By Nadine Yousif, Local Journalism Initiative Reporter, Toronto Star
Experts are sounding the alarm on an impending fourth wave of the pandemic — a wave characterized by psychic trauma, burnout, mental illness and economic injury that is projected to be the largest, most enduring health footprint of COVID-19.
“I think we’re seeing the beginning of an echo pandemic, and I think it’s going to worsen,” said Dr. David Dozois, a professor of psychology at Western University and a member of Mental Health Research Canada’s board of directors.
When Premier Doug Ford announced a province-wide state of emergency on March 17, 2020, very few people could envision the drastic changes to daily life that lay ahead. One year later, a growing body of research on the mental health of Canadians during the pandemic paints an alarming picture of higher rates of reported depression and anxiety, substance abuse and eating disorders, and a cohort of young Canadians deeply struggling with the uncertainty of their futures.
The Star breaks down each stage of the pandemic and how fear of the virus, economic uncertainty and the inability to see our loved ones affected our mental health, through the help of ongoing research by the Canadian Mental Health Association, Mental Health Research Canada (MHRC), and other hospitals and agencies in the country.
While indicators of mental health slightly fluctuate with economic relief programs, severity of lockdowns and other factors, what remains clear is the pandemic’s undeniable, prolonged effect on our well-being — an effect that will likely linger long after mass vaccination efforts wrap up.
“It’s devastating to the individual,” Dozois said, adding he predicts depression rates will rise as a result of the pandemic. “But it’s also devastating to the economy and our society, and I think those issues are going to be here for a long time.”
The initial lockdown
Lockdown measures quickly came into effect as coronavirus cases ramped up across Canada. Casinos first closed in Ontario on March 15, followed by a state-of-emergency declaration two days later and the closure of businesses on March 23.
Students who were on March break were told not to return to the classroom, and continued their studies from home for the duration of the semester, placing added strain on parents with no child-care plans. As governments were grappling with the rapid spread of the virus, millions of Canadians lost their jobs in the aftermath of these swift lockdown measures.
Historically, tough economic times go in tandem with a general decline in mental health and well-being — as evidenced by the financial collapse of 2008 — and researchers moved quickly to measure this impact in real time. This is coupled with loneliness induced by social isolation, which previous research shows can reduce mortality rates overall.
“It’s a recipe for mental health issues,” said Dozois.
In April 2020, a Morneau Shepell poll revealed 50 per cent of Canadians reported their mental health had worsened during the pandemic, with over 40 per cent saying they were worried or anxious. In May 2020, Statistics Canada noted a 14 per cent decline since 2018 in the proportion of the population identifying their mental health as “very good” or “excellent.”
In another May survey by the University of British Columbia and the Canadian Mental Health Association, 38 per cent of Canadians said their mental health had worsened since lockdown, with women expressing higher rates of decline. That number jumps to 45 per cent for members of the LGBTQ+ community, and 43 per cent for people whose household income is less than $25,000 a year.
About half of those surveyed said they experienced anxiety, and 23 per cent said they felt depressed. These rates were higher for lower-income people and those with a disability, research found.
As people lost their jobs or income, financial concerns became a major point of stress. Other stressors were the fear of becoming ill, having a family member die of COVID-19, and, above all, being separated from friends and family.
Suicidal ideation was also flagged through these polls. Six per cent of respondents said they thought of suicide, but alarmingly, that rate more than doubles to 14 per cent for LGBTQ+ people and those who are low-income.
With the abrupt changes to schooling, the mental health of young Canadians is also worth noting: In a Sick Kids study conducted between April and June 2020 of Ontario children aged 10 to 18 and their parents, 70 per cent said their mental health was worse in the aftermath of the first lockdown.
Post-secondary students — more than half of whom had pre-existing mental health conditions before the pandemic — also reported a decline in mental health after lockdown, especially around their exam period in April.
According to research done by the Investigative Journalism Bureau at the University of Torontos’ Dalla Lana School of Public Health, the number of college and university students who reported a mental health decline in both the U.S. and Canada rose by 10 per cent.
A summer of hope?
The summer months typically bring some relief to many — most students are no longer bound by the stressors of school work, longer days to enjoy by people working nine-to-five and warmer weather to relish the outdoors.
COVID-19 infection rates also slowed enough in the summer months that many municipalities, including Toronto, began to lift their lockdown measures. Indoor dining was permitted again, so were small gatherings outside and shopping for non-essential goods.
Some surveys conducted at that time, namely from the Centre for Addiction and Mental Health (CAMH), showed significant declines in moderate to severe anxiety levels among Canadians in June and July, though depression levels remained roughly the same. While there was a decline in anxiety, rates in general remained higher than pre-pandemic days.
“It’s a quite powerful message that even though things had improved, restrictions had lifted and the curve was being flattened, that proportion of people who said their anxiety and depression was high kind of remained the same,” Dozois said.
The summer of 2020 was also particularly difficult for Black, Indigenous and people of colour (BIPOC) who were reeling from the death of George Floyd, an unarmed Black man who was killed by a Minneapolis police officer in May. This sparked widespread protests around the globe, including here in Canada, and a large reckoning with racism that has had a profound impact on the mental health of visible minorities.
This is also when data began to emerge on COVID-19’s disproportionate impact in BIPOC communities, where there were higher rates of infection than in the general public.
The disproportionate impact on BIPOC communities is reflected in mental health data from the summer. A Statistics Canada survey conducted in July revealed visible-minorities were more likely to report poor mental health and a higher rate of moderate or severe generalized anxiety disorder.
Around this time, children’s hospitals also noted an alarming increase in eating disorder-related hospital visits by people aged three to 17. In July, the hospitalization rate for youth in Ontario was three per 100,000, higher than the average of around 1.8 per 100,000.
By and large, the pandemic was far from over and fear of the virus remained. Dozois added that data from MHRC in the summer showed the things people relied on for support — having more time to read books and watch movies, or be physically active — quickly began to lose their effect.
“It seemed to just dissipate very quickly, and those things were no longer having a positive impact on our mental health,” Dozois said. “You can only distract for so long before it becomes kind of useless.”
“By August, we knew it was going to be a long haul,” added Michael Cooper, MHRC’s director of development.
After much debate on what a return to classrooms would look like, most jurisdictions across Canada agreed that students should return to in-person learning, both for their own mental health and well-being — as Sick Kids hospital had advocated for — and to aid a growing chorus of parents who remained concerned about how to juggle child care and work responsibilities, though some parents opted for their children to continue learning virtually.
But September had seemingly brought a host of mental health challenges for many Canadians, data revealed. Calls to 2-1-1 for substance abuse support, crisis intervention and counselling from Toronto residents were 50 per cent higher in September than in February, reaching an all-time high since the pandemic began.
A more alarming revelation was that many who were seeking help for substance abuse through 2-1-1 calls were not receiving it due to a shortage of detox beds in the city.
Rates of anxiety rose again for most Canadians surveyed by CAMH and resembled near May 2020 levels. Depression rates continued to rise as well, from 10 per cent in April to 12 per cent in October, according to MHRC’s continued surveying of Canadians’ mental health.
Teachers and front-line health-care workers in particular were feeling the strain, data showed. MHRC reported anxiety levels for teachers increasing by 500 per cent in that time frame.
The second wave
Mental health issues were further exacerbated when COVID-19 infection rates soared in late 2020, prompting most jurisdictions to enter a second lockdown.
“Around that time, we started seeing depression numbers consistently moving up,” Cooper said, adding part of that is long-term anxiousness turning into depression.
“Anxiety is cognitively more of a helplessness, whereas depression is more of a hopelessness,” Dozois said. He added it was harder at this point in the pandemic to see the light at the end of the tunnel for many people.
Health-care workers continued to feel the strain through the second wave, and a Statistics Canada poll conducted at the end of November to mid-December showed 70 per cent of physicians, nurses and personal support workers reported worsening mental health. Nurses fared the worst, and much of it was tied to access to Personal Protective Equipment, which some health-care workers said was still restricted in certain cases.
The vaccine effect, or lack thereof
By the end of December, three vaccines had already been approved by Health Canada, and the first shipments of the Pfizer COVID-19 vaccine were arriving in the country. The first doses were administered on Dec. 14, and while vaccine rollout has had some hiccups, several million people have now had at least one dose of the vaccine.
Alarmingly, vaccine rollout seems to have had no effect on Canadians’ depression and anxiety rates, according to the latest survey conducted by MHRC in February, which collected responses from 3,005 people across Canada. In that survey, depression rates hit an all-time high of 17 per cent since the pandemic began.
“It’s very troubling from my perspective, because of the long-term implications of depressive symptoms,” Cooper said.
Six per cent of the total population, Cooper added, said they weren’t feeling resilient at this point of the pandemic. A large proportion of that six per cent are people between the ages of 18 and 34 whose employment had become precarious as a result of the pandemic.
Social isolation is also having more of an impact on people’s mental health now than it did at the beginning of the pandemic, with 51 per cent reporting negative impacts in February versus 41 per cent almost a year ago.
Cooper said these results show that vaccines only fix one of many pandemic issues: the fear of the virus.
“Are we going to see the economy open back up? Are people going to be able to see their loved ones again?” Cooper asked. “There are so many questions and variables that are hard to answer.”
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