Apathy, anxiety, depression, sleep disorders, but also hyperactivity, the desire to transgress restrictions and rebel against closures to “feel alive”. The coronavirus epidemic is having dramatic consequences for the entire population, but while those on physical health are limited directly to the infected, the psychological effects they are not sparing anyone. One study conducted by the Istituto Superiore di Sanità on a sample of 2700 adult twins (average age 45 years) and 878 families with underage twins, it reveals the impact of the pandemic on mental health, in terms of perceived stress and the presence of anxious and depressive symptoms. “Depressive or stress symptoms were observed – explains the ISS – in 11 and 14% of the sample, respectively. The anxiety levels, on the other hand, were found to be beyond the normal range in about half of the subjects examined”. 6% of the subjects surveyed slept worse during the lockdown period, 4% showed a strong concern for their physical and mental health, 13% said they felt sad quite often and 11% reported having felt quite often alone. In a recent interview with La Repubblica, the French philosopher Edgar Morin argues that “life is a navigation in an ocean of uncertainties through islands of certainty.” But in a pandemic, even the few “islands” to which we thought we could cling risk crumbling with unpredictable material and psychological consequences. We talked to Professor about mental health in relation to the pandemic Massimo Di Giannantonio, elected president of the Italian Society of Psychiatry.
Almost 40 thousand deaths, hundreds of thousands of infected people, the health system in great trouble and great economic uncertainty about the future. Yet there is an issue that has rarely been addressed in Italy, that of citizens’ mental health.
The consequences of the pandemic have been important both on the population in general, and on that part that for some time belonged to the mental health departments because it carries a psychiatric pathology, and in the great galaxy of health workers. Too little is said about it, but the psychological consequences of the pandemic will be serious and widespread.
What did you find?
We are faced with an increase in adjustment disorders with generalized anxiety and somatized anxiety. This is clearly demonstrated by some neurobiological indicators such as the alteration of the circadian sleep-wake rhythm, the corticosteroid production of the hypothalamus-adrenal-pituitary axis and the alteration of the basic biological parameters. It is then necessary to make some distinctions: there are personality profiles so-called “dependent field” which in recent months have had an increase in negative symptoms, such as a decrease in actions, a decrease in relationships, a decrease in interest in social activities, a decrease in ability of social interaction, refuge in virtual worlds and eating disorders. Many of them have also found refuge in self-treatment by consuming legal psychopharmacological substances such as anxiolytics, hypnotics and antidepressants, not forgetting alcohol and psychoactive substances. Besides them there are also subjects that we in the field define as “independent fields”, who have had diametrically opposite reactions: activation of behavior, tendency to hyper excitability, desire to break the limits and restrictions and a strong instinct to transgress; for them the “action” is a way to break the vicious circle of anxiety and worry.
The great dilemma that we have all had to face is that between the defense of health and the defense of personal freedoms.
With respect to this great dichotomy, people reacted according to their specific personality profiles and according to the characteristics of their psycho-affective development. For example, we found that the more the subjects had a childhood full of trauma and conflicts, the more they developed reactions of an “independent field”.
You mentioned the use of psychotropic drugs. Do you have more specific information?
There are still no official statistics on the consumption of psychotropic drugs but we have recorded in the large regional drug reservation centers a 35% increase in the supply of anxiolytics and hypnotics and a 28.2% increase in antidepressants. These, I stress, are the quantities of wholesale orders by retail pharmacists, but they are significant numbers. If this is supply, demand cannot be very different …
Among the indirect effects of Covid-19 is the so-called “limbo” anxiety. What is it about?
It is a new type of anxiety – “from suspension of time” – which increases the mental illness of many people. Limbo is the symbolic representation of an unending wait: that of the vaccine, of the result of the swab, of the hospitalization of a loved one. This expectation can be experienced in different ways depending on the personality. We see every day more and more people who passively suffer it, making it a sort of alibi to implement a passive and renunciative attitude. Then we see other intolerant ones who react aggressively, sometimes violently.
For days there has been talk of restrictive measures reserved exclusively for the elderly. Would they make sense, in your opinion?
It is an extremely dangerous proposal: I must remember that older people are citizens like everyone else and cannot be limited in their constitutional rights. Their health would not benefit since very often in the third and fourth age there is a clear decrease in emotional relationships. For example, those who have been hospitalized in the RSA for many months do not see their loved ones. We register more and more often among the elderly feelings of loneliness, abandonment and anguish, it makes no sense to consider them people with different and negligible needs compared to those of younger citizens.
Other major players in the pandemic are children and adolescents.
In them we register a condition of slowing of psychoaffective maturation, a slowing of the maturation of the psychosocial condition, a feeling of disorientation and a regression in the ability to develop independent relationships. I remember that while the family is considered the primary socialization agency, the secondary and equally fundamental is the school. When this disappears in a particularly delicate age such as early childhood, second childhood and early adolescence, the effects on developmental and maturation pathways cannot be negligible.
Are there any remedies that families can use?
Sure there are. It is essential to maintain an emotional climate as serene and creative as possible in the family by allowing frequent contacts in video calls and telephone calls with close relatives, especially grandparents.
Public health has suffered major cuts in recent years. What is the situation in the mental health departments?
The mental health departments in the territories have 900 thousand people in charge, but we expect a shock wave with another 300 thousand new cases in the coming months. These are patients who can have from brief and transient problems to more serious psychopathologies, in particular post traumatic stress syndrome and panic attacks. The departments have given a great organizational response also by resorting to telepsychiatry, but today we are suffering from a dramatic reduction in the workforce in recent years with a ratio between new hires and retired professionals that is 1 in 4. We want to carry out our business as well as the large European countries like France, England and Germany, but we desperately need funds. By law, departments of mental health should draw on a share of 5% of the budget of regional health companies. Today, however, they receive 3.2 percent funding on company budgets. Here, today we risk paying a high price for public disinvestment in protecting the mental health of citizens.
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