Financial issues and mental health problems often go hand-in-hand. — Pexels.com pic

KUALA LUMPUR, April 28 — Just like other countries, Malaysia is at war to flatten the curve of Covid-19 infections.

But another bomb waiting to explode is projected to arrive in a wave right behind it.

Consultant psychiatrist Dr Aida Syarinaz Ahmad Adlan today warned that a "silent” mental illness pandemic is likely to hit us as a result of anxiety and depression caused by the economic fallouts of the pandemic and the movement control order (MCO).

However, she said due to the stigma, people may not be truthful of their mental and emotional state unlike the classic form of an infectious disease pandemic.

According to her, financial crisis and mental health problems often go hand-in-hand.

"Those with existing mental disorders will have a tough time managing their finances due to their reduced capacity to think clearly and deal with adversities.”

Citing a 2013 study, Dr Aida said those who have no existing mental illness, but experiencing financial difficulties or debts may develop symptoms such as depression and anxiety three times more likely than those without debts.

"When one sees the financial problem as getting out of hand, they perceive life as getting out of control, and this, in turn, induces overwhelming fear and anxiety.

"Additionally, when their coping skills are challenged, they may be in denial and resort to avoiding their problems, which may cause further accumulation of debts,” she added.

How does anxiety break down bodily functions?

Dr Aida, who is also a senior lecturer at Universiti Malaya psychological medicine department, said anxiety puts the body in an alert mode as it perceives the presence of threat and danger.

"This is when your fight-and-fight mode takes place.

"Through a combination of nerve and hormonal signals, the adrenal glands are prompted to release a surge of hormones, including adrenaline and cortisol,” she added.

As a result, Dr Aida said adrenaline increases the heart rate, blood pressure and energy, while cortisol may cause various physiologic effects, including catecholamine (hormones made by your adrenal glands) release, suppression of insulin and mobilisation of energy stores to give your body the energy needed to deal with the crisis.

On top of that, Dr Aida noted that anxiety can also suppress the immune-inflammatory response.

The immune system is a complex network of cells and proteins that defends the body against infection.

"When there is no more threat, our body stress-response system would go back to normal.

"However, when there is chronic anxiety, cortisol is continuously produced, and this further suppresses the body’s immune system,” she said.

Simply put, Dr Aida said when one was having chronic anxiety, the person was more vulnerable to getting sick, while continuous stress may increase the risk of developing cardiovascular disease, elevated blood pressure, infectious illness and cognitive deterioration.

Its social effects

Dr Aida agreed that unlike most diseases, mental disorders may not show immediate symptoms until it develops into a severe state over time.

However, she said the risk of having undiagnosed people with mental disorders is going to be there as long as there’s a stigma around the topic.

"What is more complex is when there is an internal stigma.

"Despite society now being more open about mental disorders and its treatment, internal stigma is subjective perception of devaluation of self and shame, which prevents people from acknowledging their problem and hinders treatment,” she added.

To break the stigma, Dr Aida said more awareness and outreach programmes are needed to address the issue.

She pointed out the Health Ministry’s "Let’s TALK Minda Sihat” awareness programme as an example to help encourage people with mental illness to open up about their problems.

The acronym for TALK stands for: Talk to someone, Ask for help, Listen without prejudice and Know where to get help.

"If we see someone we know is showing signs of distress following the financial constraints, ask them how they are doing.

"By asking, we are sending a message that it is okay to talk about our problems and it is not a sign of weakness as it often perceived,” she added.

Domestic Violence

Responding to recent news reports about a spike in the number of domestic violence cases following the enforcement of MCO, Dr Aida cautioned that such incidents could increase as a result of financial difficulties.

Referring to a 2008 study, she said it was found that large-scale disasters are often accompanied by an increase in depression, post-traumatic stress disorder, substance use disorder as well as a broad range of other mental and behavioural disorders, domestic violence and child abuse.

"Viewing economic hardship following the current pandemic, we could take into consideration the findings of this review, to expect psychological sequelae and to prepare the nation on handling the consequences,” she added.

While many may link mental illness to violence or vice versa, Dr Aida said such thoughts are baseless and may form a stigma that often clouds the perception of the community.

"Mental illness does not cause violence, but not handling it well may lead to multiple unhealthy reactions and behaviours,” she said.

Dr Aida also advised people going through difficult times to be aware of their mental state and acknowledge the fact they are facing a problem.

"It is unhealthy to deny your problems and project your frustration onto your spouse or children.

"After understanding and accepting that you are having a mental health issue, seek help.

"Most problems will have a solution, but you need to have the right state of mind to find the solution”

Be aware of your cognitive health

If you are becoming forgetful while staying at home or lose track of the days, Dr Aida said forgetting some details if you were idle could be fine.

However, if it was becoming something regular to the point that it involves compromise on self-care, she said that could be a sign that something is not right.

"These could be symptoms of underlying depression.

"Some of the common features of major depression are sleep disruption, changes in eating habits, poor concentration and focus (which can manifest as forgetfulness), lack of energy, and losing interest to socialise or do anything that used to be pleasurable,” she added.

According to her, human beings often associate social isolation to loneliness.

"Loneliness, as defined by Perlman and Peplau (1981), is a negative feeling whereby a lonely person is experiencing a discrepancy between desired and actual social contact.

"Humans have a fundamental need to be socially connected and supported by others.”

Dr Aida also pointed out that some children may feel lonely following the school closures and MCO, which may greatly impact the children’s life in the future.

Citing an international research, she said it was found that children who have been socially isolated tend to have lower subsequent educational attainment and be part of a less advantaged social class in adulthood.

She said the same study also revealed that those children are more likely to be psychologically distressed in adulthood and become obese and smoker.

To help promote mental health among children, Dr Aida said the United Nations International Children's Emergency Fund (Unicef) and UM Cares (a community and sustainability centre under University Malaya) have done a collaborative work to address the issue.

"Using the Telegram app, we are encouraging children and youth to join in and stay connected with the @KitaConnect.

"In there, there are several videos uploaded addressing the common problems encountered by children and youth during the MCO,” she added.