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Stress-related disorders, including the impact of the pandemic
The term ‘stress’ has entered everyday language and is used in many situations, sometimes to describe a behaviour or event which was caused by stress, without much consideration what stress really means.
The framework of this article does not make it possible to provide definitions of the most common concepts of stress. Interested readers may refer to other studies [e.g. 1, 2]. However, it should be remembered that not only the objective characteristics of a given situation are important, but above all the subjective assessment of one’s ability to cope with it or such qualities of an individual as, for example, resilience [3].
In the context of mental health, a group of stress-related disorders has been explicitly identified and defined as ‘severe stress reaction and adjustment disorders’ according to the terminology of the International Statistical Classification of Diseases and Health Problems ICD-10 developed by the World Health Organisation (WHO). As the name suggests, the causal relationship between symptoms and the experience of an extremely stressful situation or a significant change in life circumstances is emphasised here. For the purpose of this article, the description of the disorders provided below takes into account their most important features, with the exception of the grounds for exclusion or other specificity, which remain at the discretion of the diagnosing professional.
The sudden experience of significant physical or psychological stress (experienced or observed by oneself), e.g. an accident, natural disaster or the death of a close friend, may lead to a transient disorder of considerable severity called an acute stress reaction.
Initially, there occurs a state of shock and disorientation, which later transforms into a variety of emotional reactions such as anger, despair or fear accompanied by physical symptoms (e.g. rapid heartbeat). Such a condition may continue for a period lasting from a few hours to about 3 days.
The reaction to significant stress may also be delayed or prolonged when symptoms develop within six months following the event. PTSD, or post-traumatic stress disorder, may sound familiar to fans of popular movies (e.g. The Deer Hunter) or war-themed books (e.g. American Sniper). PTSD symptoms include persistent vivid memories or dreams related to the stressful situation (flashbacks), avoidance of situations reminiscent of or related to the stress experienced, partial or complete oblivion of the situation, sleep disturbances, irritability, outbursts of anger, difficulty concentrating, hypervigilance and reactions to unexpected environmental stimuli (e.g. shielding oneself at the sound of an ambulance). People with PTSD often experience anxiety, depression or addiction disorders (alcohol, medication).
An adjustment disorder may occur during the first month of adapting yourself to significant life changes or changes resulting from a stressful event. It may be triggered by psychosocial circumstances (e.g. a serious illness or migration) which do not need to be “unusually” severe. Symptoms include feelings of inability to adapt, reduced effectiveness of coping with daily functioning, worry, anxiety, lowered mood, tension, anger. Usually, they do not last longer than six months. In terms of an academic experience, a situation which may potentially trigger an adjustment disorder is a scholarship or internship in a country with a radically different culture.
The relationship between stress and mental health becomes particularly relevant in the context of the current COVID-19 pandemic. The idea of writing this article arose six months after the pandemic announcement by the WHO. During that time we somehow managed to get used to it, and even forget about the risk or question it. The need to confront the second wave announced by specialists came as a shock to us. In many countries, the number of people who fell ill and went into quarantine increased rapidly, and new recommendations, restrictions and even legal changes related to the situation were introduced from day to day. The situation was dynamic causing a string of uncertainties. They involved not only such issues as the expected duration of the pandemic or the timing of the vaccine introduction, but also things that had to do with everyday life ranging from the ability to plan trips freely, participation in various events to functioning at work, school or university. Not without significance was the impact of the pandemic on the state of the economy and the labour market. Uncertainty was also exacerbated by ambiguous information resulting from still limited knowledge about the coronavirus and its health consequences.
Undoubtedly, the initial information about the scale of the threat, and above all the lockdown experience and, for some people, the quarantine, tests, deaths or health hazards for others, could have triggered an acute stress reaction and possibly also a post-traumatic stress disorder. It is worth noting that there was no previous epidemiological threat in Poland of a comparable scale. The 2009 A(N1H1) virus pandemic caused 182 deaths in the country, while only a few cases of the disease were reported in Europe during the MERS outbreak in 2012 [4-6].
Since the beginning of the current pandemic numerous studies have been conducted to examine its consequences for mental health and various guidelines have been developed. Undoubtedly, our knowledge is expanding, and the readers who are interested may find out more about it in the work of J. Heitzman [7] and the recommendations of the World Health Organisation [8].
Above all, it is important to remember that it is always advisable to consult a psychologist or psychiatrist if you experience intense, prolonged or concerning difficulties with regard to your ability to cope with life situations and your well-being.
Reference literature
- Kaczmarska A, Curyno-Sikora P., Problematyka stresu – przegląd koncepcji, Hygeia Public Health 2016, issue 51(4), p. 317-321.
- Heszen I., Psychologa stresu, Wydawnictwo Naukowe PWN, Warszawa, 2013.
- Szwajca K. Sprężystość (resilience) i odpowiedzi na doświadczenia urazowe – fascynujący i trudny obszar badań., ‘Psych Pol’ 2014; issue 48(3), p. 563–572
- https://stansanitarny.gis.gov.pl/stan_sanitarny_kraju_za_rok_2010.pdf [online access: 2 July 2020].
- Romanowska M., Stefanska I., Donevski S., Brydak L.B., Infections with A(H1N1)2009 Influenza Virus in Poland During the Last Pandemic: Experience of the National Influenza Center. In: Pokorski M. (eds) ‘Respiratory Regulation - The Molecular Approach. Advances in Experimental Medicine and Biology’, vol 756. Springer, Dordrecht, 2013. [online access]: https://doi.org/10.1007/978-94-007-4549-0_34
- https://www.euro.who.int/en/health-topics/health-emergencies/middle-east-respiratory-syndrome-coronavirus-mers-cov-and-the-risk-to-europe [online access: 3 July 2020].
- Heitzman J. Wpływ pandemii COVID-19 na zdrowie psychiczne. ‘Psychiatr. Pol’. 2020; issue 54(2), p. 187–198.
- https://apps.who.int/iris/bitstream/handle/10665/331808/WHO-2019-nCoV-MentalHealth-2020.1-pol.pdf?sequence=2&isAllowed=y [online access: 21 September 2020]
About the author
Katarzyna Klasa, MA – research assistant at the Department of Psychotherapy of the Jagiellonian University Medical College, senior assistant at the Department of Psychotherapy of the University Hospital in Kraków, specialist in clinical psychology and certified psychotherapist of the Polish Psychiatric Association.
A graduate of postgraduate studies in sexology and a postgraduate programme in mediation, she provides training at a comprehensive postgraduate psychotherapy course and the Postgraduate Studies in Psychotherapy offered by the Department of Psychotherapy of the Jagiellonian University Medical College in collaboration with the Postgraduate Medical Education Centre.
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