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Mental health challenges evolving – not diminishing

COVID-19 anxiety will persist after return to more normal social interaction: researcher
University of British Columbia assistant professor of psychology Nancy Sin: “Much of the stress that we see … are stresses associated with taking care of family, working during the pandemic combined with social isolation”l | Submitted

With Canadian provinces now starting to loosen COVID restrictions, the pandemic’s toll on Canadians’ mental health up to this point still cannot be fully calculated.

What experts can confirm, however, is that the cost is large – and the uphill battle to maintain Canadians’ mental wellness will continue, despite government health officials’ policy shift towards dealing with COVID-19 as endemic.

Christine Korol, director at Vancouver Anxiety – a clinic dedicated to treating patients for a variety of mental illnesses – said that while her business was oversubscribed with patients even before the pandemic, patient demand over the last two years has increased continually.

Korol said she has brought in more graduate students from the University of British Columbia (UBC), Simon Fraser University and the University of Victoria to help with treatment.

“They need the experience, and the public needed therapy. And they’ve all been busy; I’ve had up to 10 students, and they’ve all been full. So I don’t think I would have had that – to have this many students with full [patients lists] – prior to the pandemic.”

Korol’s is not an isolated experience.

In November 2021, the Canadian Medical Association and consultancy Deloitte co-released a report on the COVID-19 pandemic’s effects on health care.

Among the findings: as many as 27 per cent of Canadians were experiencing “high levels of anxiety” last June – well before the highly contagious Omicron variant led to the last round of restrictions starting late 2021 and lasting into the first two months of this year. That anxiety index has not dropped below 20 per cent since the pandemic started.

Depression levels, meanwhile, were not far behind – hovering around 15 per cent of the total population, according to the same report.

Perhaps even more indicative of the toll is the Centre for Addiction and Mental Health reporting a 750 per cent increase to its number of virtual care visits in the first wave of the pandemic alone: to 3,000 from 350.

But Korol said the numbers show only part of the picture, because the number of people seeking help hasn’t risen as fast as the severity of existing patients and cases.

She added that while some people might expect the gradual return of social contact to ease that trend, the situation is likely to create new sources of mental distress.

“You are going to see people who are uncomfortable, having trouble adjusting and not feeling safe, just seeing the number of people without masks on when mask mandates are dropped,” she said. “When B.C. dropped some mask mandates last summer, people got really nervous because they’re masked, and they wanted everyone to have masks.”

UBC assistant professor of psychology Nancy Sin has been working with her colleagues to track monthly data on how people coped with the pandemic between 2020 and 2021. Sin said the team is planning to reconnect with respondents this spring about their experiences during the Omicron-driven surge in late 2021, adding that she hopes to have some empirical insights by last summer.

But Sin agreed that for those who hope the reopening of society will bring about a dramatic improvement in people’s mental health, the results are likely to be mixed.

“There seem to be divisions centred around one’s vaccination status, personal health vulnerability and comfort level with public health restrictions,” she said.

“Among my students, I see a huge amount of variability. Many students are – after spending a lot of time studying remotely,… so ready to get back to the classroom …. But that said, I have talked to a number of students who are either themselves or have household members with health vulnerabilities, and they are very concerned about restrictions being lifted.

“We’ve all sensed out anxiety heightened during the Omicron surge; national surveys at the time showed that people did become more fearful over that time, although their mental health didn’t take a big hit. But people with existing mental health issues and also other vulnerabilities became much more threatened…. So a key theme is that there’s a lot of up and down in a pandemic that has been so unpredictable.”

According to Sin, the previous research completed by her team indicates that certain demographics were having a much harder time than others coping with the mental stress of a pandemic. Sin said the data showed that younger people – ranging from students to young professionals with new, growing families – had significantly higher levels of anxiety than those in age groups older than 55.

The findings coincided with a February 2021 Ipsos poll showing that while 56 per cent of Canadians said they were more stressed during the pandemic, that number jumped to 63 per cent for people between the ages of 18 and 34.

For the 55-plus demographic, meanwhile, a relatively lower 46 per cent reported increased stress.

Sin attributes that phenomenon to the pandemic raising people’s doubt in their ability to earn money, build careers and raise families – while a lack of child-care options added an additional vector of stress into people’s daily lives.

According to the research, older demographics were able to cope better – perhaps surprisingly, given the coronavirus’ higher threat of severe illness among the elderly – because they had previous life experiences on which to lean during difficult times.

What isn’t debatable, Sin said, is that cases of depression have continued to grow, and there’s one overwhelming main reason.

“People who were affected to a greater extent were people who had resource scarcity,” she said. “These were people who had problems obtaining food, goods and necessities of daily life. That’s where we saw the greatest increases of depression over time. Those with financial instability … much of the stress that we see there are stresses associated with taking care of family, working during the pandemic combined with social isolation.”

Korol agreed, but added that in her treatment of patients, the fundamental fear driving economic anxiety isn’t necessarily what people assume it would be.

“What we do in therapy is ask, ‘What do you think will happen?’ or ‘What is the worst possible scenario?’” she said. “It often surprises me what it is that people would be most nervous about. Someone may be fearful of losing their jobs, but their biggest fear would be to move back in with their parents if they had to, rather than going hungry. Then we would come up with a plan about how to cope with that situation.”

Korol added that the pandemic’s restrictions on gatherings have created challenges for health professionals like her, because, while she was able to move 99 per cent of her practice online, some treatments are possible, or effective, only when done in person.

“I’m really excited about things opening up for my socially anxious patients, because they will now have more things to do,” she said. “That has probably been the toughest thing during the pandemic, dealing with patients with social anxiety … because I feel like I’m trying to do things with one hand tied behind my back.”

What can people do to alleviate these anxiety challenges?

Korol said that, if you are an employer, offering at least some work-from-home options would help employees uneasy about returning to an office setting.

For individuals, Korol’s advice is more about resetting one’s mindset.

“For people with OCD [obsessive compulsive disorder], it’s about facing your fears,” she said.

Sin, meanwhile, said her team’s research showed that more positive outcomes stem from an individual’s sense of purpose. So social interaction – anything from having a long phone call with a loved one to delivering groceries to helping neighbours – would buttress mental health.

For others in higher-risk groups, Sin had another suggestion.

“For people who are under greater risk of severe illness from COVID, they might try to cultivate smaller groups of friendships with people they can trust,” she said. “That’s where having a smaller group of friends and family members can make sure you socialize in a setting that’s comfortable for you. And for bolstering mental health, it’s crucial to take care of one’s physical health. Engage in physical activities. Practice good sleep behaviours. It helps maintain stability and increases your capacity to cope with stress.” •