Social distancing and mental health: How to avoid taking the TB route in coronavirus

Social distancing and mental health  

At least 10 people on my Instagram have declared themselves “Queen of Quarantine”. Social distancing and isolation are the two new buzzwords, and the most trending hashtags. While this is great, because we can’t flatten the corona curve without following these tenets, it is easy to forget that for some, isolation can be tough, and even triggering. People with pre-existing mental health issues might find it hard to socially distance themselves – being alone (for someone who lives away from their family) could potentially be depressing as well.

Worse still, is when someone tests positive for an infectious disease. The diagnosis in itself is a huge shock- and then there is the stigma that silently but significantly underlines most of the social distancing and isolation.

But isolation is the need of the hour, and to meet this need better, there are certain lessons we can draw in this pandemic from India’s tuberculosis epidemic and experience. Society often tends to forget to be warm to those who are suffering – and the TB experience stands as testimony to this. Not all forms of TB are infectious. However, TB patients are often compelled to physically isolate. This is because in some cases of TB, such as pulmonary TB, patients are infectious for the first few weeks of treatment and require quarantine measures. Similarly, in Covid-19, though the exact potency of the virus is still under research, we know for a fact that it is highly contagious, and thus, isolation is best advised.

The absence of warmth

In TB, the isolation is often caused by the stigma attached to TB. Patient narratives reveal that people tend to avoid being in the same physical space as them not just while they are on treatment but in some cases even after they are cured. These people could be community members, family members, and in some cases even partners.

In both cases, physical isolation – which translates to the absence of human touch and warmth – has a significant impact on the patient’s mental health, often leading to feelings of alienation, worthlessness, self stigma, and depression. TB treatment is long and is known to have mental health side effects in addition to other side effects. The length of treatment and the side effects often result in psychological distress, hopelessness, depression and in extreme cases mental health breakdowns.

News from all over the world has been pouring in about racism against people from East and Southeast Asia during the coronavirus pandemic. The fear and frenzy is gradually taking the form of a foe with which TB and HIV patients and survivors are all too familiar – stigma. And as can be observed from both these diseases, the stigma associated with a disease often not only heightens the mental health issues a patient may face as a result, but also drives the testing for, and reporting of the disease, underground.

In Mumbai, the hands of potential Covid-19 patients who needed home quaratine were stamped.

If we do not stop and take stock of how these diseases have played out, we are bound to take the same route with Covid-19, and the future of public health then, does not look pretty. If patients abandon treatment mid-way, they might still be infectious or develop an infection subsequently, and pose the threat of spreading this infection. As a result, infection rates could go up and endanger public health.

What can we do to address the impact coronavirus has on mental health?

Phone a friend, revive the art of letter writing even if what you are sending out is actually a long email or participate in a silly social media challenge. While we must continue to remain physically distant from each other, we need to find other ways to rekindle the spark of human connection – the antidote to isolation.

Workplaces should institute work-from-home policies and provide paid leave to those affected so as to alleviate the psychological stress that comes from the threat of financial insecurity. In the informal sector, where workers do not have the luxury of working from home, employers ought to provide access to clean water, soap, and sanitisers as well as economic and social support to workers in the form of paid leave in case of ill health.

The need for empathy

At a programmatic level, we need to develop a National Covid-19 programme along the lines of the national TB programme, and integrate mental health as a critical component of it. Patients and families have to be provided counseling and support right from the time of diagnosis through the process of treatment. Additionally, public information campaigns targeted at communities and health personnel ought to be launched to increase literacy about the impact coronavirus has on mental health as well as the ways to deal with it.

Coronavirus has caused one too many casualties. Do not let your empathy be one of them. When you interact with another person, take your precautions, but remember to see the humanity in them instead of reducing their existence to “potential carrier” or “Covid-19 patient”. Dehumanisation and othering have a catastrophic impact on mental health of the person at the receiving end of such behavior.

Why should that be your concern?

Albert Camus, in his novel The Plague, wrote “From now on it can be said that plague was the concern of all of us.” This is as true for the coronavirus today as it was for the plague then. Covid=19 can happen to anybody. Please remember, we are all in this together.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

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Exercise helps improve one’s cerebral health

Shaheen Bhatt’s recently released book on her struggle with depression has once again turned the spotlight on the issue of mental health in India, which has the dubious distinction of being named by the WHO in 2018 as ‘the country most affected by anxiety, schizophrenia and bipolar disorder.’

Despite one in every six Indians suffering from some form of mental illness, as per the WHO, such problems continue to have a stigma attached to them, causing people to shy away from seeking help. Doctors are trying to phase out the term ‘mental’ because of the stigma linked to it. “We are referring to it as cerebral health or brain fitness, as they are better scientific words,” says a chief consultant psychiatrist.

What can a person who is in the grip of a mental ailment do to help himself?

Well, it appears that exercise can go a long way in bringing about positive change. There is significant research to support this. A recent study in JAMA Psychiatry, a monthly, peer-reviewed medical journal published by the American Medical Association (AMA), found that physical activity is an effective prevention strategy for depression. Earlier, a study published by the UK-based Taylor and Francis Group, stated that exercise improves both mental and physical health in patients with major depression.

How does exercise help?
Leading psychiatrists explain that exercise should not be regarded as a cure, but rather, as an effective prevention strategy for depression.

A consultant psychiatrist says “Doctors suggest walking, along with medication, for patients diagnosed with clinical depression because it releases mood-enhancing hormones like endorphins, dopamine and serotonin. Exercise also means a change in environment and stepping away from enclosed spaces that a person may want to be in, and this can infuse positivity in their daily routine.”

Exercise puts people on a faster track to recovery from depression and also helps either prevent or reduce the severity of another possible episode, she adds.

How much to exercise?
“There are three cornerstones of health — food, rest and exercise,” according to a consultant psychologist. Giving the break up, she says, “70 per cent is food, 10 per cent is rest and maintenance, and 20 per cent is physical activity.” Getting down to specifics, she says a person with a sedentary lifestyle needs at least an hour of dedicated exercise every day, including 20 minutes of working up a sweat,” she notes.

Pointing out that mind and body are two sides of the same coin, and that you cannot work on one without considering the other, says the Dr. older forms of fitness activities, such as Tai-chi and Yoga,envisage the two as a single unit. “Physical fitness can reduce anxiety, depression and the perception of negativity and also improve sleep. There is an increase in cognitive function when the body is fitter and the mind is more alert, which increases insight levels,” she concludes.

A chief consultant psychiatrist, agrees that physical fitness helps to cope with factors that precipitate mental illness, but warns that it does not guarantee a cure. “Physical exercise is a controlling factor that improves the immune mechanism, which helps people cope better and not relapse into disease,” he explains. He advises a healthy diet, sleeping on time and getting enough exercise to maintain good mental health.

The limitations of exercise
Exercising is not as simple an option as it sounds, and comes with limitations. For example, finding the motivation to exercise is the key to fitness, but for people with depression, this is a challenge. A vicious cycle is created when lack of regular exercise leads to weight gain, which intensifies depression. “Expecting people to stick to an exercise routine and push themselves consistently is not realistic. So, suggesting exercise can be helpful only in some cases of mild depression. Even in such cases, it should be seen as a complementary and alternative therapy,” cautions a Dr.

(Un)Healthy Minds and (Un)Healthy Bodies
Mental health is similar to physical health. There could be multiple causes, including diet, lifestyle, environmental factors and genes, for a mental ailment, says the Dr. A person may have the genetic makeup for depression, just as he may have one for diabetes. This genetic predilection is triggered by risk factors such as an unhealthy diet, and precipitated beyond the threshold level into the disease level, he explains. “With any illness, multiple biochemical changes occur. Typically, the common pathways of a disease are inflammation and impaired immunity. This means, the early symptoms of either a physical or a mental issue can show up as a headache, chest pain, lung pain, etc. So, when you look at it from such a perspective, physical is the same as psychotic illness, only the medication and treatment are different,” he added. “Mental health issues make a person think negatively about themselves, the world, their past and future. They typically lose confidence, have feelings of guilt, feel inferior, and have negative thoughts about others as well. And just as conditions such as high cholesterol can lead to heart disease and heart attacks, depression can lead to suicidal thoughts as well as the act of suicide itself. Therefore, these symptoms require treatment and medication, he cautioned.
 
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12 Important Mental Health Facts Everyone Needs to Know Inbox x

Of all the medical conditions, mental health has the worst rep. It is often misunderstood or dismissed as fake or unscientific, and patients are thought of as faking or exaggerating their condition. While it’s definitely true that mental health is among the least understood fields of medicine, it’s also impossible to ignore mental illness, as anyone who has ever experienced or witnessed depression, anxiety, or any other mental condition will know.

The bottom line is, the fact that you can’t observe something under the microscope doesn’t mean that it’s less real or serious, and we are firm believers that everyone will gain a lot from knowing more about mental health, especially since it’s so common. Here are 12 facts about mental illness that everyone should know.

1. Mental health disorders are more common than you would think

We often think that mental health is something that affects others and couldn't possibly be something we or our loved ones will face one day. And while that thought sure sounds comforting, in reality, mental illness is more common than you think.

For one, the most common disorder is anxiety and panic disorder, with an estimated 18% of the population in the US alone suffering from the illness according to the Anxiety and Depression Association of America. Of these, only 36% seek treatment, despite the fact that it's among the most treatable mental health issues.

The numbers speak for themselves. According to MentalHealth.gov, 1 in 5 American adults had a serious mental health issue at some point in their lives, and 1 in 25 live with a major mental illness (e.g. bipolar disorder, schizophrenia, major depression). Finally, suicide is the 10th leading cause of death in the US, taking twice as many lives as homicide each year. 

2. It’s possible to prevent mental illness

It's certainly true that there is a genetic and hereditary component to mental health problems, but these are only one of the contributing factors that make a person susceptible to specific mental illnesses. The remaining factors affecting mental health, such as trauma, a safe and supportive environment, a healthy diet, abstinence from alcohol and recreational drugs, and an active lifestyle are all environmental, and can be as important as the hereditary predisposition.

That's why it's of key importance to raise children and adolescents in a safe and positive environment and prioritize a healthy lifestyle, especially if you know that a child is at risk of developing mental illness.

3. Weakness or strength of character has nothing to do with mental health

One common misconception about mental illness is that it stems from a lack of character and self-discipline, and if people suffering from a mental condition would try harder, they could be back to normal. This misconception stems from the belief that mental conditions originate from emotions, so, for example, a person who suffers from depression is just sad or lazy, or someone who is in mania is just hot-headed or angry.

Unfortunately, things are not so simple, as no amount of self-discipline can undo the trauma or regulate the neurochemical disturbances in a person's brain, both of which are major physical contributing factors of mental illness. For this reason alone, don't demand from a person with a mental issue or from yourself to just snap out of it, seek professional help instead.

4. It’s possible to fully recover from mental illness

Another persistent misconception about mental illness is that it's irreversible, meaning that a person suffering from mental health issues will never recover. This, too, isn't true, and many patients recover completely or get much better if they get treatment and the social support they require.

The likelihood of full recovery will depend on the type of condition, the stage of development of said condition, as well as the treatment and support the patient receives. That's why it's always good to turn to mental health professionals and seek treatment as soon as possible.

5. People suffering from mental illness can hold full-time jobs just like everyone else

Like we've mentioned previously, the number of people suffering from mental health issues is massive. In fact, nearly everyone will suffer from some kind of mental illness at some point in their lives, and as many as 1 in 10 young people have had major depression. Needless to say, most of these people have lives, families, and jobs.
Many psychiatric patients are productive and manage to hold full-time jobs without frequent absenteeism and other negative side effects of their condition, given that they manage their condition. In addition, having a steady income and maintaining social activity has been found to be highly beneficial to persons suffering from mental health issues. 

6. Children, as all other ages, can and do experience mental health issues

Many mental illnesses manifest themselves in the form of early signs and symptoms during childhood or youth, and there are a few disorders, such as autism, that begin in early childhood. It has been estimated that 50% of all mental illnesses exhibit the first symptoms before the age of 14, and 75% of them begin before the age of 24.

It is unfortunate that most of these early symptoms don't get the attention they require, and it is not until the illness reaches its developed stages that the patient seeks treatment. On the bright side, the statistics of the early diagnosis are improving, and an increasing number of patients have a better prognosis and have a chance for a better life as a result.

7. Stigma is one of the biggest issues for people with mental health problems

Social acceptance is incredibly important for anyone, really, so it's not surprising that people suffering from mental health issues are often ashamed to discuss their condition with other people. Patients are afraid to be diagnosed because this may cost them their job, their family and their social circle.

But the adverse effects of stigma related to the mental health field, in general, are a lot more far-reaching, as many patients refuse or deter the necessary treatment due to the fear of being labeled 'crazy' or 'psycho', which decreases their chance of full recovery. Acceptance and understanding from the patient's social connections are key in helping their recovery and long term well-being, as well as preventing suicide.

8. Genetics alone cannot trigger mental illness

Contrary to popular belief, the vast majority of mental conditions are not genetic, all of them are acquired, though some have a stronger genetic component than others. Even autism, the first symptoms of which are often exhibited as early as 8 months, occurs as a result of both genetic predisposition and abnormalities during pregnancy and childbirth, which makes autism an inborn, but not a genetic condition.
The genetic component for other mental illnesses, such as bipolar disorder, depression, schizophrenia, etc., is even smaller than that, and as a result, these conditions are preventable, much like many acquired physical conditions, such as chronic obstructive pulmonary disease, cirrhosis or type 2 diabetes.

9. Exercise has a surprisingly beneficial effect on mental health

Many people underestimate the beneficial effect of good lifestyle changes on mental health. The reality is, however, that maintaining a physically and socially active life, having a healthy diet and even spending time in nature can help your symptoms.

For one, exercise has been found to improve the symptoms of anxiety, depression, and ADHD, likely because it is known to relieve stress, boosts your mood and improves sleep. Needless to say, all of the activities and habits we mentioned are also good preventative methods.

10. There is no link between creativity and mental illness

If we were to ask you to name at least a few famous creatives suffering from mental illness, we're more than sure that you'd be able to come up with several examples off the top of your head: van Gogh, Hemingway, Sinatra, the list goes on... This prompts the question, "Is there a link between mental illness and creativity?"

Luckily, we have a ready answer, and it's a definitive 'No', and there is nearly a century's worth of scientific studies to back up this claim. People suffering from mental illness are not more creative than those who don't, and conversely, artistic minds are not more likely to suffer from a mental condition than non-creatives. Lastly, if you, as a creative, will take medications to address a mental issue, it will not directly affect your level of creativity.

11. Mental illness and intellectual disability or brain damage are not the same

This is another popular misconception, and we recognize where it comes from, as it often happens that people with brain damage or cognitive deficits have mental health issues, and it's also the case that mental illness in its advanced stages can cause brain damage.

What further complicates this question is that many brain disorders can be accompanied by psychotic episodes or mood disorders. For example, advanced Parkinson's disease often causes hallucinations, delusions and psychosis. Still, this doesn't mean that neurological and psychiatric illnesses are the same, it merely showcases that structural and functional changes in the brain influence our mental health.

12. Sleep deprivation affects mental health

We live in a society that often values productivity and hard work more than health. The truth is that by depriving yourself of sleep or sleeping too much, you can set yourself up for danger.

In fact, research from Harvard University has shown that 65–90% of adults with major depression also suffer from sleep problems. This is because REM sleep promotes learning, memory and emotional well-being, and the lack thereof, as the authors suggest, can worsen or even potentially trigger psychiatric illness. So, fluff up your pillows and have a good night's sleep.

 

this is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     
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HIV patients face premature heart ailment and barriers to care

A new study has claimed that people living with HIV are at a higher risk of heart and blood vessel ailments compared to people without HIV.

According to the study,' the risk arises due to interactions between traditional risk factors, such as diet, lifestyle and tobacco use, and HIV-specific risk factors, such as a chronically activated immune system and inflammation characteristic of chronic HIV.
 

Tobacco use, a major risk factor for cardiovascular diseases, is common among people living with HIV. In a nationally representative U.S. sample, 42 per cent of people living with HIV were current smokers.

Heavy alcohol use, substance abuse, mood and anxiety disorders, low levels of physical activity and poor cardio-respiratory fitness are also common among people living with HIV and may contribute to elevated risk for diseases of the heart and blood vessels, according to the study.

"Considerable gaps exist in our knowledge about HIV-associated diseases of the heart and blood vessels, in part because HIV's transition from a fatal disease to a chronic condition is relatively recent, so long-term data on heart disease risks are limited," said a researcher.

In addition, people living with HIV are often stigmatised and face significant barriers to optimal health care, such as education level, where they live, healthcare literacy, disenfranchisement from the healthcare system, cognitive impairment, injection drug use, internalised and anticipated stigma, gait and mobility impairment, frailty, depression and social isolation. There are also disparities in care based on age, race, ethnicity, and gender.

Another area of concern is the ageing population of people living with HIV - 75 per cent of people living with HIV are over age 45. "Aging with HIV differs greatly from the ageing issues facing the general population," said a Dr., in an accompanying patient perspective.

"On average, people living with HIV who are over 60 years old have 3-7 medical conditions, including heart attacks, strokes, heart failure, kidney disease, frailty and bone diseases and many take 12-15 medications daily," said the Dr.

Providing scientifically based recommendations on how to reduce the risk of cardiovascular disease among people living with HIV is also challenging.

To assess a person living with HIV's cardiovascular risk, the study advised a nuanced approach. This approach includes quantifying traditional risk factor burden using tools such as American Heart Association/American College of Cardiology Atherosclerotic Disease Risk Calculator, which estimates a person's ten-year risk of having a heart attack, stroke or other cardiovascular condition, as a starting point.

However, the authors caution that people living with HIV may have a higher risk than indicated by the calculator.

To keep people living with HIV healthy, the Dr. emphasised the importance of a healthy lifestyle that includes smoking cessation, adequate physical activity, eliminating or reducing the amount of alcohol consumed and a healthy diet.

In addition, medications such as statin drugs, which lower cholesterol, and other medications that make blood less likely to form clots may be helpful, although more clinical trial data are needed.

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