, from that point on, would not soon be hitting the US, but I still thought it would be insignificant, at worst. After all, the “very few” who had been exposed to it were going to be kept from everyone else until they were “all clear”.
Then, it seemed like a slow-to-start fire as the news reported one “known” person to have it. Then, another…until I now sit here feeling like I am stuck in a bad dream, just wanting to wake up, but can’t. I could never have imagined in a million years that life as I (we) are now living it in the San Francisco Bay Area (as well as in the rest of the country) would be like this.
I am still trying to wrap my head around there not being any toilet paper available anywhere, let alone trying to accept that our new normal really is going to be all of our children out of school, all of us physically isolated from anyone other than those already living in the 4 walls in which we currently live…and that the world outside of our homes, will essentially be….well, eerily quiet and empty.
Initially, I admit, I thought this was all a big overreaction. I did. I looked at the comparison between the seasonal flu and the corona virus in terms of symptom severity, cases and death rates. I wondered why we weren’t reacting more seriously to the seasonal flu given what was presented. Now, as time has gone on and more information has come out…as more and more people are infected and dying, my opinion has changed.
One thing to note here…I do not want anyone to die as a result of this Corona Virus.
And it is for that reason I am writing this article.
We are so focused on people dying from the virus for physical reasons…from the actual virus itself.
My concern is that there is another issue nobody seems to really be discussing. The other ways this virus could result in the suffering and deaths of hundreds, if not thousands, of people, if the way we are living continues for too long.
WHAT? What am I saying? How could the way we live result in more suffering and more deaths, you ask?
Well, I am a licensed psychologist, and I can tell you that while all of the talk right now is focused on talking to medical doctors regarding how the virus affects the body (which, of course, makes sense), we are not just a biological being. We have feelings, emotions and don’t just suffer physical pain.
If you disagree with me at all here, then please tell me if there is anyone out there who is not:
• Missing a loved one that they cannot see due to this sheltering in place
• Worried about their job or financial situation
• Upset that they cannot go out and see their friends
• Scared they or someone they love might get the virus and die
• Frustrated that they cannot go grocery shopping and find the items they want
But I will be honest about what I am most scared of in all of this. I am worried because I know that mental illness is serious. I know there is a stigma out there and that there may be many of you out there reading this saying things like “whatever, you are not a “real doctor”, or “whatever, shut up, this virus really is and will kill people, so be quiet”. I saw my first patient over 25 years ago, so believe me, I have heard it all. I get it. But, believe me. I do GET it.
And that is why I am writing this. It is important that we get ahead of all of what I am writing here given this dramatic and rather abrupt change in our lives that seems to have no known end-date in sight. Because if we don’t, more people will die as a result of this pandemic than at the hands of this virus alone.
Now, let’s just get to the basics here:
• Suicide is one of the leading causes of death in the United States.
• 90% of those who died by suicide had a diagnosable mental health condition at the time of their death*
• Suicide occurs in the presence of any psychiatric diagnosis, but studies repeatedly show that rates for suicide are more common in some, including:
o Major Depressive Disorder
o Eating Disorders
o Mixed Drug Abuse, Alcohol and Opioid Abuse
Ok, so..again…why am I writing about this and why is this related to the Corona Virus Epidemic?
Well, I will tell you why. In just the past few days alone, I have seen and heard first-hand from posts on FB, friends and family members as well as the vast majority of my patients many things that lead me to believe that many, if not all, will be at risk for an increase for at least one of the above psychiatric disorders during this Corona Virus Epidemic.
This alone is something that should be of concern. As this epidemic goes on, many people may unknowingly be struggling with an illness and, because of a lack of mental health awareness and education, may not know what is going on or why. So, one aim of me writing this is to simply get more information and knowledge out there so that if anyone is experiencing any symptoms they read about here, they can reach out for help and treatment so they can get better and hopefully prevent their risk for suicide.
Furthermore, if someone already has had in the past or already has one of these disorders, their symptoms could worsen during this time, rendering them at more at risk for suicide.
Major Depressive Disorder
One of the first things I heard from many people today was something like “my depression is getting worse”, or “all of this is not helping my depression any”.
This did not surprise me, but it is alarming me and of great concern.
I won’t go into great, complicated detail here, but here is the bottom line:
When we experience a STRESS (i.e. how the the Corona Virus epidemic is personally affecting them), our bodies have a physiological response that, over time, can result in the body no longer being able to fight/manage it. When we have long-term stress, it can lead to depression.
Basically: The more things we are stressed about and the longer we are stressed about them, the more likely we are to be at risk for depression.
As a note here, chronic stress can also increase the risk of: A) viral infection and B) Type 2 Diabetes. I note this here because we are trying to prevent people from getting a virus AND those with diabetes have been identified as in the higher risk group for Corona Virus**
Symptoms of depression to be aware of:
o Feeling down, depressed or hopeless
o Sleeping more or less than usual
o Not enjoying anything you normally do
o Extreme guilt or feeling bad about yourself
o Decreased or increased appetite
o Difficulty concentrating or making decisions
o Moving or speaking so slowly that people have noticed (or being so restless that you’ve been moving around a lot)
o Thoughts that you would be better off dead or of hurting yourself in some way
So…I mentioned that I have been hearing or seeing a lot over the past week or so that started my concern for there being an increase in the potential rise in suicide rates during and after this Corona Virus epidemic. Many of those things, or STRESSORS, happened to be factors that contribute to suicide
Many factors contribute to suicide among those WITH and WITHOUT known mental health conditions. Yes, I said it. Even though I mentioned above that 90% of those who died by suicide had a diagnosable mental health condition at the time of their death, there is the other 10% who do not have a known or diagnosed mental health condition.
So what are those contributing factors? According to the CDC***, they are:
o Relationship Problems (42%)
o Having a crisis in the past or upcoming 2 weeks (29%)
o Problematic substance use (28%)
o Having a physical health problem (22%)
o Experiencing a Job/Financial Problem (16%)
o Having a Criminal/Legal Problem (9%)
o Loss of Housing (4%)
Let’s discuss these in relation to the Corona Virus epidemic, shall we?
I have heard and seen people going through pretty much every single factor mentioned in that list above.
I don’t think I am going out on a limb here in stating that this epidemic is, well, a crisis. It is a crisis globally, nationally, and personally. It has infiltrated every aspect of our lives and changed the way we conduct our everyday way of living. No longer are we continuing to have the same daily routines or worries that we had just 2 a mere 2 weeks ago.
Just as we are trying to digest and get used to one piece of shocking information and trying to implement whatever changes we must make into our daily lives and those of our families, we must shift gears and do so for another one. As if this is not enough, the influx of information coming at us about the downfall in the economy and heightened numbers of those infected and dying all around us and all over the world is a lot to take in.
The overwhelming shifts, changes and shocking information along with the actual fear for survival with the inability to just procure the basic supplies to help protect oneself from actually getting the virus left many feeling helpless and with an increasing sense of fear and anxiety about their ability to be safe. This feeling increased even more as empty shelves were everywhere, leaving many fearing that they would be unable to feed themselves and/or their families should they be required to stay home as they started to hear other countries were doing.
So, I think it is safe to say that everyone is having a crisis in the past or upcoming 2 weeks (one of the factors stated above).
For those that actually, unfortunately, do contract the virus, they will have a physical health problem (another factor stated above).
Let’s talk more specifics, though. For many, they are or will experience stress from the other factors mentioned above in relation to the Corona Virus Epidemic.
Experiencing a Job/Financial Problem
o Those that work in restaurants, bars, theaters, etc.. who are suddenly finding themselves home without a job or income for an unknown amount of time.
o Those that have been engaged and excitedly planning their weddings and are now devastated at having to cancel what was supposed to be the best day of their lives or are anxiously awaiting news to know if the plans can go on. The stress is costly emotionally and economically.
o Entrepreneurs who just started a business who are now in shock and disbelief, wishing they had never left their more “secure” job as they fear financial devastation.
o Single parents trying to focus, working from home due to a stay at home order while also caring for children who are home due to closed schools and daycares.
o People in relationships anxious and saddened over not being able to see each other and having no idea when they will ever get to do so again.
o People who live alone, but have very active social lives now working from home and lacking any in-person social contact for the foreseeable future.
o Family members of the elderly in a nursing home who cannot go visit them; knowing they are missing out on what could be some of their last days together.
o A family, separated because someone could not get home while in another country, wondering how and when they will be reunited.
o Kids who now have stay at home orders who are unable to see their friends and are, in their minds, “stuck” at home with their families and missing their friends.
Loss of Housing
o Those who are now without an income due to a layoff or job loss for an unknown amount of time worry about not being able to pay their mortgage or being evicted.
o Those who rent rooms and who are not on a lease actually being asked to leave because of job loss or a layoff because of their inability to pay their share.
Problematic substance use
This factor is more complicated and requires a bit more of a discussion.
People are facing many stressors from this Corona Virus epidemic. Life as everyone knew it has changed dramatically and drastically in ways that nobody could have imagined, and in such a short period of time.
If any changes and stressors have been brought about in someone’s life by this epidemic that makes them feel like they have no purpose, someone may turn to substances to feel artificial happiness or numb the pain. When someone feels this way, they are also more likely to end their life.
If someone has problematic substance use, they are much more likely to have suicidal thoughts, make a non-fatal suicide attempt or die by suicide.
Furthermore, alcohol use has been found to increase the occurrence and severity of domestic violence, so I am very concerned for anyone in an abusive relationship who is now going to be at home together with their abuser. This will only lend to more opportunities for abuse to occur, rendering those who are subjected to it feeling even more vulnerable and unprotected.
With what is going on with this epidemic, the financial strain and worries that some families are having could be causing marital stress and conflict, increasing the alcohol consumption of the abuser and increasing the risk of violence between partners.
And, as noted above, relationship problems are a factor contributing to suicide. But, domestic victimization, in particular, is correlated with a higher rate of depression and suicidal behavior.
However, the sobering fact is that with domestic abuse also comes homicide.
• 72% of all murder-suicides are perpetrated by intimate partners
• 1 in 3 female murder victims are killed by intimate partners
• 1 in 20 male murder victims are killed by intimate partners
And, I want to mention children who witness violence. Living in a hostile environment experiencing this can make them anxious and scared. They, too, can start to feel worthless and powerless in this situation and are susceptible to depression as well. The longer-term effects for children who have witnessed violence in the home include them being at risk for (among other things), depression, substance abuse, and becoming much more likely to perpetuate the cycle of abuse in their own relationships as they grow into adulthood.****
A QUICK NOTE ABOUT TEENS
I work with many teenagers. And I do think it is worth mentioning that the effects on them and their lives now and after all of this could go unnoticed given all of the (completely valid and necessary) concern and focus on the virus itself as well as just the basic daily survival and economic concerns.
This could not come at a worse time for them. Let’s face it. Especially high school seniors. They are the ones I am most concerned about in regard to depression and potentially having a higher risk for harming themselves or having suicidal thoughts. And here’s why:
o They finally made it to the final year of school. And now all of the things they “earned” and were looking forward to all of this time are never going to be experienced. You just can’t postpone Senior Ball, Grad Night or Graduation.
o This is the last, few precious months that they had to spend with their friends before they all went their separate ways. Now all of that time is being taken from them as they are given orders to stay at home. Sorry, Snapchat, texting and social media just aren’t the same as actually seeing your friends in class or walking down the hallway. Especially if it happens to be your girl or boyfriend.
o With college on the horizon for many, the announcement (at least in California) that school being cancelled until the next academic year without much discussion brought a lot of questions and anxiety to many. They wondered how this would affect graduation…college acceptances, etc….
While I mentioned some basic symptoms of depression to look out for, some others in teens to watch out for are:
o Excessive sleeping
o Overly sensitive or angry
o Eating a lot more than usual
o Self harm (cutting)
o Drug or alcohol use
o Socially isolating (with the stay at home order, this could look like not being on social media connecting with friends at all)
I want to mention that I am a certified as an eating disorder specialist by the International Association of Eating Disorder Professionals. So what I am writing here is based on years of experience as well as what I am hearing from many, many people. So, nothing I write here is based on any one or even two individuals.
As listed above, suicide is more common with someone who has a diagnosis of an eating disorder. However, people who have eating disorders have the highest risk of mortality of any mental health illness due to a variety of factors (not just suicide).
There are over 30 million people in the US right now who have an eating disorder. People of all ages, genders, ethnicities, cultures and socioeconomic backgrounds have them. Nearly one person dying every hour as a direct result of an eating disorder.
Because of this, I feel the need to mention this as a major concern for all of us to be aware of in this Corona Virus Epidemic.
I will speak for what is going on in those areas where there are stay at home orders, as what I have been hearing so far is based on people who have been affected by such orders.
Because the gyms are closed, people are saying that they
o feel “guilty”, “bad”
o “anxious about getting fat”
o “know they have already gained weight”
o “afraid to eat because I can’t burn it off”
o “just decided to eat everything, anyway because what’s the point if I can’t work out?”
Because the “good/healthy” foods were not available at the store when they went, they could only buy the “bad” foods and are:
o “Convinced I am going to gain a ton of weight while I am stuck at home”
o “Throwing up everything I am eating because I am afraid to gain weight”
o “Feeling disgusting”
o “Telling myself I can’t eat all day tomorrow”
Because people feel completely out of control due to not being able to control much in their lives right now, I am seeing a marked increase in eating disordered thoughts, feelings and behaviors in people who have eating disorder diagnoses. Contrary to what many believe, eating disorders are not about the food in so much as they are about control.
When things feel out of control (life circumstances, feelings, etc..), then they can feel a sense of control by using food (restricting, overexercising, etc..). Food can also fulfill and need and provide support or an escape at times when everything feels overwhelming and completely out of control.
My fear is that the longer this epidemic goes on and the longer peoples’ lives are disrupted, the more severe some of these eating disorder behaviors will become. This is of real concern for those people who are living alone in these times of stay at home orders where they truly are not in direct contact with other people.
Whereas someone with an eating disorder might have normally gone to work and seen colleagues who might have been concerned enough to mention if they looked “too pale” or asked if they felt alright after they had not eaten for days in a row, with the way things are now, nobody will be seeing them or mentioning such things.
Furthermore, if someone is malnourished or engaging in purging behaviors (i.e self-induced vomiting, fasting for days, diet pills, etc..), several things can happen. For one, they could pass out and hit their head on something and have a head injury. They could have a heart attack. If someone is engaging in their eating disorder behaviors and lives alone, they truly could be at risk for dying. People can and do die from these illnesses and they need to be taken seriously.
When I heard the things I did over the past few days, I did start to get very concerned about the ways in which this epidemic is impacting people that we have not thought about.
Everyone now says that we “should” have acted sooner to prevent the Corona Virus getting this bad and causing so many to get sick and die. I don’t want to hear later on that we “should” have thought about how our mental health and well-being “could” have been affected by us being forced into “sheltering in place”.
So, I am writing about it now in the hopes that we can get ahead of it and put some interventions into place. Let’s face it…if this really IS the only way we can stop this virus, and we can’t control or stop the orders by which we must live right now, then let’s at least talk about how it could affect us so we can get ahead of it and try to prevent this from becoming an even worse situation than it already is.
**Medical News Today: What to know about general adaptation syndrome. Medically reviewed by: Timothy J. Legg, PhD, CRNP on November 28, 2017 -Written by Lana Burgess
****World Health Organization: Global and Regional Estimates of Violence Against Women