RYAN NOACH: Pandemic’s effect on mental health, a sting in the tail

To many of us it feels like we’ve returned to pre-Covid normality. This brings a welcome sense of relief. However, in the healthcare world we remain concerned about the potential for variant-driven flare-ups of Covid-19 acute infections — and we are seeing an uptick in positive testing rates and many anecdotal cases of Covid-19.

Importantly, we are also spending time getting to grips with the pandemic’s second-order effects. Not only are we seeing the widespread effect of people living with long-Covid-19, but it is also evident that there’s a sting in the pandemic’s tail — widespread declining mental health.

Loss, grief, isolation, economic hardship, job uncertainty and unemployment levels feed general concerns about the future. For the employed, the change to work modes — hybrid, or at-home — and reorganisation of team dynamics present unique stressors that are driving burnout and mental illness in ways we don’t yet fully understand. For people who have recovered from Covid-19, long-Covid-19 symptoms bring additional stress, with widespread complaints of cognitive slowing and symptoms of mental illness.

I am deeply concerned about this landscape, supported by what I am seeing in our Discovery Health data. October is SA and global Mental Health Awareness Month and the right time to reflect on how best to reposition for the future.

Pre-Covid-19 data indicated that 16.5% of people in our country were living with a mental health disorder. Globally, depressive and anxiety disorders were among the leading causes of burden of disease too. In 2020 there was an astounding 25% rise in the global prevalence of these conditions.

A year ago, the Lancet looked at the effect of the pandemic on major depressive and anxiety disorders across 204 countries. The prevalence of major depressive disorder increased 27.6%, and anxiety disorders 25.6% overall (percentages refer to hundreds of millions of people), and by 36.4% and 38.7% in SA.

Discovery Health is a data-driven organisation. We carefully track trends emerging from the landscape of our 3.7-million medical scheme members from 19 administered medical schemes.

In the Discovery Health Medical Scheme we have seen a steep rise in mental illness prevalence between 2017 and 2021, from 10.5% to 12.5% of the scheme’s 2.7-million members. The 450,000 members now in need of mental health support are enough to fill seven and a half Ellis Park stadiums.

Depression is the primary condition driving the increase, affecting 58% — about 250,000 people — of scheme members who are experiencing mental illness, followed by anxiety disorder (a compound average growth rate of 5%).

The highest growth rate we have seen in mental health conditions was between 2018 and 2021 among those aged 20 to 34, in women and in people who also have another chronic condition (along with mental illness), especially where they have diabetes or cardiovascular disease. Mental illness as a comorbidity changes the severity of underlying disease even on a risk-adjusted basis.

More people are accessing care (psychotherapy and medicine) out of hospital. Rates of accessing care virtually are rising fast too (up 29% between 2020 and 2021) with promising scope for further growth.

Earlier this year Discovery Health surveyed about 7,000 administered medical scheme members to understand if they were living with any enduring symptoms after acute Covid-19 infection. It was frightening to identify that a high proportion were reporting headaches (31%), breathlessness (14%), problems sleeping (14%), lack of concentration (11%), muscle weakness (11%) and a deterioration in their ability to concentrate (30%), walk (20%), see (16%) or communicate (7%).

Separately, Discovery Health data show that having had Covid-19 increases the likelihood of developing depression and anxiety, with up to a 4% increased prevalence for up to six months after recovery. A study published in August in Lancet Psychiatry found an increased incidence of mood and anxiety disorders (subsiding within two months) and increased risk of psychotic disorders, cognitive deficit, dementia and seizures for up to two years following Covid-19 infection.

The jury is out on a definite Covid-19-brain link. Possible causes include the virus’s direct effects on the brain and immune system, and also the trauma of serious disease and stress from persistent symptoms.

Data from the Discovery Health Medical Scheme mental healthcare programme (launched in 2020) shows the benefits of structured mental health screening and treatment. General practitioners and psychologists are prompted to screen their patients for depression. Where required they enrol them in the mental healthcare programme to access cover for consultations, psychotherapy and medication.

We’ve seen a 17-fold increase in enrolments since June 2020. Six months into participation we see a drop in hospital admissions, with a 6.7% reduction in cost. While these are emerging outcomes, they show the importance of screening, providing cover for outpatient care and the value to be derived from being part of a structured programme. Early intervention also allows for far better management, which improves patient outcomes.

To boost mental health and resilience (especially under stress) we need good sleep quality and quantity, habits such as mindfulness meditation for stress relief, ensuring healthy eating and regular exercise.

The recently released Science of Vitality journal shares that physical activity and good nutrition are associated with up to four times lower psychological distress. Discovery Vitality has also just announced the findings of a landmark SA study published in the International Journal of Physical Medicine & Rehabilitation (in collaboration with the Harvard TH Chan School of Public Health and the University of Cape Town).

The research is a global first because it focuses on an African data set of nearly 50,000 people over a three-year period. The results show that increasing physical activity from “low to moderate” could prevent one in five cases of depression in women. Also, a relatively small increase in physical activity — say from 5,000 steps one day a week to 10,000 steps one day a week, can significantly reduce depression incidence. (For maximum health benefits the World Health Organisation recommends at least 150–300 minutes of exercise per week).

We’re all in this together. Those struggling with mental health issues or a diagnosed illness are not alone. And, for those yet to reach out for help, there’s no better time to do so than now. 

• Dr Noach is CEO of Discovery Health.