Thread by @KGuilaine, I’ve encouraged you to think about wellbeing & self-care. And was frustrated [...]

I’ve encouraged you to think about wellbeing & self-care. And was frustrated we were not talking enough about the impact of social isolation on mental health. But...we also need to think about how mental heath ‘issues’ may make some of us more at risk of #covid19
A short thread. https://twitter.com/KGuilaine/status/1242744078007230465">https://twitter.com/KGuilaine...

https://twitter.com/KGuilaine/status/1242744078007230465

Firstly, I do not espouse the medical model when it comes to psychological distress. That is to say I tend to think of so called psychological problems as natural and understandable responses to toxic, harmful of traumatic experiences or circumstances. Still...

It may be helpful to consider the particular risks those experiencing psychological distress, ‘problems’ in this pandemic, may face.

There is no clear distinction between physical health and mental health. This & #39;mind& #39; and & #39;body& #39; dualist nonsense continues to permeate our thinking. The reality is 1) anything psychological also has physical manifestations & vice versa.

2) Poor physical health will often lead to increased risks of poor psychological health. In the same way poor psychological health will negatively affect physical health. Nothing controversial here. There is only one health.

Hence...ppl with more ‘serious’ mental health or psychological ‘problems’ tend to have shorter life expectancies. For various reasons of course.

Anyway, folks to come back to #covid19, I am sure there is an an increased risk of social isolation on balance on ppl who already experience psychological distress, but I think there may also be an increase risk on #covid19 contraction.

And, if contracted, possibly higher risks of more serious presentation/higher burden from the virus.

Let’s be clear am not making any truth claim & do not want to alarm, we don’t know for certain...I am only making hypotheses based on what we know from the empirical literature

Depression we know has been found to increase risk for and to worsen a wide range of physical illnesses or conditions. In particular, certain infections. Recovery from many illnesses can also be slower when depression is a factor.

Part of the reason is behavioural (of course) so for example ppl low in mood or who feel helpless may be less likely to follow treatment plans & be less motivated to take the actions required to improve their health when ill.

They may also be less motivated to take heath protective measures or to practice self-care. In fact may actively become self-destructive.

Part of the puzzle is also physiological. And this really the point I wanted to make. Depression has long been linked to markers* of immune system suppression & compromisation.

Now, we’re not clear of the direction. Do depression cause immune issues or do immune issues cause depression. Both have been argued. I think the relationship is likely bi-directional. It’s not 100% clear as I understand.

A recurrent contemporary hypothesis is that chronic stress initiates neuro changes in the hypothalamic-pituitary-adrenal axis which affect the immune system, which then triggers anxiety and depression.

Anyway, if we know that ppl with depression (and anxiety, and likely* other mental heath struggles, although depression has been the most studied when it comes to health consequences/correlates) are vulnerable/prone* to...

1) Immuno deficiencies & suppression
2) Getting certain infections
3) less likely to respond as speedily to treatment when compared to control in other conditions
4) low motivation to get better
5) Low adherence to treatment/health protective measures...

Then I think we can hypothesise that ppl who experience depression and likely other psychological distress are likely to be at higher risk of #COVID19 contraction & if contracted of complication. All things being equal (if that’s ever possible).

That is my thinking. Now the point of this is not to scare but hopefully to help all of us think about necessary support & safeguards and preparation and I would argue consider ppl with mental health problems as a vulnerable group in this pandemic.

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