The coronavirus pandemic sweeping the world has brought about unprecedented public health measures in most jurisdictions. A host of governments have adopted self isolation, quarantine and social distancing measures to varying degrees. These terms have become a part of our everyday lexicon. The measures have led to dramatic social, economic and psychological consequences.

A question posed by many is – will the emphasis on meticulous hygiene and social distancing lead to long term psychological and psychiatric consequences? Will we see an increase in mental illness? Will our social interactions at the very least be different in the years to come?

There is no doubt that the effects of enforcing self isolation or quarantining individuals if they are at high risk of having an infectious illness or if they have tested positive to one are multiple and significant. Past studies of people who have been quarantined during epidemics show that 1/3 will experience psychological distress (most commonly anxiety and depression) versus 10% in those who are not quarantined and experience and live through the same epidemic.

Another measurable outcome shown in a study after the 2003 SARS epidemic in China was a statistically significant increase in use (abuse) of alcohol in health care workers in the 3 years after the event.

The factors associated with an increase likelihood of psychological consequences after a period of quarantine have been shown to be:
• More than 10 days in quarantine
• Lack of access to provisions or to means of communication
• Poor communication by authorities as to the reasons for quarantine.

READ MORE: Coronavirus taking a strain on mental health of footballers

There is a higher likelihood of future psychological problems for people who are:
• Isolated
• Have financial or economic hardship
• Are unemployed.

And when there is general social unrest.

The elder population is particularly at risk with any quarantine or self isolation/social distancing measures. Studies have repeatedly shown that loneliness is a significant factor for increased risk of death.

Many who are confined to their homes are able to maintain appropriate and meaningful social connectedness through technological means. Many will also be able to access appropriate medical and psychological assistance through videolink or telephone means. The older population are more likely not to be able to access such means to connect with others thereby increasing their sense of isolation.

Younger people are also at risk of becoming more psychologically vulnerable with self isolation and social distancing measures. The biggest cause of death in those under 25 years of age is suicide. Stress can be caused by the uncertainty of the future, job loss and poor future job prospects. Concerns about the economy may also contribute to an increase in distress and a sense of hopelessness in younger people. Threats of loss of loved ones and of oneself will also contribute to a sense of despair and helplessness. Despite high literacy in technological means of communication, even before the COVID19 pandemic, studies have shown high rates of loneliness in young people. As a society we need to be vigilant as we may see an increase in suicide rates in younger people after the pandemic is over.

READ MORE: Despite a decade of health cuts, coronavirus death rates appear comparatively low in Greece

People with mental illnesses such as Obsessive Compulsive Disorder (OCD) may have a worsening of symptoms and a poorer long term outcome. OCD is characterised by unwanted and intrusive thoughts and images (eg of contamination or of contraction of illness) which lead to overwhelming anxiety. These are known as “obsessions”. Repetitive acts (“compulsions”) are performed to neutralise the anxiety caused by the obsessional thoughts or images.
The OCD sufferer who has contamination and infection obsessions will potentially have a deterioration in their symptoms in the context of a pandemic because of the additional burden of the real contamination threat. Providing medical treatment via telelink is also more challenging for this sort of patient.

Is it likely that more people will develop OCD as a result of the current pandemic and our enforced societal adoption of hygiene and social distancing measures?

This scenario is actually highly unlikely. We may become more hygiene conscious as we have seen occur in East Asian societies such as Singapore and Hong Kong after their past epidemics (SARS, MERS) and in a similar fashion adopt stricter cleanliness measures in hospitality and retail settings. Studies of psychiatric outcomes after past epidemics have not shown an increased rate of OCD. The more likely long term psychiatric complications are an increase in rates of depression, anxiety, post traumatic disorders and alcohol and drug abuse disorders.

People with pre existing mental illnesses are at risk of poorer short and long term outcomes. Families, carers, friends and health care professionals need to encourage simple measures which can assist with preventing relapses or deterioration. These include attention to diet, to physical activity, to sleep hygiene, attending to physical and mental illnesses (eg with medication), avoidance of drug and alcohol abuse, use of relaxation, meditation and prayer, and, communication and connection with others.

READ MORE:How to avoid a coronavirus debt crisis? Issue a new type of government bonds linked to GDP

We must also be aware of and reduce the risk of anxiety and fear occurring on a societal level. Panic and fear are contagious and on a community level people can easily be influenced by others and by the media to feel real anxiety which can then lead to hoarding behaviours. We have seen this occur in all societies even before COVID cases became widespread.

Similarly, on a societal level, we must be attuned to and resist the temptation to stigmatise those who we perceive may be spreading or who may have “caused” the pandemic. There have been anecdotal cases of Chinese and other Asian Australians and health care workers, such as nurses, being abused as a result of this phenomenon. We have seen similar phenomena with past infectious outbreaks (eg HIV and SARS) targeting groups who are perceived to be at fault.

Many positives outcomes may come about as a result of this pandemic. We may see fewer infectious diseases if hygiene practices are maintained long term. We may become more appreciative of life’s simpler pleasures and less complicated lifestyles. We may become more spiritual and more mindful. Unfortunately, we may also see a rise in some mental health issues as a result of the isolation that the population has had to endure for months on end. Trauma related symptoms, anxiety and depression are the likely conditions we will see increase. More substance abuse including alcohol is another likely negative outcome. Thankfully, it is unlikely that we will become a society of more OCD sufferers.

READ MORE: Coronavirus is changing the way we live, pray, enjoy Easter and our spirituality too

Dr Arthur Kokkinias is a Consultant Psychiatrist, Secretary of the Hellenic Medical Society of Australia and a Board Director of Fronditha Care.