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Coronavirus outbreak: managing anxiety and depression among your workforce

As news outlets flood with reports of new coronavirus infections spreading across the world, it is important to recognize the impact on the mental health of nurses, doctors, and people who are advised to stay in quarantine. Such intensive media coverage causes anxiety, affecting workforce morale even in regions not yet affected by a coronavirus. The incidence of anxiety and depression skyrocketed in people who were forced to stay in quarantine. A recent Chinese Psychology Society survey found that 42.6% of 18,000 Chinese citizens who are still free of coronavirus have clinically significant levels of anxiety related to the coronavirus epidemic. Clinically significant depression was identified in 16.6% of surveyed individuals. Up to 40% of SARS survivors suffered from depression and Post-Traumatic Stress Disorder (PTSD) 30 months later, which is higher than the 20-30% PTSD rate after natural disasters. Healthcare providers in affected regions are also at higher risk of mental distress. Here we will discuss the anticipated impact on mental health status and the measures your company can take now to reduce the mental health fallout from this global health crisis.

The major difference between seasonal flu and coronavirus, or other pandemics, is that we understand seasonal flu very well. With coronavirus, the outlook is still unclear, even though the SARS-CoV-2 coronavirus causing COVID-19 (COronaVIrus Disease 2019) is far less contagious than viruses causing measles. The main objectives of health systems are to contain the spread of the virus mainly by limiting travel and the number of interactions people who might have been exposed to the virus have with others. For people who live in an area that has reported positive coronavirus cases, quarantine may be required. However, news outlets report that some people who are not required to be in a quarantine don’t want to leave their homes to limit potential exposure to coronavirus.

Why does self-isolation worsen mental health?

Unnecessary self-isolation can worsen mental health status for people who are prone to anxiety and social phobias. Cutting social ties and isolation can have a negative impact on mental health. Maintaining regular routines and interaction with people, as well as guided counselling, are essential for people with social anxieties.

Clear communication can help to reduce the risk of mental health stress in the workplace. Communicating the risk management plan and emergency response exercises can help to reduce anxiety amongst employees. It is important to enable easy access to mental health management with your EAP and benefits provider. Timely access to mental health services is critical to reducing the incidence of severe depression and PTSD. Proactive case management can reduce the risk of long term disability.

Advise employees to seek online psychological counselling or internet-based cognitive behaviour therapy (iCBT) if experiencing anxiety or depression. Remind them if your health plan includes iCBT coverage.

If a person’s antidepressant or anti-anxiety medications stop working, a medication review by an expert healthcare provider might be needed. The Pillcheck medication optimization service includes a pharmacogenetic test delivered to your home and online medication review by an expert clinical pharmacist. Pillcheck supports customers across Canada, including remote rural areas, providing access to advanced personalized mental health solutions.

Proactive mental health management strategies are needed for first responders, nurses and support services.

Healthcare organizations have developed emergency response procedures and training and have stocked protective gear. However, organizations should also plan for managing the inevitable mental health impact. In large-scale crises, such as SARS and coronavirus outbreaks, first responders, including nurses, ambulance services, and social workers, are at a higher risk of developing anxiety, depression and PTSD. First responders have to endure significantly increased workload, wear protective gear for extended periods, while diligently following infection control procedures.

It is pertinent to take care of employees’ mental state. During a full-scale outbreak, traditional mental health services become overwhelmed and less accessible. Proactive and alternative mental health solutions can help to reduce the severity and scale of the mental health crisis.

In-person counselling sessions will probably not be feasible due to quarantine measures. The experience in China shows that hotlines become flooded with calls from frightened and anxious people hunkered down in their homes and afraid of catching the disease. The limited number of qualified psychiatrists and psychologists creates significant difficulties for healthcare organizations to provide timely access to mental health services for their employees.

The STAR*D study shows that only 30% of patients suffering from depression respond to first line treatments. Over 70% of people require multiple drug dose trials, each of which takes 4-5 weeks. Furthermore, mismatched medications can worsen anxiety and depression symptoms. Pharmacogenetic testing services, such as Pillcheck, can help to select appropriate treatment and reduce the risk of treatment failure and antidepressant side effects, even before depression symptoms develop.

Pillcheck can be accessed now before any mental health symptoms appear. Information about the person’s expected response to antidepressants and anti-anxiety medications will provide additional peace of mind. If a crisis strikes, nurses and first responders will have a clear understanding of how their bodies process antidepressants and work with their physicians to start treatment with a drug that will be better tolerated, thus increasing the response rate.

Pillcheck pharmacists with experience in mental health management can help employers to augment mental health management solutions. Leading Canadian employers, such as GE Canada, Staples, and CMHC, provide easy access to Pillcheck services as part of health benefits.

Conclusions:

  • COVID-19 pandemic carries a risk of a large-scale mental health crisis even before the virus becomes widespread in Canada.
  • Unnecessary self-isolation can worsen mental health state. Quarantine might be needed only in specific cases when people might have been exposed to the virus.
  • Fear of viral spread already causes anxiety and depression in some people. Expert help might be needed to help to control irrational fears, and anti-anxiety medications might be required.
  • Pillcheck is one of the essential tools for improving mental health management and, unlike CBT, it can be accessed before depression or PTSD symptoms develop.
  • Consider promoting Pillcheck medication optimization service to healthcare providers, first responders and supporting workers who are at significant risk of developing severe anxiety depression and PTSD during an epidemic. Pillcheck can provide some peace of mind and connect with expert pharmacists who are also alternative mental healthcare providers. Pharmacists are less likely to become the bottleneck for healthcare services during a crisis.

Selected references:

  1. Au A, Chan I, Li P, Chan J, Chan YH, Ng F Correlates of psychological distress in discharged patients recovering from acute respiratory syndrome in Hong Kong.The International Journal of Psychosocial Rehabilitation. 2004;8:41–51 [Google Scholar]
  2. Cheng SKW, Wong CW, Tsang CW, Wong KC Psychological distress and negative appraisals in survivors of severe acute respiratory syndrome (SARS).Psychol Med. 1999;34:1187–95 10.1017/S0033291704002272 [PubMed] [ [Google Scholar]
  3. Wu KK, Chan KS, Ma MT Posttraumatic stress, anxiety, and depression in survivors of severe acute respiratory syndrome (SARS).J Trauma Stress. 2005;18:39–42 10.1002/jts.20004 [PubMed] [Google Scholar]
  4. Hawryluck L, Gold WL, Robinson S, Pogorski S, Galea S, Styra R SARS control and psychological effects of quarantine, Toronto, Canada.Emerg Infect Dis. 2004;10:1206–12 [PMC free article]
  5. https://www.businessinsider.com/mental-health-issues-anxiety-depression-skyrocket-china-lockdowns-curb-coronavirus-2020-2
  6. https://www.apa.org/research/action/speaking-of-psychology/coronavirus-anxiety

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