Health policy and mental resilience as the determinants of burnout, anxiety, and depresion amidst adversity
Authors: Lamuri Aly 
Published: July 2023

Resilience is the adaptability of an individual to adversities in a routine or occasional circumstances, factoring the biopsychososcial-ecological system supporting multiple promotive also protective factors and processes (Ungar and Theron 2020). Resilient individuals have three essential psychological characteristics, including secure attachment, experiencing positive emotions, and having a purpose in life (Rutten et al. 2013). Resilience is a dynamic process regulating the homeostatic plasticity (Vella, Pai, et al. 2019; Liu et al. 2018), which reflects a desirable mental control, emotion regulation, coping mechanism, self efficacy, sense of purpose, positive affect, and social support (Precious and Lindsay 2019). Resilient individuals are more likely to bounce back from negative events, either by promptly adapting or quickly recovering, to accomplish a more favorable mental health outcome (Ungar and Theron 2020).

Individuals with resilient trait have an overall better mental health, indicated by higher life satisfaction and positive affect. Accordingly, the lack of resilient trait also contributes to heightening depression, anxiety, and negative affect (Hu, Zhang, and Wang 2015). Several studies have also replicated the extensive impact of resilience in lowering depression (Nakazawa et al. 2018), anxiety (Ran et al. 2020; Schiele and Domschke 2018), and burnout (West et al. 2020; Luceno-Moreno et al. 2020), which shall be the main psychological outcomes highlighted in this study. Intriguingly, burnout has been established as a common association between depression and anxiety (Meier and Kim 2022; Koutsimani, Montgomery, and Georganta 2019), suggesting a generic yet distinctive process in relation to mental resilience (Luceno-Moreno et al. 2020; Serrao et al. 2021). In a situation-specific distress, e.g. the COVID-19 pandemic, individuals with higher resilience can adapt better to the abrupt changes, reflected by lower trepidation, reduced anxiety, and attenuated depression (Barzilay et al. 2020). In Indonesia, the COVID-19 pandemic has caused multitude of mental health issues, especially during the large-scale containment which halted the economic activities, mostly impacting those in mid-low socioeconomic stratum, and hindered social activities, resulting in loneliness and in some cases social dejection (Tampubolon, Silalahi, and Siagian 2021). The pandemic aggravates the mental health situation in Indonesia, where previously among older adults, 46.28% experienced stress and 31.72% felt depressed (Hanum, Utoyo, and Jaya 2022). Although the government of Indonesia has implemented The Mental Health act in 2014, the resources and facilities are not widely available (Tampubolon, Silalahi, and Siagian 2021; Hanum, Utoyo, and Jaya 2022). Several online mental health services have spurred during the pandemic, but further regulation and mitigation from the government is necessary to abate the spread of mental health problem (Ifdil et al. 2020), i.e. by establishing a government-verified digital counselling platform, multi-stakeholder mental health support program, and improving the accessibility of mental health services in the primary health care(Tampubolon, Silalahi, and Siagian 2021). Considering the intricacies between policy-driven action, resilience, situational changes, depression, anxiety, and burnout, the upcoming investigations will be mainly concerned with unravelling the question:

What is the long-term effectiveness and cost-effectiveness of various policies to maintain mental resilience amidst adversities, especially regarding their impact on depression, anxiety, and burnout also related medication use?