COVID-19, the 'echo pandemic' of suicide and mental illness, and the need to virtualize health care to mitigate risks with Dr. Roger McIntyre

Roger S. McIntyre, MD, returns the Psychcast, this time to talk with host Lorenzo Norris, MD, about the mental health hazards of COVID-19 and what clinicians can do to help protect patients.

Dr. McIntyre is professor of psychiatry and pharmacology, and head of the mood disorders psychopharmacology unit at the University Health Network at the University of Toronto.

He disclosed receiving research or grants from the Stanley Medical Research Institute and the CIHR/GACD/National Natural Science Foundation of China. Dr. McIntyre also disclosed receiving consultation/speaker fees from several pharmaceutical companies. Dr. Norris has no disclosures.

Take-home points

• Uncertainty tied to the COVID-19 pandemic threatens to undermine mental health and exacerbate problems for those with mental illness.
• U.S. suicide rates, which were already rising after the Great Recession of 2007-2009, are likely to climb further because of the impact of COVID-19.
• Clinicians can take steps to prevent some of the negative mental health outcomes tied to the pandemic.

Summary

• COVID-19 presents a triple threat to patients' mental health.
  • The fear of viral infection is a mental health hazard.
  • The financial shock that COVID-19 has had on the economy has not been seen since the Great Depression. Links between suicide and unemployment are powerful. In a study published in World Psychiatry, McIntyre and colleagues found associations between COVID-19 and major depression, PTSD, binge alcohol use, and substance use disorders.
    • French social scientist Emile Durheim, PhD described the link between suicide and unemployment.
  • Quarantining affects mental health, and there is nothing like COVID-19 in the history books.
    • The Toronto experience with severe acute respiratory syndrome in 2003 offers lessons about the devastating impact of quarantining on mental health.
• "Deaths of despair" in the form of suicides have been on the increase in the United States. From the Great Recession, researchers found that for every 1% increase in unemployment, there is a commensurate 1% increase in suicide.
  • U.S. unemployment stood at 8%-9% during the Great Recession, and now those percentages are much higher. Dr. McIntyre and his team projected that an unemployment rate of 14%-20% would lead to an additional 8,000-10,000 suicides could occur each year for the next 2 years. That's in addition to the current number of approximately 50,000 suicides annually.
  • Express Scripts, a pharmacy benefits manager, recently reported a 40% increase in prescriptions for anxiety-related medications. This suggests that people are distressed.
• Clinicians should take an aspirational approach to addressing these issues by pivoting to virtual platforms to increase patients' access to care.
  • Create medical homes that are HIPAA compliant.
  • Look toward evidence-based models such as those found in Japan. That country found that, for every 0.2% increase in GDP spending on mental health care right after the Great Recession, the suicide rate fell by 1%.
  • Encourage patients to structure the day and avoid consuming too much news or participating on social media.
    • Two studies conducted in China found that people who spent more than 2-3 hours a day on news consumption were more likely to report clinical levels of depression, anxiety, and insomnia.
    • Social media consumption has been associated with many adverse mental health outcomes, including loneliness. People who spent more than 3 hours a day were more likely to experience depression.
  • Support programs for small-business people; jobs enhance resilience.
  • Target the "basics" of self-care, such as getting enough sleep and engaging with others.

References

McIntyre RS, Lee Y. Psychiatry Res. 2020 May 19. doi: 10.1016/j.psychres.2020.113104.

McIntyre RS, Lee Y. World Psychiatry. 2020 Jun;19(2):250-1.

Shanahan L et al. Am J Public Health. 2012 Jun;109(6):854-8.

Kang S, Chua HC. CMAJ. 2004 Mar 2;170(5):811-2.

Express Scripts. America's State of Mind Report. 2020 Apr 16.

Lee Y et al. Psychiatry Clin Neurosci. 2020 Jul 1. doi: 10.1111/pch.13101.

Hao F et al. Brain Behav Immun. 2020 Jul;87:100-6.

Tan W et al. Brain Behav Immun. 2020 Jul;87:84-92.

Wang C et al. Brain Behav Immun. 2020 Jul;87:40-8.

Harvey SB et al. Am J Psychiatry. 2018 Jan 1;175(1):28-36.

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