The real mental health burden is usually felt after ‘disasters’
BY DR. TYLER AMELL
As the COVID-19 pandemic continues to disrupt our work lives, home lives and everything in between, our health has taken center stage. This has not always been the case. Many of us take our health for granted, until a scare forces some of us back to reality. Then we focus on the lifestyle choices we make that have serious implications for our current and future health. Behaviors and choices we consciously or unconsciously make have the single largest impact on our health.
During the first three months of the pandemic, it became very clear that healthcare seeking behaviors were changing. According to a study published in 2020 in the peer-reviewed journal JAMA Network Open, preventive care such as mammograms and colonoscopies, and to a lesser extent hemoglobin A1C visits and vaccinations decreased dramatically in spring 2020. These delays in care will have far reaching consequences as we emerge from the next phase of the pandemic. In many instances, we are in much worse health than when it began. Fortunately, there was a significant increase of telehealth and telemedicine appointments, long part of benefit plans, but infrequently used in comparison to in-person visits. This is just the tip of the digital solutions available to employers and plan sponsors when it comes to health assessment and solutioning.
ACCELERATED MENTAL HEALTH CHALLENGES LEAD TO INCREASED DRUG AND ALCOHOL USE
Nowhere is this more apparent than in our mental health state. A 2021 study published in the Journal of Occupational Rehabilitation, losing a job during the pandemic has been associated with mental and physical health problems, which can be moderated by social interactions and financial resources. For those who did not lose work, and where there was not a requirement to be at a specific worksite, working from homebecame an instant reality.
VIRTUAL WORKING ARRANGEMENTS required people to set up home offices, sometimes at the kitchen table, and blend work and personal time together as childcare needs collided with work needs for many. Pets were confused, but not complaining. Without the need to commute, and in response to many social activities being curtailed or closed, people spent much more time at home. As a result, when stay-at-home orders were implemented to reduce SARS-CoV-2 viral transmission, alcohol use increased substantially, according to the JAMA Network Open study. Online alcohol sales increased 262% over 2019 levels during the first phase of the pandemic and have remained high ever since.
There are well known negative physical health problems associated with excessive alcohol use. Continued use may lead to, or exacerbate, existing mental health problems, such as stress, burnout, anxiety or depression. Several studies have found that these mental health conditions are increasing in incidence during the pandemic as well due to a variety of reasons. The increases in alcohol consumption for women, younger workers, and non-Hispanic White individuals highlight that employers and health systems may need to educate employees or plan members about increased alcohol use during the pandemic and into the next phase and identify factors associated with susceptibility and resilience.
Online alcohol sales increased 262% over 2019 levels during the first phase of the pandemic and have remained high ever since.
Alcohol use is not the only indicator of potential risk to mental health. Numerous other substances are also being used in increasing frequency. In one study that looked at drug test results for 150,000 U.S. residents in the period immediately before and immediately after the pandemic began, positive tests for cocaine, fentanyl, heroin and methamphetamine increased between 0.8% to 3.8%. The increase in use of fentanyl and methamphetamine was more significant than cocaine and heroin.
The stress on people caused by the pandemic is evident all around us, from economic concerns, decreased socialization, relationship strain and decreased physical activity. COVID-19 fatigue is real, and some people have given up in some respects, according to a 2020 New England Journal of Medicine study. Burnout, a significant risk to nurses and other healthcare practitioners on the front lines of treating the sick, is not confined to workers in the healthcare space. Essential workers and everyone else can be impacted as well.
From MediKeeper’s standardized Health Risk Assessment data from a wide cross-section of employees, those self-reporting they have sought professional help for anxiety or depression has increased 105% in the past year. Stress levels have increased by as much as 12% and those worried about their health has increased 18%. This brings forward a question: given all the evidence concerning the declining mental health state during the pandemic, is protecting mental health possible during the pandemic?
Yes, it surely is! The 80 plus year longitudinal Grant & Glueck Harvard study, interestingly which began a decade after the last global pandemic, demonstrated that meaningful connections and relationships between people are the key to health and wellbeing. When you cannot easily meet face-to-face in person, there are a myriad of reliable options for people to meet using technology to continue the connection.
STRATEGIES TO MANAGE STRESS
We know that physical exercise, which does not necessarily need to take place indoors in a fitness facility, is crucial to support your wellbeing, and has a tremendous impact on mental health. The same goes for diet and nutrition from a prevention and treatment perspective. Digital Cognitive Behavioral Therapy (CBT) strategies are effective strategies at reprogramming thought patterns that can lead to meaningful, sustainable behavior change.
Together, these are the pillars of wellbeing that support your psychological state and help build resiliency. This is critical in the coming months because although the focus right now is on getting through the pandemic, which does bring out the best response in many people, the real mental health burden is usually felt after ‘disasters’ have subsided. This is when the surge in mental health cases and real breakdowns occur for the vast majority of those who managed to keep things together during the most stressful period.
Aside from these non-pharmaceutical strategies to help people manage their mental health, there are pharmaceutical strategies. Effective anxiolytic (anti-anxiety) and anti-depressants are also available through benefit plans. One common concern is the amount of time that some of these medications take to be effective, or the trial and error that may go along with finding one that will work best for you. This is where new tests such as pharmacogenomic tests help determine which drugs are safest and most efficacious for the person, based upon their liver’s ability to metabolize the drug. This helps keep mental health treatment costs down, and delivers quicker, more sustainable results to supplement any wellbeing strategy.
At this point, as we consider eventual return to the office transition, many people will question is it safe to do so? Will this place additional stress? Yes, it can, but we do know that mental health can be protected during these times and should long be a focus of employers and plan sponsors during the foreseeable future.
DR. TYLER AMELL is an internationally recognized thought leader on the topic of workplace health and productivity and chief health officer at MediKeeper. He also serves on the executive board of directors of the Work Wellness Institute and the National Wellness Institute. In the past, he served on the executive board of directors of the Integrated Benefits Institute (IBI) and the Canadian Association for Research on Work and Health. He is a past partner and vice president at a global HR Consulting and Technology company, CEO of an HR technology company and vice president of Canada’s largest independent health care, occupational rehabilitation and return-to-work company. Dr. Amell holds an adjunct faculty position at Pacific Coast University for Workplace Health Sciences. He has given seminars and presentations at more than 200 events globally.