5Ws’ Association with Mental Health — Women, Wealth, Wisdom, Weight and Worry
Tags: Depression, Anxiety, Clean Environment, Mental Health, Health Foods

The COVID-19 pandemic has triggered a global deterioration in mental health (Johnson, 2020; Duncan & Butler, 2020; Mingpao, 2020). The anxiety of infecting the virus, the worry of losing jobs and businesses, the plummets in prices (wealth), the long-term forced-stay at home during lockdowns, the endless working hours of work-from-home, etc. are probably some of the reasons.

Some preliminary studies find alarming impacts. For example, a study in China by Huang & Zhao (2020), another one in Spain by Ozamiz-Etxebarria et al. (2020), and one in Slovenia by Kavcic, Avsec & Kocjan (2020) find negative impacts of COVID-19 on mental health. In addition, Rajkumar (2020) and Vindegaard & Benros (2020) review the studies across-the-board also conclude negative effects of the pandemic on mental health. (As a caveat, there are studies that find no or little changes, Schafer et al., 2020; Wang et al., 2020).

A. Global Situations of Mental Health Before COVID

In fact, the global situations of mental health even before the pandemic was alarming. Figure 1 shows the share of population with mental health and substance use disorders in 2017. There was 1 in 5 people in the deep red zones that are with mental health or substance use disorder. The ratio is deteriorating during the pandemic.

Figure 1 Share of population with mental health. source: Ritchie and Roser (2018)

The statistics are based on the following seven types of mental health or substance use disorder, viz. (1) Anxiety disorders, (2) Depression, (3) Alcohol use disorders, (4) Drug use disorders, (5) Bipolar disorder, (6) Schizophrenia, and (7) Eating disorders. Figure 2 shows the share of the total population with each type of disorder. Anxiety disorders and Depression are the top 2, with 3.76% and 3.44% respectively in 2017. Taking the global population to be approximately 7.6 billion, these figures are equivalent to 285.76 million and 261.44 million people in the world! Bearing in mind that these figures are just the tips of the icebergs, as there are many cases that are not reported.

Figure 2 Prevalence by mental disorder. source: Ritchie and Roser (2018)

Figure 3 clearly shows that the situation of our global mental health had been deteriorating, as the number of days of poor mental health was increasing rapidly (almost 6 folds) in the past decade. The pandemic is “putting gasoline on the fire”.

Figure 3 Effect of year on mental health. Source: Rothert, VanDerwerken & White (2019)

B. Why Some Countries Are of Higher Proportions of Population with Mental Health Issues?

Why some countries would have consistently more or less proportion mental health or substance use disorder cases is always a question being asked. Figure 4 shows the share of population with mental or substance disorders of male versus female in different countries in 2017. It shows clearly that the proportion in women in higher than that in men, as there are more data points below the 45-degree line.

Interestingly, the data points of Oceania (Australia and New Zealand) are located at the very top right hand corner, indicating that their proportions are among the highest in the world. It requires more in-depth research to explain why. Furthermore, it seems that the data points of western developed countries with high per capita GDP are located far below the 45-degree line and skewed to the top right hand corner. For example, United States (>16% m, >18% f), France (>14% m, >18% f), Germany (>13% m, >17% f), Norway (>14% m, >17% f). If we want to solve the problem, we have to understand why these differences are resulted.

Figure 4 Share of population with mental disorders. source: Ritchie and Roser (2018)

Admittedly, the situations are not one-sided. The situations of some countries are found to be improving substantially in the past decades. For example Figures 5 and 6 compare the shares of population of Asia countries between 1990 and 2017. Let’s take Vietnam as an example, the proportion for female was about 12% in 1990, but it was reduced to just about 10% in 2017. If it is because of the economic improvements and the increases in wealth, then how can we explain the higher proportions in high per-capita GDP countries?

Figure 5 Share of population with mental disorders in Asia countries in 1990. source: Ritchie and Roser (2018)

Figure 6 Share of population with mental disorders in Asia countries in 2017. source: Ritchie and Roser (2018)

C. Women (and the Youths) and the Wealthy Are of Higher Proportions?

The relatively higher proportion of women than men with mental health issues is quite clear and consistent temporally and spatially as shown in the figures above. Besides, young people are also found to be more vulnerable in mental health. Figure 7 shows the age effect on mental health, and depicts a decreasing number of days of poor mental health with increasing age, no matter in the pre- or post-WWII cohorts.

Figure 7 Effect of age on mental health. Source: Rothert, VanDerwerken & White (2019)

There is another piece of mind-boggling information shown in Figure 8. Are people in wealthy countries healthier in mental health or not? Traditionally, GDP per capita (as a proxy of economic wealth) has been found to be positively correlated to life satisfaction. United States, Norway, and France, etc. are reported to achieve a very high level of life satisfaction (above scale 6 out of 10). People in richer countries are found to be happier, why it seems to be contradicting with the situations of mental health? It probably implies that a country with high life satisfaction in average does not necessarily mean that they are healthy mentally. Life satisfaction and mental health may be perceived as different metrics by respondents, even though we often mix up the two as equivalents.

There are also outliners that do not show positive correlation between GDP per capita and life satisfaction. I have discussed in details (Yiu, 2019) on one of the outliers — Hong Kong, where the GDP per capita is relative high (almost that of the US), but the life satisfaction is just above 5 (cf 7 in the US).

Figure 7 Average self-reported life satisfaction vs GDP per capita in each country. source: Ortiz-Ospina & Roser (2017)

D. People of Higher Education Level (with Wisdom?) are of Lower Prevalence of Depression

It is commonly agreed that employment is strongly and positively related to mental health, as it helps reduce worries of income and it provides a sense of ikigai (life purpose, etc). Figure 8 confirms this hypothesis in a study in Greece 2014 that whenever one was employed, no matter which level of education that one obtained, the depression prevalence was less than the unemployed counterparts.

Another finding in this study was that people of higher education level seemed to have lower prevalence of depression. Is it because people of higher education level are of greater wisdom? There can be many confounding bias in this association though. People of higher education level is more likely to be able to find a better job or even work by self-employment. No matter what is the true reason, if education really can help reduce depression prevalence, it justifies governments’ funding on providing more places of higher education for the residents.

Figure 8 Depression Prevalence in Greece 2014 of different levels of education and employment status. source: Ritchie and Roser (2018)

E. Obesity (Weight) is a risk indicator of Mental Health?

Interestingly, Rothert, VanDerwerken & White (2019) find that “mental health was worse when income was less than peer group average or weight was more than peer group average”. From their findings, it seems that it is the stereotyped social norms that impose stresses on people which cause mental health problems. When there are such social standards on minimum income and maximum weight, then anyone who are far away from the standards would receive subtle stresses from the peer group. It can have nothing to do with the actual effects on the quality of life, but merely a sense of being an “outlier” which can be highly stressful. It can even be worse if it becomes the bullying target. Fortunately, there are some new findings in the actual causes of obesity in recent years, and hopefully they can soon help more people to de-stress and bring back their healthy lives.

F. Anxiety (Worry) is a risk indicator of Mental Health?

Finally, it is commonly agreed that it is the chronic anxiety that do harm to our mental health. In modern world, we are commonly under long-term stress that our bodies are not designed to sustain. No matter it is the pursuit of good academic results, or making both ends meet, it becomes a kind of vicious circle that the endless competitions would only result in unachievable goals.

WIL (2020a) contends that anxiety is uncertainty, and because of too many choices provided by the modern society that fatigues our brain and results in anxiety. The solutions proposed are imposing constraints on choices, removing the feeling of incompletion from daily lives, and writing down planned actions for future tasks.

However, it is mostly ignored in one of the most important causes of mental disorders in the above 5Ws. It is our diet and environment. For example, modern processed foods are found to have strong association with depression and other mental disorders (Healthcare Triage, 2019). It probably can explain why mental health issues, such as depression and panic attack, have been rapidly increasing in recent decades. It can also explain why obesity is strongly associated with mental disorders. This is a relatively new areas of scientific research and more recently we understand that our foods and environment can seriously affect our brains. For example, Alzheimer’s disease is nowadays known as Type 3 Diabetes (de la Monte and Wands, 2008), and air pollutions and coffee are found to be associated with depression and anxiety (Vert et al., 2017; WIL, 2020b). If these causes-and-effects can be ascertained, then it becomes very promising to cure the mental health of our younger generations. It just requires healthy food and clean environment to save our mental health. It can prevent unnecessary tortures and suicides due to mental illnesses.

If you are interested in this area of research, please leave me a comment and we can discuss more later.

References

Duncan, P. & Butler, P. (2020) Depression in British adults doubles during coronavirus crisis, The Guardian, Aug 18. https://www.theguardian.com/society/2020/aug/18/depression-in-british-adults-doubles-during-coronavirus-crisis?CMP=fb_gu&utm_medium=Social&utm_source=Facebook&fbclid=IwAR2R4blUjqu3yYG5fQ35FDEi9h2A5HJ-OiHtJcOZtJ6a2Bwvmt5RyVZ1Peo#Echobox=1597746125

Healthcare Triage (2019) Your Diet and Depression, youtube, Nov 1. https://youtu.be/wuMp-C_zoog

Huang, Y. & Zhao, N. (2020) Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey, Psychiatry Research, 288, 112954. https://doi.org/10.1016/j.psychres.2020.112954

Johnson, S. (2020) She was left with no one: how UK mental health deteriorated during COVID, The Guardian, Sep 21. https://www.theguardian.com/society/2020/sep/21/left-no-one-uk-mental-health-deteriorated-covid?CMP=share_btn_fb&fbclid=IwAR2GFg7pvh37Xcq92xCZd54G-3bzl1wozBKxDfbn5Hzd6AMxSagw6dJyv_M

Mingpao (2020) 未來城市：有街出不得 為心靈「開一扇窗」 遙距心理治療 疫境成發展契機，明報，4月26日 (in Chinese)。https://news.mingpao.com/pns/%E5%89%AF%E5%88%8A/article/20200426/s00005/1587839945512/%E6%9C%AA%E4%BE%86%E5%9F%8E%E5%B8%82-%E6%9C%89%E8%A1%97%E5%87%BA%E4%B8%8D%E5%BE%97-%E7%82%BA%E5%BF%83%E9%9D%88%E3%80%8C%E9%96%8B%E4%B8%80%E6%89%87%E7%AA%97%E3%80%8D-%E9%81%99%E8%B7%9D%E5%BF%83%E7%90%86%E6%B2%BB%E7%99%82-%E7%96%AB%E5%A2%83%E6%88%90%E7%99%BC%E5%B1%95%E5%A5%91%E6%A9%9F

de la Monte, S.M. & Wands, J.R. (2008) Alzheimer’s Disease Is Type 3 Diabetes — Evidence Reviewed, Journal of Diabetes Science Technology, 2(6), 1101–1113. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/

Ortiz-Ospina, E. & Roser, M. (2017) Happiness and Life Satisfaction. Published online at OurWorldInData.org.

Ozamiz-Etxebarria, N., Dosil-Santamaria, M., Picaza-Gorrochategui, M. & Idoiaga-Mondragon, N. (2020) Stress, anxiety, and depression levels in the initial stage of the COVID-19 outbreak in a population sample in the northern Spain, Cadernos de Saude Publica, 36(4). https://doi.org/10.1590/0102-311X00054020

Rajkumar RP. (2020) COVID-19 and mental health: a review of the existing literature. Asian J Psychiatr. 52:102066.

Ritchie, H. & Roser, M. (2018) Mental Health, Published online at OurWorldInData.org.

Rothert, J., VanDerwerken, D. & White E. (2019) Socioeconomic factors and happiness: evidence from self-reported mental health data, Empirical Economics, 58, 3101–3123. https://link.springer.com/article/10.1007/s00181-019-01655-y

Schafer, S.K., Sopp, M.R., Schanz, C.G., Staginnus, M., Goritz, A.S. & Michael, T. (2020) Impact of COVID-19 on Public Mental Health and the Buffering Effect of a Sense of Coherence, Psychotherapy and Psychosomatics, 89, 386–392.

Vert, C., Sanchez-Benavides, G., Martinez, D. et al. (2017) Effect of long-term exposure to air pollution on anxiety and depression in adults: A cross-sectional study, International Journal of Hygiene and Environmental Health, 220(6), 1074–1080. https://www.sciencedirect.com/science/article/pii/S1438463917302973

Vindegaard N, Benros ME. (2020) COVID-19 pandemic and mental health consequences: systematic review of the current evidence. Brain Behav Immun. doi: 10.1016/j.bbi.2020.05.048.

Wang, C., Pan, R., Wan, X. & Others (2020) A longitudinal study on the mental health of general population during the COVID-19 epidemic in China, Brain, Behavior, and Immunity, 87, 40–48. https://doi.org/10.1016/j.bbi.2020.04.028

WIL (2020a) Why are you Uncertain, Unfocused and Anxious? What should we do about it? What I’ve Learned youtube, May 24. https://youtu.be/GaJmw54BMcw

WIL (2020b) Does Coffee make you Fat and Anxious? What I’ve Learned youtube, Sep 28. https://youtu.be/pVXHD1gl6c4

Yiu, C.Y. (2019) Can Money Buy Happiness? Medium, Nov 28. https://medium.com/@ecyY/can-money-buy-happiness-ac7ab97e6373