Mental disorders and calls for help growing fast

The recent measures undertaken by the government establishing the so-called “state of relative confinement” are highlighting existing problems of mental disorders including depression, anxiety, insomnia, and suicidal tendencies, several academic studies, experts, and reports from local welfare associations note.

In the latest of these reports, local welfare association Caritas Macau has said that since the beginning of the community outbreak of Covid-19 last month and over a period of just three weeks, the association’s suicide prevention and mental support hotline received over 500 requests for mental help, 18 of them directly related to suicide, Hoje Macau (HM) newspaper reported.

The figure represents an exponential spike in the number of calls for help, which according to Caritas statistics topped the figure commonly received over four months.

“Usually, in a year, we receive between 45 and 50 calls [related to suicide prevention], but this year we have had more people addressing this issue. Right now, we need more resources and partners to help all these people. We need to have staff working 24 hours a day at this hotline,” Paul Pun, Secretary-general of Caritas said to HM, adding that he expects that the number of requests for help arriving through this phone line will increase even more during the period of confinement, that will last until July 18.

“I expect that during this partial confinement period there should be many more cases. Some of the requests we have received are already related to the confinement that started on Monday. Many people are feeling enormous pressure, and for vulnerable groups, that pressure is even greater. At least, through this hotline, they can express what they feel and share their emotional problems, to better cope with them and avoid committing suicide,” Pun said, advising that from the over 500 calls for help most involve issues related to depression, anxiety, and family conflict.

Interviewed by the same media outlet, psychologist Goreti Lima, currently in Portugal after several years working in Macau, said that she continues to receive a lot of requests from people she used to assist while in Macau.

Lima said that there is a large number of residents who continue to seek psychological help outside Macau as they wish to continue to consult professionals whom they have already seen but who are no longer in Macau.

According to the psychologist, most of the problems on the line are related to depression and anxiety, of people who either are clinging to the past, or worried about the future.

“The problem is really how to deal and live in the present, and that’s a big part of the work I’ve been doing with them,” Lime said, noting that in the case of the Portuguese and other foreigners, many continue to wish to stay in Macau because of fears of moving children that are studying in Macau schools, while others, those who usually have a better financial situation, mostly want to leave since “there is not an [efficient] support network [in Macau] and many people do not trust local services.”

Lima also noted the many cases of people practicing self-medication, namely those suffering from severe insomnia or struck by anxiety or panic attacks.

Filipa Freire, another professional in the same field who had also worked in the territory, shared a similar story noting that many of her clients continue to be residents in Macau.

“It is a very heavy situation that people in Macau are experiencing, especially when we feel that the rest of the world has moved forward to other types of policies to manage the pandemic. When we realize that things are different in other parts of the world, it causes us to feel sentiments of injustice and anger. People are exhausted and many are driven to act on impulse and emotions. There is a great deal of epidemic fatigue,” Freire said in reference to her experience of her local clients.

Elderly citizens ‘social isolation’ cause most psychological issues

According to a report published by Macao Daily newspaper, that cites Peng On Tung Tele-Assistance Service group, the social isolation of the elderly as a result of the Covid-19 restrictions is targeted as the main cause of this group’s psychological problems.

Pun Ka Lon, a representative of Peng On Tung, told Macau Daily that a group which is part of the Federation of Neighborhood Associations also called “Kai Fong,” said that their phone assistance team has received almost 200 support requests from elderly people.

The same representative noted that most of the requests are not related to physical health, which have been steady at around 10 to 15 calls a day, but instead, most are related to the emotional state of the senior citizens.

Pun noted that closure of the local eateries was the factor pointed out by many as affecting their emotional state as “they used to spend most of their time during the day at these places chatting with friends and relatives,” an activity halted by government order which banned dine-in food and beverage establishments.

Several have also reported feeling insecure, confused, and frightened by the requirement to comply with Rapid Antigen Test rules, resulting in the support group deploying staff to help those living alone to help with that daily task.

Study: 40% of the population suffering from mental disorders

A study conducted by researchers from the University of Macau (UM) in collaboration with the School of Nursing, Hong Kong Polytechnic University, and several major national institutions for mental disorders in Beijing and Nanjing, has found that almost 40% of the population in Macau have mental disorders such as insomnia, depression, and anxiety.

The study titled “Network analysis of depression, anxiety, insomnia and quality of life among Macau residents during the COVID-19 pandemic” will be published in the August 15, 2022 issue of the Journal of Affective Disorders, an academic journal dedicated to publishing papers concerned with affective disorders including depression, mania, mood spectrum, emotions and personality, anxiety and stress.

The study was based on an online survey conducted in Macau between August 18 and November 9, 2020.

It concluded that the prevalence of depressive, anxiety, and insomnia symptoms could be found in 38.5% of the 975 participants in the study.

Researchers also noted that this work is unique in being the first to study the network structure of insomnia-anxiety-depression in Macau residents.

Sleep problems were also found to be the major central symptom in the network structure of insomnia-anxiety-depression, with “sleep maintenance” having the most relevant role in the process. Insomnia was noted as the strongest factor contributing directly to the quality of life.

“Trouble relaxing,” “interference with daytime functioning,” “irritability,” and “fatigue” were other factors identified as interfering with the quality of life of the residents.

The paper is co-authored by Wei Bai, Yan-Jie Zhao, Hong Cai, Sha Shad, Qinge Zhang, Si-Man Lei, Grace K. I. Lok, Ines H. I. Chow, Teris Cheung, Zhaohui Su, Todd Jackson, and Yu-Tao Xiang, and its major findings have been published online in late May this year on the ScienceDirect website.

In two other academic papers on the “Perceived impacts of COVID- 19 on risk perceptions, emotions, and travel intentions: evidence from Macau higher educational institutions,” and “Understanding the reactions of government and gaming concessionaires on COVID-19 through the neo-institutional theory – the case of Macao,” both from 2021, researchers also pointed out that public health measures adopted in Macau during the Covid-19 pandemic outbreak have been similar to those in mainland China. These include the issuing of a level III alert (moderate level) on January 5, 2020, in Macau, which resulted in the suspension of group tour visas for mainland Chinese visitors to Macau on January 22, 2020, suspensions of casinos and other entertainment venue operations for 15 days from February 5, 2020, and bans of all non-resident workers (except mainland China, the region of Taiwan, and Hong Kong) from entering Macau on March 19, 2020. 

Control measures “have had negative economic effects on about three-quarters of the territory’s population who were directly or indirectly employed in casinos and other entertainment venue operations, as well as government tax revenues,” the first research paper notes.

Another paper co-authored by Xiong Jiaqi from the University of Toronto and titled “Impact of COVID-19 pandemic on mental health in the general population: A systematic review” has also noted that “lower or unstable socioeconomic status and unemployment are risk factors for developing psychiatric symptoms, including anxiety, depression, psychological distress and stress during the COVID-19 pandemic.”

From this perspective, many Macau residents may experience serious mental health problems at this time in particular. 

Additionally, a large-scale nationwide study conducted in the general population of China, which targeted a universe of 56,679 respondents, reported the prevalence of depressive, anxiety, and insomnia symptoms were 27.9%, 31.6%, and 29.2%, respectively.