Scratching beneath the surface of the COVID-19 mental health link

By Chua Li Min, Science writer
Scratching beneath the surface of the COVID-19 mental health link

The mental toll of the ongoing COVID-19 pandemic now affects one in three adults—particularly women, younger adults and those of lower socioeconomic status as a study by Tazeen Jafar’s team revealed.

Jafar’s latest foray into mental health may seem unrelated to her primary focus on cardiometabolic diseases such as cardiovascular disease and kidney failure, but Jafar, a professor with the Health Services and Systems Research (HSSR) Programme at Duke-NUS, is on a mission.

Mental health disorders are common among patients with cardiometabolic diseases, who also tend to be at a higher risk of being infected with COVID-19 and develop complications, which results in a higher mortality rate. 

To further complicate matters, when healthy individuals experience increased psychological distress, the added stress on their mental health also puts them at a higher risk for chronic diseases like cardiometabolic disease. Treating them for mental health disorders could potentially prevent some of the complications of cardiometabolic disorders.

“It is a vicious cycle,” emphasised Jafar. “A lot of preventive measures are needed, with multifaceted interventions at several levels to break it.”

Therefore, shedding light on how COVID-19 is linked to psychological distress is an important stepping stone in Jafar’s quest to building care models for cardiometabolic diseases. 

“And my motivation is eventually going to be designing innovative models of care or services,” stressed Jafar.

The data from the COVID-19 study may eventually lead to a one-stop shop that can cater to people with cardiometabolic conditions and mental health concerns to ensure that no one falls through the crack.

“The interplay is very complex, and we must prevent it,” explained Jafar.

How it all began

Jafar approached research fellow Yeli Wang and MD-PhD student Monica Palanichamy Kala about this study.

“We were so excited, we jumped at the opportunity,” said Wang.

Aided by both Wang and Kala, Jafar set out to analyse results from studies that looked at psychological distress among the predominantly general population from six World Health Organisation (WHO) regions.

“We screened more than 19,000 citations and included 68 studies with more than 250,000 participants. The speed of papers published during COVID-19 was very fast,” said Wang. “When we did our first literature search, we included around 37 papers in our review, and when we updated our search a few weeks later, another 30 additional papers were included.

As such, both Wang and Kala had to work quickly to analyse a larger dataset, before they could finalise the results and send the manuscript out for publication.

“Because our review included many papers, we had the statistical power to identify a comprehensive range of factors associated with the psychological distress in COVID-19,” said Wang, who hopes that their findings will help countries to design effective interventions to mitigate psychological distress.

Monica Kala (left) and Yeli Wang (right)

Monica Kala (left) and Yeli Wang (right) assisted Jafar with analysing the data on psychological distress among the general population from six World Health Organisation (WHO) regions  //Credit: Tazeen Jafar

The way forward

Developing mental health counselling services is on the cards, although it is in the very early planning stage, said Jafar.

“The first step is just linking up with experts and stakeholders, and having broad-based brain storming sessions,” added Jafar.

While these plans are in progress, the seasoned global health expert has also been invited to participate in early feasibility studies as a member of the advisory board of the IMPACT programme, which collaborates with key stakeholders in Bangladesh, India, Pakistan and the UK. The studies conducted under the IMPACT programme seek to improve health and reduce deaths in people with severe mental illness that are suffering from other comorbidities such as diabetes, heart and lung diseases.

“I think effective and scalable models of care for prevention and treatment of mental disorders in children and adults are needed globally, including in Singapore,” said Jafar, who hopes to build models of care in Singapore.

“That’s the work that I do, and that’s what I look forward to—collaborating and working closely with psychiatrists and psychologists here,” she said.

Elaborating on the design of these care models, Jafar shared her vision of what they might look like: “It is not going to be one approach, but a compendium with lots of different approaches according to the risk level of the population that work.”

From the initial processes of education and mental health literacy to identifying individuals at risk from screening, before moving on to possible referral mechanisms, and finally, counselling services for patients to address the problem, her plan is systematic and well thought-out.

“We start with that – then evaluate the model in a scientific study, once you have a model that works, then things improve, then you implement it to scale and include measures for continuous quality improvement, including policy improvements. You keep on improving on it,” she added.

And the beauty of this approach is that it is not just a model for Singapore, but one that can be adapted for use in other countries, through customising elements based on the population, health systems, and income characteristics of the country.  

"And my motivation is eventually going to be designing innovative models of care or service."

Professor Tazeen Jafar

Prof Tazeen Jafar