Why do many long-term COVID patients have suicidal thoughts?

OFFERone year, Diana Berrent — founder of the Survivor Corps, one Long COVID support group — asked group members if they had ever had suicidal thoughts since developing Long COVID. About 18% of those who responded said they did, a figure much higher than 4% of the general adult population of the United States have had recent suicidal thoughts.

A few weeks ago, Berrent asked the same question to current members of her team. This time, of the nearly 200 people who responded, 45% said they had attempted suicide.

While her poll was small and informal, the results pointed to a serious problem. “People are suffering in a way that I don’t think the public understands,” says Berrent. “People are not only mourning the life they thought they were going to have, they’re also grieving with no answers.”

Prolonged COVID, a chronic condition affecting millions of Americans who have had COVID-19, is not usually the same as acute COVID-19. Researchers report more than 200 symptoms that affect nearly every part of the body, including the nervous, cardiovascular, respiratory and digestive systems. The condition is serious, but many so-called “long-term illnesses” are can’t workto school, or leave their home in any consistent manner.

The long-term COVID and mental health statistics are remarkable. One report published year Electronic medicine last year showed that about 88% of Long COVID-19 patients experienced some sort of mood or emotional problem during the first seven months of illness. Another studypublished year Department of Psychiatry BMC in April, found that people with post-COVID conditions were twice as likely to develop mental health problems including depression, anxiety or post-traumatic stress disorder than those with don’t get them. COVID-19 survivors are also nearly 50 percent more likely to have suicidal thoughts than those who don’t have the virus, according to a new study. research published in February in BMJ.

Discover the connection between the body and brain of Long COVID

Exploring the link between Long COVID, suicide, and mental health problems is more complex than imagined. Experts say: While some people develop depression, anxiety or other mental health problems after being diagnosed, others are suffering from physical symptoms that have a psychological side effect. or confused with mental health problems, experts say.

The virus that causes COVID-19 has well-documented effects on the brain, potentially leading to psychiatry and neurology Wes Ely, who treats long-term COVID patients at Vanderbilt University Medical Center, said the symptoms. “We collected the brains of several patients who did not survive long-term COVID,” he said. “We’re seeing ongoing inflammation and cellular abnormalities in these brains.”

Those changes to the brain can have profound effects, may include suicidal thoughts and behavior. “There is a high probability that symptoms of mental, neurological, and physical illness, as well as inflammatory brain lesions in people with post-COVID syndrome, increase suicidal ideation and behavior in this group of patients, “read January 2021” article In QJM: International Medical Journal. Research published as a pre-print last year (meaning it has not been peer-reviewed) also found differences between “post-COVID depression” and typical depression, including rates of suicidal behavior higher — suggesting “a different disease process in at least a small group of individuals. ”

Long COVID can also be extremely painful and research shows link Chronic physical pain to increased risk of suicide. Nick Güthe used to try to spread that message since his wife, Heidi Ferrer, died by suicide in 2021 after living with COVID symptoms lasting for about a year. Güthe said that among her most bothersome symptoms were leg pain that prevented her from walking comfortably, tremors and a fluttering sensation in her chest that kept her from sleeping. More than 40% of persistent COVID patients have moderate to severe sleep disturbances, According to recent researchand Insomnia has been linked to suicidal thoughts and behavior.

“My wife did not commit suicide out of depression,” Güthe said. “She committed suicide because she was in extreme physical pain.”

Since speaking out about his wife’s death, Güthe has received word from many families with similar experiences. Lately, he says, he’s noticed an unfortunate change. “I have been contacted by people who have committed suicide on social media,” he said. “Now I get reports of suicides. I had three in the last week. ”

During that time, there has been little visible progress for long-term addicts. Doctor is still I don’t understand much about the condition and how to treat it. “Now you have people who have suffered from Long COVID for almost two years,” says Güthe.

Part of the problem is that in the US, illness is often thought of as physical or mental, but not both, says Abigail Hardin, assistant professor of psychiatry and behavioral sciences at Rush University, who works with critically ill patients, including those with long-term COVID. . “Actually, all of this is very two-way,” she said. “Everything is integrated.”

In part because health systems often fail to accommodate that complexity, many chronically ill patients are misdiagnosed or mislabeled that do not capture the full reality of their condition.

Myalgic encephalomyelitis/chronic fatigue syndrome, a post-viral condition Similar to Long COVID is an example of how many long reviewers meet its diagnostic criteria. Decades ago, widely and incorrectly believed by doctors that a patient’s symptoms – including extreme fatigue, often aggravated by physical activity – are all in their heads. Even today, ME/CFS patients – as well as those with similar conditions, like chronic Lyme disease and fibromyalgia — often misdiagnosed with mental health problems because providers don’t understand their condition. Suicide is also disproportionately common among people with ME/CFS, from research.

Adriane Tillman, who has had ME/CFS for a decade and works with the #MEAction advocacy group, remembers trying to get doctors to understand the extent of her physical symptoms, which initially caused She was bedridden – only to be diagnosed with depression.

While Tillman grieves for the life she led before her illness, she says it was too simple to reduce her debilitating condition to depression. “I just thought, okay, I don’t explain this enough,” she said. “I brought my husband [with me to the doctor]. I brought my father. I brought a Powerpoint presentation”. However, the best she got was an increased dose of her antidepressant.

Many long-term COVID patients report similar experiences. Teia Pearson has faced distrust from doctors and loved ones after developing Long COVID following a case of COVID-19 in March 2020. “Doctors call you crazy. Your family and friends are… treating you like you’re crazy. That really messes with your head,” she said.

Jaime Seltzer, director of medical and scientific outreach at #MEAction, says mental health research needs to better explain the reality of chronic illness. For example, many questionnaires examining depression ask whether individuals try to get out of bed in the morning, but fail to distinguish between feelings of inability to get up and feelings of being unable to get up. “Until we have a depression scale and an anxiety scale for people with physical disabilities… people with physical disabilities will continue to be misinterpreted as depression or anxiety even when they are depressed,” says Seltzer. They’re not like that.”

Need a solution

Berrent says there is an immediate need for a dedicated suicide hotline for people with long-term COVID, as operators at other services may be unaware or unaware of the condition. She said: “Further research on a long-term treatment for COVID will also go a long way, as it will give people hope as well as relief from their often devastating symptoms.

Marissa Wardach, ex-husband John who died by suicide in March after developing Long COVID last summer, wished there were more options available to him. When he talked to the doctors, she said, “they just shrugged and said, ‘Sorry, we really don’t know much about it,'” she recalls. any kind of hope of his.”

Wardach wondered how things might have turned out if clinicians had referred John to specialist treatment centers or patient support groups, instead of sending him in. But even if the patient is connected to relatively few Long COVID treatment centers exist, they often face months-long waits for an appointment. “Long-term COVID patients feel left out, in many cases,” says Ely. “There is too much [parts of] The country does not have a Long COVID clinic. “

Emerging evidence about what seems to work for patients is also not always widely shared among doctors. For example, Güthe learned from a doctor a few months after his wife’s death that a drug called trazodone might have helped her sleep despite the palpitations – something her own doctors did not mention. arrive. “Every general practitioner in the United States should update basic guidelines to help patients with Long COVID cope with key symptoms,” he said.

Seltzer said that all doctors and mental health professionals also need a better understanding of what will – or won’t – help people with Long COVID and other similar chronic illnesses. Approaches like cognitive behavioral therapy, which focus on changing thought patterns, are often not helpful for patients with actual physical symptoms, she says. “Doctors need to know that this is a problem, and they don’t have to dismiss it,” Seltzer said. They need to “not attribute it to stress, and therefore place the responsibility on the patient to calm down, and not attribute it to an incorrect way of thinking.”

Hardin says these shortcomings point to structural problems in the US health system. Ideally, physical and psychological care would not be considered differentiated, and the patient could receive an overall assessment from any provider. At the very least, she wants every person diagnosed with a chronic illness to have a mental health professional on their care team from the outset. However, she said, that’s less common than usual.

“A lot of what we are seeing with COVID and its consequences has nothing to do with individual service providers,” she said. “A lot of it is very structured. This is an opportunity for this country to grow and fix some of the systemic problems that American medicine has had.”

If you or someone you know may be contemplating suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text HOME at 741741 to contact Crisis Text Line. In an emergency, call 911, or seek care from your local hospital or mental health provider.

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