“I’ll tell you an interesting story,” says Nasser BinDhim. “We have a mental health assessment tool on our website and one day, in April 2020, our servers went down. When I looked into it, I found a flood of people trying to access the tool – on average 10,000 per second.” BinDhim, an accomplished researcher and business leader, was witnessing the intense focus on mental health driven by the coronavirus pandemic. 

Now entering its third year, COVID-19 continues to sweep the planet. The pandemic’s psychological toll became apparent shortly after its devastating physical effects. Many found themselves beset by fear of serious illness, compounded by sudden and long-lasting periods of government-enforced social isolation.

This stark threat to mental wellbeing is driving scientists to investigate the impact of the pandemic on mental health more broadly. Following the deluge of interest in their online assessment, BinDhim and a Saudi research team set out to create a national mental health surveillance system – one of the first of its kind in Saudi Arabia. With ongoing funding from the Sharik Association for Health Research, which BinDhim founded in 2015, he and his team of volunteer scientists now conduct regular phone and app-based mental health interviews across Saudi Arabia, feeding the data to a dashboard hosted by the country’s National Center for Mental Health Promotion.

Between May and August 2020, BinDhim and his team conducted monthly interviews via a random phone list, canvassing the thoughts and feelings of more than 16,000 adults in Saudi Arabia. They found that participants had a “relatively high” risk of developing major depressive disorder (MDD) and generalized anxiety disorder (GAD)¹. When they compared their findings with data from a national study conducted in 2018, they found the risk of depression in Saudi Arabia had increased by 71.2%. In a related research project, BinDhim and his team also found a correlation between vaccination status and mental health severity — fully vaccinated people had less anxiety, depression, and insomnia than those who had received only one vaccine dose, who in turn had less adverse mental health than unvaccinated people.

Caring for healthcare

It is vital to also consider the needs of healthcare providers. Frontline healthcare is a notoriously high-stress profession, and this has been exacerbated by the pandemic. Khizra Sultana, a clinical research coordinator at KAIMRC, and a team from Saudi Arabia and India investigated the impact of COVID-19 and lockdowns on healthcare workers within the Kingdom.

“Our main aim was to protect the mental health of our healthcare workers,” says Sultana. She remembers how, during the outbreak of MERS, 75% of respondents to one study reported suffering from psychological problems. However, after a survey of healthcare workers in 2020 across the Kingdom, the team found relatively low levels of adverse mental health amongst respondents². Approximately 77% of their 1,130 participants exhibited a level of depression from ‘normal to mild.’ A similar percentage experienced ‘minimal to mild’ anxiety, and approx. 86% experienced “absence to subthreshold” levels of insomnia.

These results were initially quite surprising to Sultana, who expected less positive findings. However, as corroborating studies around the globe were published, including from China and Italy during the height of their infections, the team proposed explanations of how healthcare workers are coping so well.

One theory is preparedness. Sultana says that lessons were definitely learned in Saudi Arabia from the MERS outbreak. When COVID-19 hit the country, the government and healthcare organizations made swift decisions that saved lives and protected the wellbeing of the population. This included access to PPE, vaccinations, and psychological services for healthcare workers.

Sultana also suggests that despite the bleak context, coronavirus lockdowns can offer a silver lining in the form of greater time with family. While this is anecdotal, formal research is being conducted into the prevalence of coping strategies and their importance.

Syed Sameer Aga, from King Saud bin Abdulaziz University for Health Sciences, led a Saudi-Indian research team that studied global mental health and coping strategies among the general population in the age of COVID-19³. They revealed a less optimistic picture than Sultana’s investigation into healthcare workers, with a “significant level of depression and anxiety” in their participants. Aga and his team identified a range of coping strategies people use to try to maintain their wellbeing, including watching TV, social networking, spending time with family, cooking, sleeping, and listening to music.

These findings highlight the importance of widespread provision of psychological services to offset the stressors of these unusual times. COVID-19 has elevated the concept of mental health out of the shadows, and put it at the forefront of many peoples’ minds. There’s a clear consensus amongst researchers that mental health support needs to be a priority. Logistically, however, these services have obstacles, as social distancing forces healthcare providers to offer services remotely. Future research will explore the impact of mental health support on those afflicted by COVID-19, providing data to inform governmental and healthcare bodies on how to effectively fight the wide-ranging impacts of the disease.

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