COVID-19 and Youth Depression
In December 2019 the infection of SARS-Cov-2 , transmitted from bats and pangolins to man in Wuhan, China, was accounting for sickness. This illness had presented with fever and cough and then after 7-21 days with a severe illness affecting the lungs and breathing characterised by the cytokine storm, in which the body's response to inflammation causes a sudden, further decline in the patient's condition. The first patient died in Wuhan on 07.01.2020, the disease spread across the Far East and a new foci for spread of the Coronavirus were established in New York and Western Europe, and by March 2020 the World Health Organisation declared COVID-19 as a global pandemic.The World Health Organisation has been clear about how governments of different countries need to co-operate in the fight against the disease. Countries needed to lock down, trace the contacts with the disease as far as possible and offer as much testing for the presence of the virus as possible. The data from each country about cases and deaths is variable. Overall the death rate is low (under 3%) affecting the elderly and those with predisposing respiratory disease, obesity, diabetes melitus and hypertension more severely.
I am a Child Psychiatrist and not an expert on Infectious Diseases. I have been thinking alot about how to help young people with depression who are currently in isolation and need support. In our work, we have been having phone or video conferences with young people. In this setting it is challenging to develop the rapport. The use of video can be engaging but always as some young people prefer to see you and not be seen. If we can develop a good rapport and have a memorable meeting then we can get to the second session. There will be instances of needing to do blood tests and assessment of physical state especially if a young person has been losing weight in depression and may have addtional symptoms of an eating disorder. In the UK we are sending these patients to the General Practitioner in the first instance, because the Paediatric Service in the hopsitals is focussing more on the needs of acute patients and patient with COVID-19.
Consequently Sertraline or Fluoxetine have been initiated and other team members have been trying to to online engagement and Cognitive Behaviour Therapy. It may be harder to assess the risk of harm to self or others via an online consultation, although it can be possible to ask a young person about the extent of depression and suicidal thinking in detail. It is good to reflect back and check in with a young person by summarising your understanding of their situation. This gives young people the opportunity to correct your views and to feel heard and understood more deeply. Patients who present as more risky in terms of suicide need more frequent telephone or video calls. However there will be a need to see them face to face if the clinical picture is very severe and heading towards consideration of admission to an adolescent unit, where some patients are very likely to have COVID-19. Therefore there is a need to practice normally in this context and make adjustments for the Coronavirus pandemic in the best way that is safest for young people.
Broadly speaking we need to
1. ENGAGE YOUNG PEOPLE IN CONVERSATION ON LINE
2. PRESCRIBE SOONER
3. HELP A YOUNG PERSON ACCESS ONLINE THERAPY AND REVIEW IMMEDIATELY
4. CONSIDER SAFEGUARDING ISSUES IN THE USUAL WAY AND REFER TO SOCIAL SERVICES IF REQUIRED
5. REVIEW AND PLAN FACE TO FACE ASSESSMENT IN CLINIC, PRIOR TO DISCUSSION OF ADMISSION WITH THE INPATIENT UNIT.
Over the next few blogs I will go into more details in these areas. It would be good to hear about your experiences of management in Youth Mental Heatlh during the Coronavirus pandemic.