Interview with Maria João Heitor, specialist in Psychiatry, president of the Society of Psychiatry and Mental Health and director of the Department of Psychiatry and Mental Health at Hospital Beatriz Ângelo by Filipa Basílio da Silva
Rapid changes in people’s lives can cause psychological distress at any age group. And adaptation to stress can take more or less transient and moderate forms, such as adaptation disorders, or more severe forms of marked anxiety and major depression. We must be aware of the possible greater risk of suicide, both in the pandemic and post-pandemic period.
The effects of the threat caused by the Covid-19 pandemic are not long in coming. According to the specialist in Psychiatry Maria João Heitor, “the number of cases of anxiety, depression and problems related to alcohol and drug addiction will probably increase”. The president of the Society of Psychiatry and Mental Health says that “it is difficult to predict what kind of marks will or will not persist” in the mental health of the Portuguese. But one thing seems certain: “We will not return to normality as we knew it.”
What challenges for psychological balance do we currently face?
We are in an unprecedented period, full of uncertainty, insecurity and fear, resulting from a threat to public health. This threat has set in abruptly, has led to social and family confinement, there are separated families, there has been no time for people to adapt. It is a threat that poses numerous challenges: physical, personal, social and emotional.
What are the factors that most threaten our mental health right now?
Grief, separation from the family, circumstances where life is at risk. And the deterioration of socio-economic conditions can have a ripple effect. Unemployment and temporary work are associated with lower income and greater social inequalities, situations that predispose to stress, anxiety and depression.
Are there higher risk groups?
Yes. People already suffering from severe mental illness and individuals where the pandemic or economic crisis has precipitated a latent psychiatric disorder. Vulnerable groups include infected patients and their families, people with pre-existing medical conditions, health professionals and women. Another group at greater risk are older adults, with more limited resources – such as reduced access to the internet and smartphones, devices that can be useful in this new context.
Why do you include women in risk groups?
Women, in general, have more psychological distress, anxiety, depression and post-traumatic stress disorder.
And to what extent do health professionals also fit in?
The risk is greater for health professionals who work in the Emergency Department, with patients positive for SARS-CoV-2 and in Intensive Care. Because they are exposed to various stressors and risks that can cause immediate emotional distress and, in the medium and long term, cases of post-traumatic stress can arise.
Can you give examples of the stressors and risks that can lead to mental problems?
There is a realistic, pandemic fear of being infected and a more than legitimate fear of infecting family members. They can be stigmatized by the infectious risk, both at home and in the communities where they live. In many cases, the distance from the family (especially the children) put pressure on family relationships and it was necessary to organize logistics that were different from the usual dynamics. The increase in the workload and the use of very uncomfortable personal protective equipment are other stress factors.
Do you anticipate that the prevalence of certain mental illnesses will increase?
The number of cases of anxiety, depression and problems related to alcohol and drug addiction will probably increase. We’re going to see different problems throughout the lifecycle. From the newborn, he can be deprived of an early relationship with his mother, if she has Covid-19, with all the possible consequences of a poor bonding. Even the elderly with dementia or depression who may be more isolated or abandoned. We will see more situations of post-traumatic stress disorder, for example in Covid-19 survivors, even in the post-pandemic phase. There are also other aspects that, due to their transversal nature, I cannot fail to enumerate: domestic violence, abuse and mistreatment.
Is it possible to prevent the mental illnesses you mentioned under current circumstances?
This will essentially depend on a concerted, intersectoral intervention, with the implementation of healthy public policies that do not just involve health. It is very important to invest in basic self-care that promotes well-being and personal resilience, that in turn, helps prevent psychological distress and mild to moderate forms of anxiety and depression.
How are the mental problems of the Portuguese being monitored?
Psychological and emotional support lines aimed at the general population or health professionals, local or national lines, have a prominent place in the response in terms of emotional first aid and crisis intervention. But, in the phases of deflation, we still have to strengthen the articulation between mental health services, primary health care, municipalities, IPSS, Non-Governmental Organizations and other community partners. Above all, mechanisms and channels must be created to avoid delays in diagnosis, medication failures and clinical decompensation with a worse evolution of the disease.
Can self-medication increase?
There is always the risk of self-medication, especially if people are less informed and access to services is difficult. Consumption of benzodiazepines must be avoided, as these drugs have very precise indications and their use must be of short duration. As for antidepressants, they should always be prescribed by a doctor according to the therapeutic indication – for example, in cases of marked depression or anxiety.
What advice would you give to someone who needs help?
That you look for your family doctor and, if necessary, the psychiatrist, so that a good clinical evaluation can be carried out, a diagnosis established and a therapeutic approach indicated. This approach may include psychotherapeutic and/or pharmacological follow-up. Depending on the case, the psychiatrist, in addition to his intervention, can refer to other health professionals, namely a psychologist or others, in a multidisciplinary perspective.
Will the pandemic leave permanent marks on mental health?
It’s hard to predict what kind of marks will and won’t persist. We are probably not going to return to normality as we knew it. But there will be an accelerated evolution of trends that were already drawing. Above all, communication will change, with greater social distance being maintained, with virtual meetings, teleconsultations, video consultations, and the more frequent use of masks will also hide part of non-verbal communication. Rapid changes in people’s lives can cause psychological distress at any age group. And adaptation to stress can take more or less transient and moderate forms, such as adaptation disorders, or more severe forms of marked anxiety and major depression. We must be aware of the possible greater risk of suicide, both in the pandemic and post-pandemic period.