Given the enormous media focus on mental illness as a result of coronavirus, you'd be forgiven for thinking that psychological disorders have become more commonplace. But is that really the case? Other reasons, such as a lowering of the threshold for diagnosis, better knowledge of a phenomenon we didn't previously know much about or changes in people's attitudes, are all potential causes of this increased prevalence.
In this article, Dr Conradt puts these theories to the test and presents systematic solutions.
Accumulation or pathologisation of everyday occurrences?
It would seem as if the coronavirus pandemic is leading to a rise in the incidence of mental health disorders in all areas of life: kids, parents, people working from home and/or in factories, the term mental stress was no longer confined to the practices of psychotherapists, it was an ever-present in the media too. Given the enormous media presence and the associated growing acceptance of mental illness, you'd be forgiven for thinking that psychological disorders have become more commonplace and more readily accepted. But perhaps the diagnostic practices when it comes to managing mental stress have changed too, with a lowering of the threshold for diagnosis. The result? Ordinary situations that are part and parcel of everyday life are being increasingly characterised as medical conditions and described as mental illness. Unlike a genuine rise in mental illness, there is a risk here of "pathologising everyday occurrences".
Working from Home – Good or Bad?
Some media reporting during the coronavirus pandemic suggests that close to 100% of workers are working from home. According to a study by the Hans-Böckler Foundation, no more than 1/4 of workers were working from home in 2020. This resulted in a hugely polarised depiction of well-being among people working from home, as either a paradise found or a well-being killer. On the one hand, it has led to new-found freedoms, while on the other it has had a negative effect on mental health due to the blurring of the lines between work and home life, among other aspects. In a Health Report published by health insurer TK, 42% of respondents reported feeling stressed or very stressed during lockdown. The main stress factors mentioned were: lack of personal interaction;worries over catching coronavirus or others catching it; closures of schools and nurseries; and more stress at work. These are existential issues in people's lives, so it is perfectly understandable that significantly more people are reporting mental stress and/or mental disorders during the pandemic.
Psychological disorders on the rise?
First, we need to be clear about the fact that we are in the midst of a mega-trend: incorrect diagnoses of "Psychological and behavioural disorders", for example, have been increasing consistently for a solid 15 years according to the TK Health Report 2021. Absences have doubled in that period. Taking a look at the frequency of diagnoses made over the past 15 years confirms this picture of a rise in cases. A Psychotherapy Report published in 2020 by the German Association of Psychotherapists (Deutsche Psychotherapeutenvereinigung) indicated a rise of between 20% and 40% across different age groups. Meaning that even without the pandemic, the incidence of these diagnoses would have been expected to rise anyway.
Coronavirus escalating matters
What has happened during the coronavirus pandemic is that this trend has intensified. Major health insurers are reporting a significant rise in mental illnessesin both children and adults. A recent meta-study by Kunzler et al. (2021) which reviewed 104 scientific studies on mental health before and during the pandemic confirmed what the health insurers were saying. Symptoms of anxiety and depression were observed among the general public significantly more frequently during the pandemic than before. Media reports of an increased incidence of mental stress and mental disorders are also largely backed up by empirical data.
Greater awareness?
Of course, the question of whether mental illness is becoming more frequent can also be explained, at least in part, by other factors: greater awareness among the public, better diagnoses, changes in diagnostic habits and a greater openness among society as a whole to personal struggles could all bear some responsibility for this trend. It is also not inconceivable that workers in the healthcare sector have lowered their threshold for diagnosis, meaning that a greater number of people are diagnosed as having a "mental illness".
Two sides of the same coin
On the one hand, we need to ask whether the prevalence of psychological disorders has increased as dramatically over the past 15 years as the data would suggest. On the other hand, the significant documented rise in diagnoses of psychological disorders shows that something fundamental has changed and that more people are struggling with their mental health.
But struggling with your mental health is not always the same as having a psychological disorder. At the same time, studies show clearly that the "heatmap" of symptoms has moved significantly towards mental illness during the pandemic. This increase in everyday struggles for sufferers can be easily explained by the stress factors reported in the TK survey, such as existential issues. For people who were already struggling before the pandemic, for example, a feeling of social isolation caused by restrictions on personal interactions can quickly exacerbate sub-clinical symptoms.
What is to be done?
We have to assume that there is an enormous structural gap between people's everyday struggles and available healthcare. Having fast access to professional, modern advice that does not diagnose and instead offers guidance and immediate support, contextualises everyday struggles and is found by sufferers to be helpful could make a number of therapy requests redundant. Even if a mental illness is identified, it is absolutely crucial that this illness be explained in detail and that sufficient time be invested in mental health education. The quicker this happens, the greater the chance of a quick recovery. Proactively helping people who require treatment to choose the right type of therapy for them is just as important. We must continue to help sufferers look for and find a place to get treatment. By implementing and providing support for these issues as a sort of "stop-gap", we can counteract the enormous rise in the need for therapy. The consequences of the pandemic on the population's mental state are already clearly tangible and measurable, and demand vastly more sustainable structural solutions than simply increasing the number of therapy practices.
Literature
TK Health Report 2021: https://www.tk.de/presse/themen/praevention/gesundheitsstudien/gesundheitsreport-2021-2108392
Psychotherapy Report 2020: https://www.deutschepsychotherapeutenvereinigung.de/informationen/verbandspublikationen/report-psychotherapie/
Kunzler et al. : Mental burden and its risk and protective factors during the early phase of the SARS-CoV-2 pandemic: systematic review and meta-analyses. Globalization and Health (2021) 17:34.
