While there are no definitive studies yet on the psychological impact of COVID-19, most psychologists would agree that it has contributed to heightened anxiety across all age groups. The impact on our young is something we need to keep an eye on especially. 

In Singapore, the lifetime prevalence of general anxiety disorder (GAD) – the occurrence of anxiety symptoms at some point in their lives – was observed at 1.6% in 2016 – a 0.9% increase over a 2010 study. The study also indicated youths (ages 18 to 34) to be a particularly vulnerable group, more likely to be associated with mental disorders. 

However, this increase in the prevalence of GAD, was not matched by increases in people seeking treatment. This is concerning because anxiety, if untreated, can have a range of health repercussions (i.e., on your cardiovascular, immune and excretory/digestive systems) as well as social and psychological effects. In the worst-case scenarios, anxiety has been known to lead to depression, substance abuse and suicide.

Understanding anxiety

Anxiety is a normal reaction to stress, which can be beneficial in certain situations. It is a gift bestowed through millions of years of evolution when we have had to fend for ourselves, out in the wild. It still serves us, in situations where real dangers lurk, by heightening our alertness, quickening our thinking and activating our fight-or-flight response mechanisms.

However, the muscle tensions and avoidance mechanisms we experience can do us more harm than good in situations where they are not warranted.

Anxiety disorders, which involve excessive fear or anxiety, differ from the normal feelings of nervousness or anxiousness, that all of us experience every now and then. Anxiety disorders are frequent among mental health disorders, with an early onset and are chronic, recurrent, and persistent in the lives of many individuals. General Anxiety Disorder (GAD) is characterised by six months or more of chronic, exaggerated worries. People with GAD may seem to “worry about everything all the time.”

For some, the workplace is a healthy break from the stresses at home, which work-from-home may have deprived. 

Heightened anxiety due to COVID-19

In a study conducted by the Institute of Mental Health between May and June 2020, about 4.9% out of about 1,000 Singaporean residents met the criteria for anxiety and depression. Encouragingly, 81.8% of respondents said they would seek professional help if they experienced emotional or psychological problems relating to Covid-19.

The top five avenues that respondents would turn to for help to address their anxiety issues were general practitioners or family doctors, counsellors, polyclinic doctors, psychiatrists, and religious or spiritual advisers. However, there was a sizeable number who said they would not seek help from professionals, preferring to rely on their own resources.

Another survey, by the National Youth Council, conducted between April and December 2020, found that at least 52 percent of youth felt that their mental health was challenged during the current COVID-19 pandemic. Youths cited anxiety over their future (53%), financial stress (41%) and worries over academic or work performance (39%) as sources of anxiety.

There are number of ways in which COVID-19 contributes to anxiety:

• Fear of the unknown
• Excessive worrying about consequences
• Concerns over personal health and that of loved ones
• Unanswered questions about jobs and livelihood
• Long-term effects of the disease and its ramifications
• Difficulties in adapting to new lifestyle changes
• Being forced into unfamiliar environments, with expectations to stay there for prolonged periods
• Fear of being violated when living in close quarters with unfamiliar people
• Being abused or mistreated without immediate help i.e., domestic violence
• Relationship strains due to staying apart

Working from home can be stressful also. Having to accommodate to the home environment, workstation setup not being conducive to work, limited space for working, having to contend with household distractions and needs, difficulties with time management and lack of proper breaks can all contribute to stress and anxiety. In addition, restrictions on having person-to-person meetings may also be not very fulfilling. For some, the workplace is a healthy break from the stresses at home, which work-from-home may have deprived. 

Among younger individuals, academic stress, relationship issues, school bullying, high expectations of oneself or from family and peers and future planning are some possible factors.

Common symptoms of GAD

GAD can creep up on people unsuspectingly. How would you know if your or your loved one is suffering from GAD? The following are some tell-tale signs:

• Constantly feeling restless, wound-up, or on-edge
• Being easily fatigued
• Having difficulty concentrating; mind going blank
• Being irritable
• Muscle tensions
• Difficulty controlling feelings of worry
• Having sleep problems (i.e., difficulty falling or staying asleep, restlessness, and/or unsatisfying sleep)

Causes of GAD

Causes of GAD can be varied and multifactorial. It can be triggered by a range of different life circumstances, across the age groups. Life shattering events, major losses, situational reactions, family matters, economic and financial difficulties, occupational changes, illness factors, and lack of social and support systems are some of the foremost causes of anxiety.

Among younger individuals, academic stress, relationship issues, school bullying, high expectations of oneself or from family and peers and future planning are some possible factors. Even positive changes like marriage, childbirth, relocation for work or studying can cause anxiety.

In many instances, a certain degree of anxiety can be stimulating and be a spurring factor for people to achieve what they set out to reach. However, when this anxiety exceeds a certain threshold (and this can vary from individual to individual), it can develop into a disorder. 

Management of Anxiety Disorders

Diagnosing GAD would start with physical examinations or lab investigations to identify physical causes, as well as detailed reviews of personal and family history. Once diagnosed, the treatment may include pharmacological, psychological and social approaches. A specialist opinion from a psychiatrist would be valuable in establishing and maintaining a plan of care for affected individuals.

Medications used to treat GAD can include antidepressants for six months or longer. If the patient desires to stop the medications it is best done in consultation with the doctor, as further plans for care and resuming medications can be discussed. If sleeping pills are prescribed, they are usually for short-term use only. Psychotherapeutic regimes such as cognitive behaviour therapy could also be used. Medications, psychotherapy and social support go a long way in improving symptoms of anxiety in majority of individuals.

As with any illness, early interventions are always the best for tackling GAD. Where youths are concerned, having youth-friendly and accessible care centres (i.e., central locations where youth hang out) can not only help with them staying in the programmes, but also contribute to earlier detection and treatment of mental disorders.

There are several organizations that focus on youth welfare in Singapore. The Singapore Association for Mental Health, National  Care Hotline, Samaritans of Singapore, Lifeline NUS, Support for Wellness Achievement Programme (SWAP) Hotline/Institute of Mental Health, Helpline/Clarity Singapore Limited are some of the resources which offer help. There are many others available for people across all age groups too.

Dr Nigila Ravichandran is a psychiatrist and consultant with over 18 years experience in the field of mental health. She has been a keynote speaker and presenter at international psychiatry conferences. She is currently also the vice-president (clinical) of Club2CARE, Singapore, a voluntary organisation geared towards educating the community at large and sustaining a mentally healthy society. 

Where to turn to, if you or someone you know is suffering from an anxiety disorder:

Institute of Mental Health’s Helpline: 6389 2222

Samaritans of Singapore Hotline: 1800 221 4444

Singapore Association of Mental Health Helpline: 1800 283 7019

National Care Hotline: 1800 202 6868

Lifeline NUS: 6516 7777

Clarity Singapore Limited: 6767 7990

You can also find a list of international helplines here. 

References:

•  Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO
• Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
• MOH Clinical Practice Guidelines 1/2015 Anxiety Disorders, Executive Summary
• Subramaniam et al. Tracking the mental health of a nation: prevalence and correlates of mental disorders in the second Singapore mental health study. Epidemiology and Psychiatric Sciences, 2019

Visual credit: Freepik 

Work from home blurs boundaries