IT’S TIME TO TALK ABOUT ANXIETY
As record numbers of patients struggle with stress and anxiety, Dr Sarah Jarvis wants us all to ask for help when we need it
Dr Sarah Jarvis offers her wisdom
For most of us, 2020 is a year we’re all too happy to consign to the past. We’ve had to live with so much uncertainty: worrying about health and work, being isolated from those we care about and having school exams cancelled and university dreams crushed. It’s little wonder that so many of us have felt more stressed, lonely, anxious and unhappy.
Mental health fallout
When I was a student, I had little formal training in mental health problems. Once I became a GP, I had a very steep learning curve, as up to two in five GP appointments now relate, at least in part, to mental health.
In my 30-year GP career, I’ve seen a steady increase in patients suffering from depression, stress and anxiety. Women are more likely to have depression than men; about one in four women and one in 10 men will have symptoms severe enough to need treatment in their lifetime. But this year, my experience suggests those figures significantly underestimate the extent of mental ill health in a time of Covid.
Sleep was an early casualty. Depression and anxiety can both disrupt sleep, and insomnia affects one in three people at the best of times. Add a loss of routine, lack of exercise and anxiety about the virus, and these numbers have soared.
Sleeping tablets are virtually never the answer. They are ineffective in all but the very short term, and carry significant health risks. Instead, I focus on underlying mental health issues. Then I advise on ‘sleep hygiene’: a regular routine, avoiding alcohol and caffeine, and banning electronic equipment from the bedroom (the only exception being the insomnia apps available through the NHS apps library at nhs.uk/apps-library).
While talking therapy may not solve the day-to-day issues that triggered the anxiety and depression, it has a great track record in helping people to cope. In England you can refer yourself through IAPT (Improving Access to Psychological Therapies); search the NHS self-referral section on patientaccess.com. In Wales, Scotland and Northern Ireland, referral is through your GP.
Added burden
Most of us have seen our mental equilibrium affected by the pandemic, but disabled people in the UK have been disproportionately affected. Many have physical disabilities that make them more vulnerable to severe complications of illness, while others are reliant on outside carers, limiting their ability to protect themselves from the risk of infection.
In addition, many require regular medical care and around half have had treatments cancelled, not started or only given in part. This compares with just over one in four non-disabled people who had a physical or mental health condition and were receiving care before the pandemic.
While figures from the Office for National Statistics (ONS) show that the pandemic has worsened the mental health of one in five non-disabled people, that figure rises to two in five for disabled people. Almost half report high levels of anxiety, a significantly higher figure than a year ago.
Anxiety after Covid
In the early days, Covid-19 looked like a variant on many other coronaviruses, which affect predominately the respiratory system. As time has gone on, we have learned that it can also affect the blood, kidneys, liver and even the brain.
As many as one in 20 people with Covid-19 may have symptoms lasting at least two months, and for many, ‘long Covid’ lasts even longer. Along with shortness of breath and a cough, up to 17 in every 20 suffer extreme fatigue, and three in four have sleep problems.
What’s more, one in five people with a diagnosis of Covid-19 are given a diagnosis of anxiety, depression or insomnia within three months, and of these, one in four had no psychiatric diagnosis before becoming ill.
The NHS has launched a website offering advice for people with long Covid (yourcovidrecovery.nhs.uk). Some campaigners are concerned the NHS expects too much in terms of physical progress, and so face-to-face services for people severely affected are slowly building up. Speak to your GP if you feel you need a referral.
Behind closed doors
In March 2020, more than 2m people thought to be at highest risk of dying from Covid-19 were advised to stay inside for three months. By mid-june, two in three were still following this guidance.
By the second lockdown, many of us in the medical profession recognised the huge toll this self-imposed isolation had taken on those most vulnerable. Many were living alone, too terrified to have contact with anyone. More than one in three reported worsening of their mental health, rising to almost half of under-60s. Women were more likely to struggle.
But loneliness has not been reserved just for those who are shielding on their own. Before lockdown, one in 10 people said they felt lonely: within weeks, this rose to one in four. Social distancing, curtailment of social events and even lack of familiar features because of masks, all contribute. Almost a year on from the start of the pandemic, it may feel as if we will never hug again.
Age UK, Independent Age and Befriending Networks, as well as local bodies, offer support for people who are lonely. If you’re lucky enough not to feel alone and have time to spare, consider volunteering for one of these services.
Impact on children
There has been good news for children in the shielding category, as we have learned that the risk of severe complications of Covid-19 in children, even for those with underlying health problems, is tiny. As a result, the vast majority of the 90,000 children in this category have been advised they will be able to return to school when other children do.
But many parents continue to worry about letting their children out of their protective bubble. Also, a significant number of children live with a parent who is clinically vulnerable. I have had all too many conversations with young people who live in a state of fear that they will be responsible for their parent’s demise. The mental health impact of this burden will live on for years to come. If you’re concerned about how your children are coping, speak to your GP.