Over the last seven months the Coronavirus and with it our physical health, determined all other aspects of life. Although the pandemic entails great psychological stress and risks, mental health has been pushed to the background. The World Mental Health Day is an opportunity to bring psychological well-being back to the fore and to evaluate how Turkey fares in terms of mental health.
“Stay safe and healthy.” Nowadays this wish probably became the most frequently used phrase at the end of phone calls, e-mails and messages. During the COVID-19 crisis, our physical health became the most important factor in our lives. Social contacts, travels, physical education, public transportation – we completely abstained or at least limited and still limit many of these activities for the sake of our health.
At the same time, we all became Corona-experts. We keep track of the latest infection numbers; we know about the symptoms of COVID-19 and we enforce social distance, hygiene, and wearing masks. We even live healthier: According to a recent study by researchers from Ondokuz Mayıs University in Turkey’s Samsun, 42.5 % of the participants who used to smoke regularly, reduced or quit smoking after the outbreak of the pandemic.
The fear of COVID-19 became omnipresent. Yet, while we were focusing more than ever on our physical health, our mental health quietly moved into the background. Warnings from psychologists that the Corona crisis also affects our psychological well-being get lost in the dozens of headlines about COVID-19 every day. Little do we talk about what to do when loneliness overcomes us in self-isolation, how to avoid freaking out when anxiety starts to control us or how to find sleep after the fifth night of insomnia.
Today is the World Mental Health Day. It’s time to give mental health a stage and take stock of the psychological condition of the Turkish population in times of COVID-19.
HEALTHCARE PROFESSIONALS BURN OUT
Over the last week, a study from Austrian, British and Belgian researchers reached the headlines of many newspapers worldwide, including Turkey. The research had brought to light that the rate of depression and anxiety disorders tripled from around 17% before the pandemic to 52% during the early Coronavirus lockdown in April in the United Kingdom. Scientists from Boston University School of Public Health revealed a similar phenomenon in the US, where 27.8% of the adults showed depression symptoms in mid-April compared to 8.5% before the pandemic.
Although to date, no comparison of pre- and post-pandemic depression levels in Turkey exists, research indicates that the Turkish population is not spared the psychological side effects of the pandemic. Those affected first are healthcare workers, who have been at the forefront of the fight against the virus with “superhuman efforts” since March. They work extended shifts and are constantly exposed to the risk of getting infected. Some even live apart from their families to avoid infecting their loved ones. Additionally, they have to witness traumatic courses of infections, deaths of patients and colleagues and notify about deaths – due to the prevention measures sometimes even over the phone or per video talk. That has of course repercussions. “After encountering very sick patients, healthcare workers experienced an acute stress response at home, easily becoming angry, emotional and behaving erratically. Sleeping and eating patterns also became significantly disturbed”, describes the Mental Health Specialist Hakan Öğütlü from Ankara City Hospital.
Due to these conditions, 800 health workers have resigned already. In September, the Turkish Medical Association launched a campaign to draw attention to the burning out of health workers and to call on authorities to step up their measures under the hashtag #YönetemiyorsunuzTükeniyoruz (“You cannot govern, we are burning out”).
PSYCHOLOGICAL ASSISTANCE LACKING
Studies are underlining the significance of the situation: Among 939 surveyed healthcare professionals in Turkey, three out of four exhibited symptoms of depression and distress. Insomnia (50.4%) and anxiety (60.4%) add up to the burden on the psyche of the professionals. Scientists draw attention to the fact that nurses are at greater risk of psychological distress than physicians due to their workload, night shifts and more intense contact with risky patients. Although the Turkish Ministry of Health has established psychiatric helplines and the mental health support application RUHSAD, it seems that these efforts do not reach the healthcare workers at a broad level. The majority has not applied for this kind of psychiatric support.
In an interview with dokuz8NEWS, the Secretary General of the Psychiatric Association of Turkey, Dr. Koray Başar, explained that despite the established hotlines for health professionals and citizens, “psychosocial assistance to society was lacking throughout the process and still is”. He emphasizes that mental health experts have not been included sufficiently into the struggle against the pandemic: “Mental health was not only ignored to a degree, mental health professionals, their education and experience, were also kept aside.”
YOUNG PEOPLE BEAR THE PSYCHOLOGICAL STRAIN OF THE CRISIS
The Coronavirus pandemic impacts everyone. “Such a mass trauma has effects on the mental well-being of individuals in the society in general, not limited to individuals physically affected by the virus”, highlights Dr. Koray Başar. In addition to isolation and the deprivation of social life, school and work, there is the fear of being infected with the virus or of infecting others as well as worries about the future. Some groups such as elderly, COVID-19 patients, travellers and foreigners may even become the target of stigmatisation.
It comes to no surprise that in a survey among 1586 individuals in Turkey, more than 40% of the respondents indicated that the pandemic made them “really anxious”, “mentally depressed” and “think of death more often”. While the numbers may differ slightly in individual studies, a general trend cannot be denied: the pandemic has increased the level of stress, anxiety and depression in society. This holds particularly true for women, who exhibit significantly higher depression and anxiety scores than men – although men have higher hospitalization and mortality rates than women.
Another fact stands out: Although the elderly belong to the highest risk group concerning a COVID-19 infection, youngsters seem to be affected stronger psychologically. The home quarantine that the elderly experienced for months in Turkey increased their feeling of loneliness and anxiety while decreasing their feelings of self-worth. Moreover, their risk of hospitalization and mortality is much higher in comparison to the younger generations. But if one thinks that consequently youngsters “don’t care”, they are wrong.
In fact, the 18 – 29 year age group shows higher depression levels than other generations. Particularly students seem to be prone to suffering psychologically. Not being able to go to school and university, having to adapt to an unfamiliar education system and worries about the future burden the generations Y and Z. Moreover, their exposure to social media and disinformation makes them feel the threat of the pandemic more intensely.
PSYCHOLOGICAL IMPACT OF THE VIRUS
While experts are hopeful that COVID-19 may be overcome with the help of effective treatment, medication and the development of vaccines, the after-effects of the pandemic on our psychological well-being may last much longer. Especially survivors of COVID-19 are at risk. Three years after the outbreak of SARS in 2003, one quarter of the survivors in Hong Kong, which was among the most affected areas, still struggled with post-traumatic stress. 15 percent suffered depressive disorders. Given that COVID-19 spread over the whole world and infected much more people, this should be a warning to not only monitor the physical but also mental recovery of COVID-19 patients.
If we want to defeat COVID-19, stopping the spread of the pandemic itself will not be enough. The virus has already infected the psychological well-being of our societies, too. According to psychologists, certain practices can increase mental health during times of crisis. For example, preventive behaviours like wearing a mask, avoiding public transportation and washing your hands frequently does not only protect from COVID-19, it also affects mental health positively. Yet be advised to be careful but not to carry it too far. Excessive (!) and permanent cleaning will not make you feel better.
SOCIAL MEDIA CONSUMPTION INCREASES INSECURITY
Knowledge has a similar effect. Since insecurity feeds the fear of an infection and increases the stress level, a lack of knowledge about the coronavirus can worsen psychological well-being. It is the government’s responsibility to win the trust of the population and to reduce uncertainty among the population. According to Dr. Koray Başar, “individuals should feel that they have a control over the situation which they are threatened by. This sense of control could be constructed with the help of scientific, clear and practical information.” Mental health professionals and the Turkish Medical Association have called on the governmetn repeatedly to convey information about the disease, the way to protect oneself and loved ones and the numbers and the distribution of cases more clearly so that the people could estimate the severity of the situation.
On the other hand, it is important for individuals to approach the media carefully when seeking information about the pandemic. While knowledge can positively impact emotions, the continuous exposure and rapid (over)flow of information conveys a constant sense of threat and confusion. That’s why after one hour on Twitter, Facebook and in WhatsApp groups, one may even feel more insecure than before. Social media is particularly critical due to its high rate of fake news. During the pandemic, nearly half of the Turkish population was exposed to social media more than before. The ones who increased their social media consumption also tend to have higher depression rates.
To find a sustainable balance between a healthy level of information and information overflow, the World Health Organization recommends checking the news only once or twice a day. Staying away from an excessive social media consumption and instead spending time with the members of one’s household, making time for oneself or engaging in home education or work may help to improve your mental well-being.
In that sense, stay healthy and safe!