What to Do About the Mental Health Consequences of COVID-19

Interview with Dr. Ali Jawaid on the short- and long-term effects of COVID-19.

Posted Jul 23, 2020

Coronavirus has already caused myriad mental health problems for people around the world. These impacts, though, may persist even after restrictions are lifted. In this interview, Dr. Ali Jawaid describes the risk and resilience factors he and his team discovered in their recent research.

Dr. Ali Jawaid is an M.D.-Ph.D. with training in both clinical and basic neuroscience. An alumnus of Aga Khan University, Pakistan; Baylor College of Medicine, USA; and University of Zurich, Switzerland; he is a senior group leader at the Center of Excellence for Neural Plasticity and Brain Disorders in Warsaw, Poland. He is also an adjunct professor at the Department of Neurology, University of Texas, Houston. His work is focused on the role of epigenetic and metabolic factors in pathogenesis and inheritance of brain pathologies. He has published in top-tier scientific journals, such as Science, Nature Neuroscience, Neuron, and Nature Communications, has been a TEDx speaker, and uses his Instagram for scientific advocacy. He is a fiction author and poet outside of work.

JA: How did you first get interested in this topic?

AJ: I have previously worked on studies looking at the impact of traumatic events on the brain and other body organs. After COVID-19 emerged, it quickly became evident that it would be a ‘global traumatic event’ of sorts. Within days of lockdowns, people started reporting all different kinds of psychological symptoms, from sleep disturbances to suicidal ideation. Our motivation was to go one step further than just reporting how many psychological disturbances have stemmed out of the COVID-19 crisis but to also identify which factors can make a person more vulnerable to or more resilient against these psychological disturbances. This approach could help inform health systems about which populations should be a focus for targeted psychological interventions. Additionally, this study provides inspiration to people directly to incorporate the resilience factors, such as exercise or a positive attitude in their daily life.

JA: What was the focus of your study?

AJ: I assembled a team of neuroscientists, psychologists, data scientists, and medical students from some of the best institutes in the world for the study design, execution, and analysis. We were further supported by another team of volunteers including social media influencers across the globe to diffuse our survey to the masses. Through this approach, we managed to screen more than 13,000 individuals worldwide for general psychological disturbance, post-traumatic stress, and depression attributable to COVID-19.

We further followed up on more than a thousand participants a month later to check which symptoms were persistent. Our follow up study was targeted to European participants as the COVID-19 scenario changed rapidly there. During the primary assessment period—March 29-April 14—COVID cases were peaking in Europe and the continent was largely shut down. During the follow-up time—May 15-May 29—most of the European countries had managed to flatten the curve and had opened many restrictions. This helped us differentiate between 'acute' vs. 'persistent' effects. 

JA: What did you discover in your study?

AJ: In our primary assessment, we found that around one half to one-third of all participants globally reported some level of psychological disturbance. Notably, roughly the same proportion reported psychological symptoms in the follow-up study on European participants indicating that these effects might be persistent. Female gender, people who were already suffering from a psychiatric condition, prior exposure to trauma, and being quarantined alone at home increased the odds of being psychologically affected during the COVID-19 pandemic acutely. More or less the same factors with the addition of encountering loss of a loved one during the pandemic increased the likelihood of being persistently affected.

Optimism, satisfaction with actions of one’s employer and state during the pandemic, positive prediction about the resolution of the COVID-19 pandemic, and exercise even as less than 15 minutes per day decreased the likelihood of COVID-related psychological impairment. 

JA: Is there anything that surprised you in your findings, or that you weren't fully expecting?

AJ: We have been particularly surprised by two findings. The first, and unfortunately an alarming one, is that the psychological effects of living through COVID-19 can be persistent. We expected our repeat assessment in Europe would reveal much less psychopathology because lock-down measures were lifted at the time of the second assessment and life had slowly started to normalize. However, this was not the case, and this should be an important consideration for health systems across the globe—COVID-19 could be followed by a lingering mental health crisis.

The other surprising finding was that we expected the elderly to be disproportionately affected. However, they had even fewer symptoms compared to young adults. We speculate that it might have to do with less usage of social media compared to young adults. Another plausible cause could be that perhaps people are checking on their parents and grandparents more often than usual during this time, and such contact is probably good for the mental health of the elderly. 

JA: How might readers apply what you found to their lives during COVID-19?

AJ: First and foremost, exercise even for 15 minutes a day could add to your resilience during the COVID-19 pandemic or its aftermath. The other important lessons are to keep a positive attitude. People who felt they were not completely helpless during the COVID-19 pandemic but could control getting infected or infecting others were less likely to experience psychological symptoms. Promoting such attitudes and other interventions to increase optimism could definitely be helpful. Those who were able to maintain contact with their friends and family like usual also did better mental-health-wise, which clearly indicates that people need to know the distinction between physical distancing and social distancing, keeping engaged in social contacts. Regular contact with family and friends is crucial.

JA: How can readers use what you found to help others amidst this pandemic?

AJ: One would be a continuation of my previous answer: promote positivity. The other would be to look out for vulnerable populations, which, according to our study, include women, people with pre-existing psychiatric conditions, people who have been previously exposed to traumatic events, and those being quarantined alone at home. Checking up on these vulnerable populations, encouraging them to seek psychological support and lending them an ear would be an invaluable support. Call a friend who you feel might be struggling and ask them to be your 'Zoom exercise buddy'; help your and their mental well-being in the same go.

JA: What are you currently working on that you might like to share about?

AJ: I have launched a study looking at neuropsychiatric manifestations of individuals who tested positive and then recovered from COVID-19. Besides this, I will continue my research on long-term epigenetic effects of traumatic events and identify ways to intervene, hopefully without relying on chemicals, to lessen the harmful sequelae of trauma and enhance resilience patterns.

Follow Dr. Ali Jawaid on Instagram @alijawaid_ and on Twitter @alijawaid20.

References

Plomecka MB, Gobbi S, Neckels R, Radziński P, Skórko B, Lazerri S, Almazidou K, Dedić A, Bakalović A, Hrustić L, Ashraf Z, Es haghi S, Rodríguez-Pino L, Waller V, Jabeen H, Alp AB, Behnam MA, Shibli D, Barańczuk-Turska Z, Haq Z, Qureshi SU, Strutt AM, Jawaid A. (2020). Mental Health Impact of COVID-19: A global study of risk and resilience factors. medRxiv  2020.05.05.20092023. doi: https://doi.org/10.1101/2020.05.05.20092023