Jul 15, 2020
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.
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.
Norris has no disclosures.
- Uncertainty tied to the COVID-19 pandemic threatens to
undermine mental health and exacerbate problems for those with
- 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.
- 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
- 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.
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
- 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
- Target the “basics” of self-care, such as getting enough sleep
and engaging with others.
McIntyre RS, Lee Y. Psychiatry Res. 2020 May 19. doi:
McIntyre RS, Lee Y. World Psychiatry. 2020
Shanahan L et al. Am J Public
Health. 2012 Jun;109(6):854-8.
Kang S, Chua HC. CMAJ. 2004
America’s State of Mind Report. 2020 Apr 16.
Lee Y et al. Psychiatry Clin Neurosci. 2020 Jul 1. doi:
Hao F et al. Brain Behav Immun. 2020
Tan W et al. Brain Behav Immun. 2020
Wang C et al. Brain Behav Immun. 2020
Harvey SB et al. Am J Psychiatry. 2018
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