The “shadow pandemic” of psychological distress is this clinician-scientist’s top concern.
“This year, the mental health day is of even greater significance as COVID-19 has ravaged the health systems disrupted lives and exacerbated the rising burden of mental health disorders globally,” said Professor Tazeen H Jafar from Duke-NUS’ Health Services and Systems Research Programme as she opened a panel held to coincide with World Mental
Health Day. The discussion topic was spot on — the global mental health challenges of a post-pandemic world.
And she would know. Late in 2020, Jafar and her team had published the results of a systematic review and meta-analysis that synthesised the results of 68 studies involving 288,830 participants from 19 countries. What Jafar got was a snapshot of the global mental health situation,
spanning low-, middle- and high-income countries.
“Our findings were — and remain — quite alarming,” reflects Jafar. “We under-appreciated how severe these issues were.”
One in three adults suffered from psychological distress during the pandemic. With COVID-19-induced lockdowns, quarantines and social distancing as well as job losses and other stressors, this “shadow pandemic” knew no boundaries.
While she had initially expected some countries to emerge more resilient than others, her results showed that the mental health crisis was truly a global one. Roughly 33 per cent of the general population was anxious. And 30 per cent experienced depressive
symptoms.
“It was an eye-opener,” she says of the study. “It screamed ‘Gee, people need help.’”
Looking out for the vulnerable
Jafar, a practising kidney specialist and global health expert with a root specialisation in cardiometabolic diseases, had embarked on
this project because mental health is intricately linked with these conditions.
“And COVID-19 unfortunately attacked and impacted people with cardiovascular disease risk factors, with hypertension and diabetes disproportionately,” she explains. “And mental health was a huge issue because it impacts how they take
care of themselves.”
But her findings — true for country after country — had implications for almost all reaches of society, often affecting those most vulnerable the most. Among those most likely to experience anxiety and depression were women, younger adults,
individuals of lower socioeconomic status as well as those living in more rural areas.
The consequences will be long-lasting and far-reaching, economic and societal, she worries.
“If you have a large proportion of the population who won’t be able to reach their full potential, the impact will be felt at the national level,” she says.
All the more so as this shadow pandemic was playing out in the context of very performance-driven societies, creating a negative spiral where the rise of unhappiness would feed the rise of chronic illnesses like diabetes and cardiovascular diseases.
“It is just going to be a very unhealthy setting both in the short and long term,” adds Jafar.
Huge issues call for huge solutions
Jafar had long been advocating for mental health to be integrated into physical health programmes and vice-versa. When COVID-19 hit, this project was a natural extension of her work.
“Optimal cardiovascular and metabolic disease risk reduction requires addressing mental health as well as other pharmacological and lifestyle interventions,” she explains.
She uses her seats on boards of funding and advisory bodies, such as the Medical Research Council in the United Kingdom, to advocate for large-scale programmes that tackle mental health disorders. She calls for more recreational activities and healthcare
resources to be directed to high-risk populations.
A concerted effort is necessary to reduce the rural-urban, socioeconomic and gender disparities in psychological distress created by the pandemic, she notes.
TAZEEN H JAFAR DREAMS OF CREATING LARGE-SCALE, CUSTOMISABLE, LOW-COST PROGRAMMES THAT BENEFIT EVERYONE
But for programmes to scale up, policymakers and institutions have to address a shortage of qualified counsellors, psychotherapists and health workers with different levels of mental health expertise. “We need to train more people going into
these fields and we need to create awareness,” she emphasises.
“Mental health is a huge issue,” stresses Jafar.
While anxiety and depression remain mild for most, they still have a deep impact on people’s lives. And if left unaddressed, personal mental health struggles will have larger implications for society.
“Even minor things will lead to people not being as productive, not reaching their potential,” warns Jafar. “This could have a very negative impact, potentially, from a long-term perspective, unless — and until — we intervene.”
Championing holistic care
This holistic care approach, which treats mental and physical health as one, is a COVID-19 intervention that Jafar actively champions. It may also be the key to bolstering public healthcare systems during a protracted pandemic.
The coronavirus disproportionately impacted those with existing conditions, influencing the severity of disease, need for intensive care, and even the probability of death. Jafar’s kidney transplant patients, who take immunosuppressive medication,
remain extremely vulnerable. And her study showed that those at higher risk of severe infection were more likely to experience anxiety and depression.
More robust treatment plans can target these intersecting problems by offering mental health support alongside lifestyle management and pharmacological interventions.
With her own patients, Jafar tries to assess their mental health regularly. She provides counselling and introduces coping strategies whenever she can.
“Measure and intervene, measure and intervene,” she affirms. “That’s what we have to do; that’s how we make a difference.”
Jafar hopes that the wider medical community will also adopt such a strategy. “A comprehensive, optimal cardiovascular and renal risk reduction strategy requires addressing mental health in addition to the pharmacological and other lifestyle
interventions,” she elaborates.
More, such holistic care has to be available to everyone.
At the heart of Jafar’s work is an unflinching focus on public health equity — the belief that everyone should have access to quality medical care.
“I’ve done large programmes,” she says. “What I want next is a big non-communicable disease — or a chronic disease control — programme which brings things together holistically. How can we deliver packages that
are uniform, so that they can be applied in different countries? Both high-income countries and low-income countries.”
“Programmes that are customisable; but not something that’s just only going be for that one little population of one hospital,” she continues. “I want things that can go to the masses. To the public; so that the vast majority
of people can benefit from that; that are cost-effective.
“I want to eliminate the disparities, that’s my dream.”