Pine Rest: COVID-19 will have lasting impact on mental health

Study finds unemployment spike is risk factor in suicide attempts.
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Michigan is expected to experience a spike in mental health issues even after COVID-19 dies down.

According to a study by experts from Pine Rest Christian Mental Health Services, COVID-19 has led to an emergence of many of the conditions that are known to increase risk for suicide.

Economic downturns overall are shown to increase suicide rates 1.3% for every percentage point increase in unemployment, according to the study. Michigan’s unemployment rates rose more than 17% with over 1 million Michigan residents filing for benefits in just one month.

While Pine Rest said the “Stay Home, Stay Safe” order has been effective in saving lives, the study acknowledged Michiganders are finding themselves separated from their core social supports of friends, extended family, coworkers, teachers and health care providers. Additionally, the Michigan economy has slowed dramatically, driving up unemployment, threatening health care benefits and shuttering businesses throughout the state.

The Michigan unemployment rate is now 21%, the second highest in the nation, according to the study. Taking this spike into account, Pine Rest estimated an increase in suicide deaths of at least 23% in the coming year. In the two years preceding the COVID-19 pandemic, 16% of those who died by suicide had experienced a job loss or financial problem.

Calls to national suicide hotlines have increased an average of 47%, with some crisis lines experiencing a 300% increase in calls, according to the study. Crisis calls to a hotline in southeast Michigan already have increased 35%.

Along with social distancing comes isolation, which can lead to increased suicide risk. Living alone and feelings of loneliness are strong predicators of suicidal thoughts and suicide attempts, according to Pine Rest.

Quarantines also increase depression, acute stress disorder, post-traumatic stress disorder, anxiety, insomnia and cognitive symptoms.

Pine Rest President and CEO Dr. Mark Eastburg, who co-authored the study, said Michigan also could experience a spike in trauma-related mental health issues.

“If you work in health care or if you’ve had loved ones who passed away, that can affect your mental health,” Eastburg said.

Eastburg said the organization has not yet seen a spike in mental health cases as a result of COVID, but similar to other health care providers, Pine Rest has observed a growing trend of people delaying the care they need for fear of contracting the virus.

“We have seen an increase in the level of severity of people who are coming to our hospital and an increase in people wanting to extend their outpatient care through telehealth,” Eastburg said.

Predictions in the study also are based on research of previous epidemics, including the Severe Acute Respiratory Syndrome (SARS) outbreak in Asia in 2003.

“It’s hard to predict because this is new territory for us as a country and a region, but if we take examples from the SARS epidemic and data coming out of China, we can expect a spike in depression and anxiety,” Eastburg said.

According to the study, early phases of the SARS epidemic saw increases in depression, anxiety, panic attacks, psychomotor agitation, psychotic symptoms, delirium and risk of suicide. Suicide rates in Hong Kong also rose 31.7% two years after SARS.

Conversely, health care providers’ reaction to SARS can provide a blueprint for dealing with the long-term mental health affects of COVID. Examples of what worked with SARS include:

  • Multidisciplinary mental health teams supporting patients and health care workers
  • Specialized mental health services for COVID-19 patients with comorbid mental health disorders
  • Provision of psychological counseling via tele-technology for patients, families of patients and the general public
  • Regular screening for depression, anxiety and risk of suicide by mental health workers for COVID-19 patients and health care professionals

Before COVID-19 hit the U.S., Pine Rest already was moving in the direction of giving people the option to seek tele-therapy, Eastburg said.

“Our patient doors are virtually wide open,” he said. “We were fortunate if people were in the middle of care they could keep that going.”

Eastburg said many businesses have employee assistance programs that provide outpatient counseling. For business leaders going forward, it’s time to find out what those services are about and devise a communication plan for their employees to understand what’s available to them, he said.

Another item for business leaders to be aware of is if an employee has experienced COVID and is coming back to work, that person may experience some difficulty returning to work and need some extra time, Eastburg said.

Eastburg also warned West Michigan’s mental health resources were stretched thin even before COVID hit. He argued the U.S. has had a longstanding view of mental health care as a luxury or an add-on to the health care system and it hasn’t been properly strengthened.

“Pine Rest is the fourth-largest (such facility) in the country, but even in this state we are stretched,” Eastburg said. “A lot of areas have no mental health providers at all … I think this crisis will shed a light on the fact that if someone is mentally unable to function, that affects everything about their lives, their family life, how they work as an employee.”

Telehealth services have been a good way to spread resources to people who previously couldn’t find care, but similar to how health care providers reacted to the SARS epidemic, Michigan needs to prioritize its health care workforce and have more people ready to serve, Eastburg said.

Other findings

Michigan also has seen increased substance use as a consequence of the COVID quarantine. Since the onset of the virus, alcohol sales in the state have increased by 41%, and marijuana sales have nearly doubled. Due to isolation and restrictions on gatherings, many of the support groups critical for substance use disorder recovery are limited, increasing the risk of relapse.

COVID-19 both directly and indirectly causes sleep impairment and insomnia. This could be due to the physiological effects of the disease or the increased anxiety and stress that comes from navigating the pandemic. Insomnia has been shown to increase suicide risk two to four times for the general public, and 18 times for those with mental illness, according to the study.

A recent increase in gun sales adds to the risk of suicide. There was an 85% increase in overall firearm sales and a 91% increase in handgun sales in March 2020 compared to March 2019. Access to firearms in the home more than triples the odds of suicide given that guns are the most common means of suicide in the United States and are more often fatal than most other means of suicide attempt.

Reports of domestic violence also have doubled in some Michigan counties as people have fewer options of escape due to stay-at-home orders, the study said. Instances of domestic violence increase the risk of PTSD by six times compared to other types of trauma, with 64% of victims developing symptoms. Approximately 48% of victims will experience depression, 19% will present with alcohol use disorder and 9% will present with a different substance use disorder.

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