How space psychiatry became relevant during the pandemic

Anastasia Tsirtsakis

5/01/2021 3:55:56 PM

As NSW and Victoria see a COVID resurgence, an expert gives GPs management strategies for the psychological consequences of isolation and quarantine.

Many astronauts find isolation challenging despite years of training and preparation. (Image: Wikimedia Commons)

Dr Marc Jurblum’s research interest in space psychiatry and the psychological impact of long duration space flight was considered niche. That is until COVID-19 emerged and the concepts of social isolation and quarantine went mainstream.
As countries including Australia were plunged into lockdown, report after report on the resulting mental health burden came as little surprise to the psychiatry registrar.
‘Astronauts spend three years training to be in a small space for six months, doing really cool stuff and seeing amazing things, and they struggle enormously with it – and these are professionals who are used to going through this,’ he told newsGP.
‘So then to suddenly expose the entire population to it, people who have no training, no experience, I was not surprised at all with the mental health impact.
‘I don’t think people really had a concept of just how toxic long-term social isolation and being in a static environment for a long period of time can become without careful planning.’
As cases of COVID-19 resurge in NSW and Victoria, Dr Jurblum says GPs, who are the first port of call for people with mental health concerns, have a key role to play in helping to guide patients through both pre– and post–quarantine, and social isolation.
In his experience, he says those with pre-existing mental health issues are at greater risk of struggling with confinement and changes to their routine.
‘For someone who’s dealt with depression in the past, it’s quite possible that when you go through a period of lockdown or hotel quarantine – which are pretty stressful experiences – they can be the spark that can set things off again,’ Dr Jurblum said.
‘I’ve seen a fair bit of that in the last six months.’ 
As well as assessing a patient’s risk factors for a previous history of psychiatric illness such as depression, anxiety and PTSD, Dr Jurblum says asking about any family conflict or violence is also important.
What is clear, however, is that not all people’s experience of social isolation is the same, and a key factor is personality.
‘When you look at types of personalities, you have specific vulnerabilities and strengths,’ Dr Jurblum said.
‘So in a confined situation, certain people have skills that are going to predispose them to cope with that situation better, and conversely, some will be specifically vulnerable to the challenges of that situation.
‘The relatively introverted person who doesn’t mind spending lots of time on their own, but doesn’t mind having group dinners, is going to find it relatively pleasant possibly. In contrast, someone who’s already quite isolated and is always looking for social contact to then be placed in a hyper isolated situation might find it utterly intolerable.’
Dr Jurblum says a simple 20 minute conversation with a patient can be very beneficial, and advises GPs to ask how they usually experience stress.
‘A really good one is “have you ever broken a leg and been stuck at home with a leg in a cast for a long period of time? How did you deal with that?”,’ he suggests.
‘Questions like that get a picture of how someone has dealt with similar situations in the past, and can give a sense of what the likely natural history is going to be of their coping.’

Melbourne-based psychiatry registrar Dr Marc Jurblum says the mental health impacts of quarantine and social isolation are not surprising.

In a recent article published in the Australian Journal of General Practice (AJGP), Dr Jurblum and his colleagues recommend six simple strategies GPs can suggest to patients, which when appropriately targeted can significantly reduce the psychological impact: 

  • offer simple psychoeducation on the balance between build-up of stressors and the ability to offload them using coping strategies
  • encourage patients to brainstorm multiple coping strategies to try, including both individual (eg learning to draw) and group strategies for the entire household (eg board games)
  • advise that strategies should be a combination of goal-directed (eg learning a skill/creating) and non-goal-directed (eg absorbing media)
  • reinforce how important routine, diet, exercise and sleep hygiene are to maintaining mental health
  • promote social engagement via phone, video chat or socially distanced meeting wherever possible to improve connectedness
  • recommend simple changes to the home through light, furniture layout and decorations to bring novelty and visual interest to the environment
But when is it time to refer a patient on?
As well as considering their personality and mental health history, Dr Jurblum says it is important to discuss the direct impact on their life; are they struggling with work? Finding it difficult to focus? Is their sleep affected? Has their ability to cope day-to-day deteriorated?
Another key factor is whether they have a support network, and are willing to seek out help from those around them.
‘One of the things I notice commonly is the people who get into the most trouble are the people who have a need to deal with things on their own and have a propensity to internalise,’ Dr Jurblum said.
‘People with those sorts of coping mechanisms are more at risk of having a stressor that they’re unable to offload. So it cycles within them and becomes more and more problematic.
‘If they say “I’ll just go home and talk to mum”, they’re going to be a little bit less at risk. But if they’re not even willing to talk to their family, I’m more likely to say “Okay, let’s get some professional support in earlier”.
‘That’s how I’d assess if this if someone I should be concerned about.’
Dr Jurblum is not alone in predicting that the mental health impacts of the pandemic will be felt for years to come, and says the role of GPs will be equally important in the aftermath.
‘In my work in the space sector, we often talk about deorbit, so the experience of coming back to normal life,’ he said.
‘One of the hard things that people are going to experience is that things aren’t suddenly going to switch back to the way they were – which is okay, if it’s planned for.
‘There’s going to be a role, especially for GPs in helping to guide people through that process, that psychological experience of coming to terms with the experience, but also coming to terms with the fact that they need to get used to this new normal, that things aren’t changing back the way they hoped.’
Dr Marc Jurblum’s article ‘Psychological consequences of social isolation and quarantine: Issues related to COVID-19 restrictions’ published in the AJGP can be accessed on the RACGP website.
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