COVID19 Archives - Promises Healthcare
ENQUIRY
COVID-19, Singapore Easing Measures and Mental Health

COVID-19, Singapore Easing Measures and Mental Health

The COVID-19 pandemic is unprecedented. The ubiquitous influence of the pandemic has been—and continues to be— felt by individuals globally. Many experiences the fear of being infected or infecting others, disruptions in their daily routines, social isolation, the likelihood of unemployment, financial hardship and the looming economic uncertainty (Ministry of Health Singapore, 2020). As such, there is a detrimental impact on the mental health and wellbeing of individuals, including an increased risk of suicidal behaviour.

Globally, the prevalence rates for depression and anxiety in the COVID-19 pandemic were 28.0% and 26.9% respectively (Nochaiwong et al., 2021). Factors contributing to depression and anxiety include suffering, fear or potential death, grief and financial stressors (World Health Organization, WHO 2022).

Young people have been identified as at increased risk for suicidal and self-harming behaviours (WHO, 2022). Women’s mental health, compared to men’s, has been more adversely impacted by the pandemic (WHO, 2022). In addition, people with existing medical conditions such as asthma, cancer and heart diseases, have been found to be at higher risk for developing mental health disorders (WHO, 2022).

In Singapore, a study conducted by the Institute of Mental Health (IMH) (Ministry of Health Singapore, 2020) found that 8.7% of Singapore residents reported having clinical depression, 9.4% reported having clinical anxiety and 9.3% reported mild to severe stress levels.  Older adults were identified as a vulnerable group, particularly, those who lived alone. Similar to the findings from WHO (2022), youths in Singapore were also identified as vulnerable to experiencing poor mental health in response to the pandemic. There is an urgency for countries to boost their mental health and psychosocial support services as part of the pandemic response plan.

According to the COVID-19 mental wellness task force, initiatives in Singapore include providing psychological support via helplines such as the National CARE hotline and a mental health help bot (‘Belle’), incorporating mental health materials in the school curriculum, fostering family resilience and supporting parents with parenting skills.

Here are some recommendations for mental health support during this pandemic:

  • Parents are encouraged to have conversations with their children about their children’s worries and responses to the pandemic. Parents have been found to underestimate such responses (Pfefferbaum & North, 2020). Such “talk time” can also help in trust and bond-building
  • Seniors can be equipped with digital skills and also expand their options for help and support i.e. the provision of telehealth counselling and support services (Brydon et al., 2022). 
  • Health care workers can monitor their stress responses and seek assistance in relation to both their work and personal lives from a mental health professional (Pfefferbaum & North, 2020).  
  • People can be encouraged to limit their consumption of news related to COVID-19 to once a day and to focus solely on credible news sources. 
  • Having social interactions with family and friends and offering to help support one another during this difficult period can also be particularly beneficial.
  • Being outdoors and exercising are good habits for maintaining healthy wellbeing. 

As restrictions are slowly easing around the world, it can also be challenging for most people to adjust back to when restrictions were first introduced (during lockdowns). With new changes and uncertainty, being mindful of one’s mental health and well-being is crucial. For example, larger social gatherings (e.g. group of 10) may seem overwhelming at first, therefore it is important for people to recognise their anxiety levels related to social gatherings. 

Here are some suggestions that might help regulate your emotions as you enter this new season of Singapore opening up amidst the COVID-19 Pandemic (Black Dog Institute, 2022):

  • Gradually, increase your time spent in a larger social gathering at your own pace. 
  • You can also start to focus on things that are within your ability and control. For instance, you can engage in different relaxation techniques such as deep breathing and focusing on being in the present in order to better cope with your stress levels (American Psychological Association, 2021). 
  • it can be useful to discuss reasonable adjustments back to work with your managers such as flexible working arrangements and other training opportunities in order to increase work efficacy 
  • Seek professional help if there are concerns regarding stress levels related to the easing of restrictions.

It is particularly evident that the COVID-19 pandemic has taken a toll on the well-being of Singaporeans and the rest of the world. The pandemic has highlighted the importance of mental health and wellbeing and there is an urgent call for countries worldwide to provide people with mental health and psychosocial support to help them maintain psychological wellness.

Some Local Helplines and support:

Additionally, you could make an appointment to speak with one of our mental health professionals (a psychologist or counsellor) should you require counselling support.


References 

Black Dog Institute (2022). Coping with anxiety about COVID-19 restrictions easing.  https://www.blackdoginstitute.org.au/news/coping-with-anxiety-about-covid-19-restrictions-easing/

Brydon, A., Bhar, S., Doyle, C., Batchelor, F., Lovelock, H., Almond, H., Mitchell, L., Nedeljkovic, M., Savvas, S., & Wuthrich, V. (2022). National Survey on the Impact of COVID-19 on the Mental Health of Australian Residential Aged Care Residents and Staff. Clinical Gerontologist, 45(1), 58-70. https://doi.org/10.1080/07317115.2021.1985671 

Ministry of Health Singapore (2020). COVID-19 Mental Wellness Taskforce Report.  https://www.moh.gov.sg/docs/librariesprovider5/covid-19-report/comwt-report.pdf

Nochaiwong, S., Ruengorn, C., Thavorn, K., Hutton, B., Awiphan, R., Phosuya, C., Ruanta, Y., Wongpakaran, N., & Wongpakaran, T. (2021). Global prevalence of mental health issues among the general population during the coronavirus disease-2019 pandemic: a systematic review and meta-analysis. Scientific Reports, 11(1), 10173. https://doi.org/10.1038/s41598-021-89700-8

Pfefferbaum, B., & North, C.S. (2020). Mental health and the Covid-19 pandemic. The New England Journal of Medicine, 383:510-512, 291-299. https://doi.org/10.1056/NEJMp2008017

World Health Organization (2022, March 12) COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide

Photo by Markus Winkler on Unsplash 

Confinement (Circuit Breaker) Emergence and Mental Health: Be Kind To Yourself

Confinement (Circuit Breaker) Emergence and Mental Health: Be Kind To Yourself

Written by: Andrew da Roza, Psychotherapist, Promises Healthcare

As the COVID-19 confinement continues, you may have a nagging question on your mind – “what have I managed to achieve”?

Tidy, clean desk draws, closets, and glove compartments; a surprising proficiency in a new language; the final 100 pages of War and Peace; an impressive yoga position; a dazzling new magic trick?

Several weeks into the confinement in Singapore and with several weeks to go before we can be physically social with our friends, some of us may be deflated. 

When the confinement/circuit breaker started, we may have vowed to use all the new free time to do things we have never got around to doing. 

Now that time is gradually slipping by – we may think that we still haven’t accomplished our goals.

As a psychotherapist, I listen to many people starting to stress that this opportunity of more time isn’t panning out the way they imagined – and that critical voice in their heads is telling them they are inadequate and unworthy.

Feeling Stuck in Shame 

What I hear is the frustration of “stuckness.”   

Clients tell me: –

  • I must be more productive 
  • I should have achieved more since confinement began
  • I should be able to concentrate more and procrastinate less
  • I must have more enthusiasm, motivation and energy

Note the use of the words “should” and “must”. Our inner critic loves to remind us of all the things we should have done or must do.  

It is important to be compassionate to ourselves and banish these words from our vocabulary – at least for the time being.

We may have overestimated what we could achieve in confinement; and underestimated the power of the inner critic, worry and low mood. These are preventing us from feeling satisfied with what is. 

Perhaps we had the fond notion that confinement would be like a holiday – more rest, more family time, novel and interesting things to do, and relief from work and the other routines in life.

Reality may now be striking home. Anxiety about our jobs, income, and savings; fear about us and our loved ones contracting the virus; worry that food, masks, and other resources may be scarce; boredom at a routine in the cramped confines of home; the resurrection or development of old family dynamics, fraught with irritations, frustrations, disappointment, mistrust and anger. For some, isolation and loneliness may be an even more crushing weight.             

Reframing our Expectations

What will help is kindness – and, in particular, kindness to ourselves. 

Perhaps some of us are high achievers, driven by: concrete stretch goals, targets and objectives; KPIs; reports; numbers; test or exam scores. 

But COVID-19 confinement is not the time to measure yourself in this way. It’s like drinking soup with chopsticks – frustrating.

I recommend that we redefine productivity and measure our day by whether:

  • we have achieved an emotional connection with ourselves and others, 
  • ate healthily, 
  • slept well, 
  • got some exercise, 
  • meditated for a few minutes, 
  • did some yoga or Tai Chi, 
  • walked outside, 
  • read something (other than COVID-19 news or social media content); 
  • did something creative, like photography, videos, painting, made some music, baked something new; and 
  • spent “me time” – just sitting quietly, relaxing and enjoying being in the moment. 

 

This confinement is not a competition – so we do not need to compare ourselves against others. 

We must permit ourselves some numbing out to Netflix and videos – and not beat ourselves up if we eat some chocolate, cookies or chips. 

Let’s also be realistic and recognise that our routines will be different – and that we won’t accomplish the same things in confinement. We will have accomplished things – but they just won’t be the usual things.

Manage your expectations, be gentle with yourself and kind to others – and you will find that there is meaning and purpose to your confinement.   

 


Photo by Paolo Bendandi on Unsplash

Youth Depression in times of COVID19 Pandemic: How Can We Help?

Youth Depression in times of COVID19 Pandemic: How Can We Help?

Youths these days have a lot on their plate. Teenagers have to cope with the highly competitive education system, and the fresh graduates are worried about employment opportunities or career advancement. Coupled with the need to maintain good relationships with their friends and family, these individuals may be experiencing high levels of stress. Some people do thrive well under stress, but what happens when stress levels exceed the healthy range? For those who are unable to cope, chances are their mental wellbeing would take a toll.  

 

With young people unable to attend school in person regularly or go into the workplace during the circuit breaker, they might have felt increasingly isolated due to the lack of face-to-face social interaction over this extended period of time. Furthermore, having to fight for their own space while at home with their family members may have caused some conflict and frustration for some. Undoubtedly, cabin fever may have also kicked in for some of them. Although circuit breaker measures have recently been eased, youths may not be able to adjust back to the norms as easily as one might expect. Reports have shown that it is expected that more youths will be prone to developing mental health issues such as depression due to the various implemented COVID 19 pandemic coping measures. 

 

Depression is one of the world’s leading mental health disorders, and youths have become increasingly prone to it. Studies have shown that depression affects up to 18% of Singaporean youths. People with depression may turn to self-harm or experience thoughts of suicide. These are often methods they adopt in order to cope with their difficult emotions. According to the suicide prevention agency Samaritans of Singapore (SOS), suicide remains the leading cause of death among youths aged 10 to 29 in Singapore, and as of 2018, 94 of them had succumbed to suicide. In order to curb the rise of depression cases among youths, it is important that we are able to identify the early stages of depression. Doing so will allow them to seek treatment earlier and to help them get back onto their feet. Depression, if left untreated, will severely impact people’s lives in a negative light, causing personal, educational and familial difficulties. 

 

Here are some of the most common symptoms of depression that you should look out for (not exhaustive): 

 

  • Extreme sadness and low mood
  • Lack of interest in activities once enjoyed
  • Lack of self-worth
  • Increased lethargy
  • Experiences sleep disturbances and loss of appetite
  • Poor concentration and impaired memory
  • Sense of hopelessness and helplessness
  • Excessive self-criticism and self-blame

 

If you notice a friend or family member of yours showing such symptoms for long periods of time, perhaps it is time to seek help from a professional mental health expert. 

 

But how can we first better support troubled youths? When it comes to dealing with depression, individuals with mild depressive conditions could adopt self-help strategies such as trying to maintain a balanced diet, to pick up on relaxation techniques, embark on daily gratitude journaling exercises (e.g. 3 things I can be thankful for today) and get some exercise in, even if it’s just a stroll around the estate or exercises from ATHLEAN-X™ or Athlean-XX for Women. Try encouraging them to live a healthy lifestyle and maybe create a ‘Daily Wellness Plan’ – a list of little and big things they can accomplish on a daily basis to comfort and keep their moods up. However, it is key to take note that even though their depression may be perceived to be mild from a third person’s point of view, we should never make assumptions as to what they truly feel on the inside. We should never, under any circumstance, tell them to “snap out of it”. It is very important for us to be patient and listen to what they have to say if they do approach and confide in you. Stay empathetic and show your concern for the individual. Acknowledge and respect their feelings and worries. Listen actively by using active listening skills. Encourage them to join mental health support groups like those conducted by PSALTCare – journeying with others that are going through similar struggles can encourage social healing.

 

On the other hand, for those coping with moderate to severe conditions, we might need to encourage them to seek a multidisciplinary approach to recovery like psychiatric help and look to taking medications, with supporting psychotherapy or counselling sessions and support groups. They might also be afraid of the stigma attached to seeing a Psychiatrist or what would transpire in that session. Try to assure them that there is nothing to be ashamed of. In fact, it is a lot more common in Singapore now, and a trip to the Psychiatrist is as straightforward as seeing your family doctor.  Alternatively, these youths can book appointments for psychotherapy first. With appropriate treatment and support, it is entirely possible for them to move on and lead a more productive and happier life. Here’s a questionnaire that is widely used by Psychiatrists to help determine depression to help you with next steps decisions: www.mdcalc.com/phq-9-patient-health-questionnaire-9

 

If you or anyone you know are struggling and are unable to cope with the post-lockdown blues, we strongly encourage you to get professional help.  Do not hesitate to contact us when necessary. 

 


 

References:

  1. Teen Mental Health: Depression (Accessed 22/05) 
  2. CNA: Under pressure at home and in school, youths battle depression (Accessed 22/05)
  3. Photo by Yuris Alhumaydy on Unsplash