PTSD and Covid-19: How to manage and minimise trauma responses to the coronavirus pandemic

In the latest episode of Covid Matters, we spoke to Professor Neil Greenberg, an academic, occupational, and forensic psychiatrist, and Professor of Defence Mental Health at King's College London. Neil is an expert in understanding how trauma affects people, particularly those working in the military and emergency services, after serving 23 years in the British Navy as a general doctor and psychiatrist. During the Covid-19 pandemic, Neil was part of Public Health England’s expert reference panel and led a team of professionals on the provision of mental health support for the London Nightingale Hospital.

We invited Neil onto the podcast to find out more about what individuals and organisations can do to protect the mental health of people exposed to traumatic situations – such as the coronavirus outbreak – and in turn, how we can minimise the impact they have on our wellbeing.

PTSD is an anxiety condition in which intense negative emotions, thoughts and memories caused by a traumatic event, persist and interfere with someone's daily life. Yet most people who are exposed to traumatic or stressful situations are unlikely to develop PTSD. “They have a non-pathological, completely ordinary distress response,” Neil says, “They can't sleep, they think about the event, they're a bit jumpy - but gradually that gets better by itself.”

The coronavirus outbreak, however, saw a rise in the number of people being exposed to traumatic situations in their everyday lives: daily death tolls were broadcast on the news, hospitals struggled with the increasing demand for beds in Intensive Care Units, and families were left unable to say goodbye to loved ones in their final moments. Meanwhile, the world tried to understand how to contain a virus with little knowledge of how it was spreading and without vaccines to offer protection.

Groups most likely affected

Neil identifies the following groups as being at an increased risk of suffering with PTSD because of the pandemic:

• Emergency service workers including health and social care workers: These people have been directly involved in dealing with the pandemic response and seeing the enormity of death and despair brought by the virus. Neil says, “If you're in a healthcare setting, and you work in intensive care, you unfortunately expect to see people who are going to be very ill and die. That's part of the job. But not on the scale that's gone on over the last few years, and not with the restrictions that prevented you from doing the job you want to do.”

• The general population: The pandemic exposed us to situations of trauma and despair which would ordinarily be distressing but which are even more so because of the Covid restrictions. For example, if a family member caught Covid, we were unable to be with them because of limitations on visiting hospitals, care homes or mixing households.

• Covid patients: People who caught severe forms of Covid and needed oxygen or intensive care may have worried that they would die. In fact, research has found a connection between the severity of Covid and the likelihood of suffering PTSD. Neil explains, “It's not surprising that the more ill you were, the more likely you are to have PTSD symptoms.”

• Vulnerable people: Those with pre-existing mental health issues or people more prone to stress may develop PTSD due to an increased exposure to distressing news and images on TV.

So, what can we do to protect the mental health of these individuals and minimise the toll of the pandemic on their lives?

Tackling stigma

The stigma against accessing support is a common hurdle in the management of mental health care. But tackling this stigma is key to minimising the lasting impact of mental health struggles in our lives. Neil says,

People also struggle on with their poor mental health after comparing their situation to others. Some talk themselves out of support, believing that someone else is worse off and therefore more deserving of help. Others see peers who have been able to recover quickly without professional help as a sign that they can do the same.

These barriers are often what hold us back from getting the treatment we need. A study called the Adult Psychiatric Morbidity Study conducted in England in 2007 found that only one in four people who had mental health problems were getting help. When the study was revisited in 2014, the number had risen to one in three. While this increase in numbers means we are moving in the right direction towards accessing mental health support, it also means that a majority of people are not receiving help. “The most common outcome, unfortunately, for people who develop mental health problems is that they struggle on with them. And at some point, they may reach a crisis point – they may get done for drunk driving or make a critical mistake at work – and that's when they seek help.”

Signs to look out for

Persistent, negative changes are what to look out for in yourself or others if you are worried about poor mental health and PTSD. Neil says, “It’s persistent negative changes over weeks and months, with a lack of positive futures and a lack of positive thoughts.” Some other red flags to be aware of:

• Changes in sleeping pattern unexplained by external noise or other distractions

• Changes in behaviour or temperament

• Concern from other people asking, “are you ok?”

• Lack of concentration

• Inability to complete previously simple tasks

“In all these cases,” Neil says, “when you don't know if you've got a problem or not, that's when it's a good thing to talk to someone you trust.”

Early intervention and support is essential

Providing mental health support at the earliest opportunity is the solution. This helps to stop the individual from reaching a crisis point in which their trauma has developed and is causing further harm or distress. “The real challenge here for society,” Neil says, “Is how do you get people upstream? Because if we could support them at a point when things weren't so serious, the solutions would be much simpler. And may prevent the downward spiral from happening.”

The Royal College of Psychiatrists has a range of online resources on PTSD and mental health issues to help sufferers and their families better understand their condition. “What the resources aim to do is try and help you identify what's okay, what you can do to help look after yourself and others, and when to seek help. They paint a realistic picture of PTSD as a mental health problem which can be serious, but the good news is there are treatments out there that can make a difference.”

How can families help?

Research shows that loved ones and family members play a vital role in directing someone dealing with PTSD or another mental health issue towards the professional help they need. A US study by the American Psychological Association on interventions, known as CRAFT (Community Reinforcement and Family Training), demonstrates this with families whose loved one had a drug or alcohol problem. Healthcare professionals provided these families with communication skills and techniques to help move their loved one towards getting help. The study was later replicated with people suffering from PTSD. Researchers provided the same communication skills to the Concerned Significant Others (CSO) of military veterans dealing with PTSD to help them access professional support. The outcomes successfully showed that when a distressed individual seeks help, the whole family benefits. Neil says, “it's a really useful way of trying to give the loved one the skills to pick the right moment, and to have ways of not just nagging or shouting, but trying to motivate them, with the outcome being that they get help.” UK military charity, Help For Heroes, have since adopted these methods.

Neil shares his tips on when to broach the topic with a loved one:

Active coping

The best advice to help manage and minimise the traumatic impact of any situation, including the Covid-19 pandemic, is to seek help. “If you think you have a mental health problem, whether it's PTSD or another mental health difficulty, don’t just sit around and hope it will all get better.” Instead, Neil suggests engaging with active coping to help gradually improve your situation. There are a variety of resources on the RCP website and the NHS Every Mind Matters website which contain evidence-based tips and interventions that you can do that will make a difference. ”If you’ve tried that, do try to get some help early on – speak to someone you trust and although it might seem like an upward struggle to get professional help, the sooner you get it the better. You may not need much to get yourself back on track, so don’t just sit around and cross your fingers to hope things get better.”

• Professor Neil Greenberg is an academic, occupational and forensic psychiatrist, and Professor of Defence Mental Health at King's College London. He is also an advisor to the Academic Department of Military Mental Health and the Managing Director of March on Stress , a psychological health consultancy.

• Listen to the full episode of Covid Matters wherever you listen to podcasts.