Jung Jong Hyun, assistant professor at NTU, has been researching social determinants of mental health, using the stress process model as a guiding framework. Here he examines how COVID-19 can undermine mental health and how we can cope with it. (Banner photo: Amanda Ho)
Another month! After hearing about the Circuit Breaker extension, I wondered how to cope with this prolonged, enforced isolation. I also wondered, how will this influence the mental health of Singaporeans? The SARS epidemic in 2003 led to higher rates of post-traumatic stress, especially among hospital employees dealing with the SARS patients. However, COVID-19 may exert even deeper, long-term deleterious effects on individual well-being. The stress process framework may help us understand this through the concept of stress proliferation.
Stress proliferation refers to new or “secondary” stressors that stem from “primary” stressors. COVID-19, a stressful event in and of itself, may take a toll on mental health; it can also contribute to multiple chronic hardships, such as unemployment, financial hardship, and economic downturn, which may undermine well-being. Inadequate financial resources may lead to additional stressors including marital conflict or divorce; this, in turn, may give rise to another detrimental stressor such as social isolation. Thus, COVID-19 may set an individual on a path to a chain of stressors across their life course, with possible harmful effects on their mental health in the long-run.
Even more troublingly, the stress process model predicts that stressors are unevenly distributed, with those in lower economic classes having more exposure. In Singapore, for example, we witness a string of new outbreaks of the virus in the cramped dorms of migrant workers, who are disenfranchised and disadvantaged. They are particularly susceptible to the virus because of poor living conditions—some workers told the media that they do not have adequate soap and cleaning supplies, and they share bathrooms which often do not provide enough water for the showers to properly function.
To make things worse, COVID-19 blocks us from one of the most valuable coping resources: social support. The negative impact of stressors can be mitigated by access to personal resources such as social support, self-esteem, sense of personal control, and optimism. As human beings are fundamentally social creatures, social support has received the most scholarly attention, and research consistently demonstrates that social support itself is beneficial for mental health, as well as providing a stress-buffering effect. However, self-isolation and quarantine cut individuals off from their close social networks, and individuals are less willing to gather together to support one another. This may lead to a heightened sense of social isolation, which in turn harms mental health.
However, there may be alternatives. For example, recently, Shannon Ang and his colleague focused on vulnerable populations suffering physical pain which restricts their activities outside the home. These individuals tend to show higher levels of depressive symptoms due to their physical pain; on top of that, the pain prevents them from maintaining a high level of social activities, which may further reduce their well-being. However, online social participation has been shown to be beneficial for their mental health. By compensating for reduced offline social activities, it can serve as a stress-buffer.
Yet this may be a double-edged sword. Some research highlights the negative health consequences of digital media use: Facebook use is associated with poorer well-being over time. So what determines if online social participations are beneficial? Some recent research looking at adolescents indicates that there is a non-linear relationship between amount of digital media use and well-being. That is, nonusers are slightly more likely to have poor well-being than light users, but beyond light use (30 minutes to two hours per day), well-being steadily declines. The heaviest users (six or more hours per day) are the most likely to have poor well-being. Hence, to experience health benefits from online social participation, we should limit digital media use to less than two hours per day.
For migrant workers, their mental health may have been undermined even before the pandemic. Migrant workers tend to face family disruption and thus reduced social support. Research in the Indonesian context reveals that labor migration increased the risk of depressive symptoms, especially for migrants who moved alone. Further, migrant workers tend to under-consume from their income, in an effort to remit more to their families, so they may gain fewer mental health benefits from any improved economic conditions. Moreover, COVID-19 makes their situations worse, as they suffer from the virus as well as a lack of offline social participation. In these circumstances, online social interactions may be very helpful as a channel of emotional social support.
In these difficult times, we need to take mental health issues more seriously. The Ministry of Health does not list psychological treatments as essential services under the current Circuit Breaker. This may be partly because mental health is still a taboo subject, with some stigma attached to mental health conditions. We need to discuss mental health more openly. Raising awareness is a start to creating a more open environment where people can freely exchange social support either offline or online.
 Wu Ping, Yunyun Fang, Zhiqiang Guan, Bin Fan, Junhui Kong, Zhongling Yao, Xinhua Liu, Cordelia J Fuller, Ezra Susser, Jin Lu, and Christina W Hoven, “The Psychological Impact of the SARS Epidemic on Hospital Employees in China: Exposure, Risk Perception, and Altruistic Acceptance of Risk”, Canadian Journal of Psychiatry, 54(5):302-311.
 Rebecca Ratcliffe, “Singapore’s Cramped Migrant Worker Dorms Hide Covid-19 Surge Risk”, The Guardian (2020)
 Sheldon Cohen and Thomas A. Wills, “Stress, Social Support, and the Buffering Hypothesis”. Psychological Bulletin, 98:310-57 (1985)
 Shannon Ang and Tuo-Yu Chen, “Going Online to Stay Connected: Online Social Participation Buffers the Relationship between Pain and Depression”, Journals of Gerontology Series B: Psychological and Social Sciences, 74(6):1020-1031 (2019)
 Holly B. Shakya and Nicholas A. Christakis, “Association of Facebook Use with Compromised Well-Being: A Longitudinal Study”, American Journal of Epidemiology, 185:203–211 (2017)
 Jean M. Twenge, “More Time on Technology, Less Happiness? Associations Between Digital-Media Use and Psychological Well-Being”, Current Directions in Psychological Science, 28(4):372–379 (2019)
 Lu Yao, “Rural-Urban Migration and Health: Evidence from Longitudinal Data in Indonesia”, Social Science & Medicine, 70:412-419 (2010)
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