fdovila/SINDEMIA CHILE 2020.txt

## SINDEMIA CHILE 2020.txt
SINDEMIA, THE TRIPLE SOCIAL, HEALTH AND ECONOMIC CRISIS; AND ITS EFFECT ON MENTAL HEALTH

CIPER Chile

ciperchile.cl - by Álvaro Jiménez Molina, Fabián Duarte and Graciela Rojas
20.06.2020

It was said that the virus does not discriminate between rich and poor. But the truth is that it does not attack everyone equally. While today people with a monthly income below £538 feel fear and sadness, in high-income families anger predominates. Today we face not only a virus but a triple crisis that has a strong and unequal impact on mental health.

Between October 2019 and June 2020, we Chileans have witnessed one crisis after another, a triple crisis of social, health and economy. The social explosion altered the ways of thinking about our collective life, making visible inequalities and precariousness that gave way to a demand for dignity and equality. The rapid spread of COVID-19 has produced a break in our daily lives, affecting our health, social relations and sources of employment. As a recent column argues, we are facing an epidemic process out of control: "the disaster is here".

The disruption to social life imposed by the social explosion and the current pandemic, along with the accompanying sources of psychosocial and economic stress, can significantly affect people's mental health.

Major protests and increased social unrest are often associated with an increase in the prevalence of mental health problems in the population, representing an impact comparable to that of socio-natural disasters [see study]. On the other hand, physical distancing measures, mobility restrictions, quarantine, temporary closure of educational institutions and teleworking modalities constitute a scenario that demands an important adaptation effort, producing wear and tear at personal, family and community levels. This scenario may be associated with a feeling of isolation and uncertainty, as well as producing stress, anxiety, sadness, irritability, insomnia, feelings of helplessness and constant state of alert in some people [see study]. Although these are expected (even adaptive) reactions, it is very likely that in the short and medium-term we will have to learn to live with a certain level of anxiety and stress. According to WHO estimates, 4% of the world's population may experience severe mental disorders from the health crisis. In comparison, 15-20% may suffer from mild to moderate disorders.

Since 18/O, we have become accustomed to hearing recommendations for taking care of our mental health. These "tips" are valuable information but have focused primarily on individual actions to cope with adversity. It is about becoming more "resilient". However, these recommendations often forget the other half of the equation: the need to address the social and economic conditions that affect our mental health. Indeed, what we call mental health is a relational phenomenon that is conditioned by social, economic and political factors: contexts of poverty and vulnerability, material and symbolic inequalities, levels of territorial segregation or deficits of social cohesion that impact on the daily life of individuals and communities.


MEASURING THE TEMPERATURE OF THE CRISIS
In March the WHO declared that the coronavirus had reached pandemic proportions. However, there is every reason to believe that what we are facing today does not represent a pandemic, but rather a 'syndemic'. By syndemic, we mean the interaction of multiple causal agents: social conditions (poverty, inequality, injustice, social conflict, unemployment), environmental processes (climate change, socio-natural and ecological disasters) and pathological states (comorbidities between diseases such as depression, diabetes and hypertension that affect many Chileans) that enhance their negative effects on the lives of individuals and exacerbate the burden of disease in certain population groups. In other words, we are not simply facing an infectious agent that parasitizes our bodies. Still, we are witnessing a complete alteration of the economic and social order. By interacting synergistically, the multiple syndemic factors contribute to the aetiology and persistence of mental health problems, exacerbating vulnerabilities and reproducing health disparities.

In March, we heard that COVID-19 does not classify people based on their wealth or place of residence. It was said that "the virus does not discriminate". This cliché proved to be false. The health, economic and social impact of COVID-19 is not the same for different social groups. To evaluate these impacts, the Millennium Nucleus on Social Development (DESOC), in collaboration with the Microdata Centre of the University of Chile and the Centre for Conflict and Social Cohesion Studies (COES), carried out a third version of the Social Thermometer (June 2020), whose previous versions were aimed at measuring the temperature of the social outbreak and constituent process.

The Social Thermometer 3 (ST3) is a nationally representative survey (n=1078), which attempts to obtain an x-ray of the perceptions, feelings and beliefs of Chileans in the current context. The ST3 is a telephone survey of individuals from all social strata and regions [more details here]. One of its results shows that 35% of those who admit to having been in contact with one or more confirmed cases of coronavirus since 16 March are mainly people belonging to families whose income is less than £538 per month, i.e. segments of the population that face difficulties in obtaining income due to loss of employment (52% of this group), or difficulties in accessing food (34%) and have been unable to comply with quarantine measures. In fact, 44 percent of the respondents believe that one of the main obstacles to containing the advance of the pandemic is the inability to stop working for a living.

In terms of perceptions of the future, people assign a high probability of occurrence to reduced income (29%) and increased debt (35%). Chileans also show a high degree of uncertainty regarding the probability of events such as a reduction in working hours, becoming unemployed or the bankruptcy of the company where they work.

- What probability do you assign to the following events occurring in the next 3 months?
Among people who declare that someone in their family lost their job after 16 March (almost 33% of the sample), 93% report that it was a direct or indirect consequence of the coronavirus health crisis.

On the other hand, when asked about the impact of the current context on psychological well-being, half of the participants stated that their state of mind is worse or much worse than before the isolation and quarantine measures, which mainly affects women (56% women vs 43% men). The results also show that today the emotional tone of Chileans is dominated by anger (30%), fear (27.4%) and sadness (2.83%). Disaggregating these emotions by income level, we note that in people living in households with a monthly income below £538, fear (29%) and sadness (27%) predominate, while in the more affluent sectors anger (37%) predominates. In other words, our emotions are not independent of our material living conditions.

- How many times during the last two weeks have you felt any of the following discomforts?
Quarantine has distanced us physically, but not necessarily isolated us from others: only 13% of participants reported experiences of isolation or loneliness. On the contrary, our quality of sleep is profoundly affected: 3 out of 5 people say they have problems sleeping and 1 out of 5 says that these problems occur every day. This is a worrying indicator, as sleeping difficulties are an important predictor of the development of mental disorders in the short and medium-term [see study].


COVID-19, ECONOMIC INSTABILITY AND MENTAL HEALTH
The results of the ST3 show that the current health crisis is producing a high degree of financial and employment uncertainty among Chileans. As some international studies show, these are conditions associated with higher levels of stress, anxiety and depression. The ST3 shows that currently, around 18% of Chileans would present depressive symptoms, while 23% would present anxious symptoms. Although these are prevalences observed in previous epidemiological studies, it is highly likely that the presence of these symptoms will increase as the current crisis context persists over time.

In Chile, some studies have shown that the feeling of insecurity related to health and work is associated with an increased presence of depressive symptoms [see study]. Indeed, anxious and depressive symptoms are associated with an experience of vulnerability or "positional inconsistency" shared by a large number of Chileans. This experience refers to the perception that places and social trajectories are unstable and highly permeable to precarisation.

In fact, in a good part of the middle sectors, there is an intense fear of falling from the social position they have reached in recent decades. According to OECD estimates, more than half of all Chileans are at risk of falling into poverty if they do not receive their salary for three months. Within OECD countries, Chile is where a person in the fourth quintile (the second-highest income segment) is most likely to fall back into the first quintile (the lowest income segment) within four years.

How can we explain this high vulnerability? Very simply: in Chile, the median monthly income (around £398) is very close to the poverty line. This reality also translates into high levels of household debt, which has a corrosive effect on people's mental health as it is associated with higher levels of financial stress, anxiety and depressive symptoms [see study].

In countries with high inequality, such as Chile, social gaps coexist with a variety of material deprivations and weaknesses in the social protection system that negatively affects mental health. Faced with this scenario, the responses cannot be only health-based. As envisaged in the recently reached "COVID Agreement", measures aimed at protecting family and worker incomes and job support schemes are needed, but at the same time security about what will happen in the future, in order to reduce uncertainty and anxiety. Therefore, the most effective mental health responses are those that reduce uncertainty arising from job insecurity, provide safety nets against loss of income, ensure the protection of those workers who become unemployed and prevent over-indebtedness. But international experience also suggests that in situations of social conflict, health crisis and economic recession, social policies aimed at restoring social links and strengthening social cohesion become very important to mitigate the effects on mental health.

We need a syndemic perspective to understand the impact of this triple social, health and economic crisis on mental health, a dimension of life that will be affected for much longer than physical health. As stated in the National Mental Health Strategy developed by the University of Chile, "mental health is one of the keys to surviving this pandemic".

-o-
	SINDEMIA, THE TRIPLE SOCIAL, HEALTH AND ECONOMIC CRISIS; AND ITS EFFECT ON MENTAL HEALTH

	CIPER Chile

	ciperchile.cl - by Álvaro Jiménez Molina, Fabián Duarte and Graciela Rojas
	20.06.2020

	It was said that the virus does not discriminate between rich and poor. But the truth is that it does not attack everyone equally. While today people with a monthly income below £538 feel fear and sadness, in high-income families anger predominates. Today we face not only a virus but a triple crisis that has a strong and unequal impact on mental health.

	Between October 2019 and June 2020, we Chileans have witnessed one crisis after another, a triple crisis of social, health and economy. The social explosion altered the ways of thinking about our collective life, making visible inequalities and precariousness that gave way to a demand for dignity and equality. The rapid spread of COVID-19 has produced a break in our daily lives, affecting our health, social relations and sources of employment. As a recent column argues, we are facing an epidemic process out of control: "the disaster is here".

	The disruption to social life imposed by the social explosion and the current pandemic, along with the accompanying sources of psychosocial and economic stress, can significantly affect people's mental health.

	Major protests and increased social unrest are often associated with an increase in the prevalence of mental health problems in the population, representing an impact comparable to that of socio-natural disasters [see study]. On the other hand, physical distancing measures, mobility restrictions, quarantine, temporary closure of educational institutions and teleworking modalities constitute a scenario that demands an important adaptation effort, producing wear and tear at personal, family and community levels. This scenario may be associated with a feeling of isolation and uncertainty, as well as producing stress, anxiety, sadness, irritability, insomnia, feelings of helplessness and constant state of alert in some people [see study]. Although these are expected (even adaptive) reactions, it is very likely that in the short and medium-term we will have to learn to live with a certain level of anxiety and stress. According to WHO estimates, 4% of the world's population may experience severe mental disorders from the health crisis. In comparison, 15-20% may suffer from mild to moderate disorders.

	Since 18/O, we have become accustomed to hearing recommendations for taking care of our mental health. These "tips" are valuable information but have focused primarily on individual actions to cope with adversity. It is about becoming more "resilient". However, these recommendations often forget the other half of the equation: the need to address the social and economic conditions that affect our mental health. Indeed, what we call mental health is a relational phenomenon that is conditioned by social, economic and political factors: contexts of poverty and vulnerability, material and symbolic inequalities, levels of territorial segregation or deficits of social cohesion that impact on the daily life of individuals and communities.


	MEASURING THE TEMPERATURE OF THE CRISIS
	In March the WHO declared that the coronavirus had reached pandemic proportions. However, there is every reason to believe that what we are facing today does not represent a pandemic, but rather a 'syndemic'. By syndemic, we mean the interaction of multiple causal agents: social conditions (poverty, inequality, injustice, social conflict, unemployment), environmental processes (climate change, socio-natural and ecological disasters) and pathological states (comorbidities between diseases such as depression, diabetes and hypertension that affect many Chileans) that enhance their negative effects on the lives of individuals and exacerbate the burden of disease in certain population groups. In other words, we are not simply facing an infectious agent that parasitizes our bodies. Still, we are witnessing a complete alteration of the economic and social order. By interacting synergistically, the multiple syndemic factors contribute to the aetiology and persistence of mental health problems, exacerbating vulnerabilities and reproducing health disparities.

	In March, we heard that COVID-19 does not classify people based on their wealth or place of residence. It was said that "the virus does not discriminate". This cliché proved to be false. The health, economic and social impact of COVID-19 is not the same for different social groups. To evaluate these impacts, the Millennium Nucleus on Social Development (DESOC), in collaboration with the Microdata Centre of the University of Chile and the Centre for Conflict and Social Cohesion Studies (COES), carried out a third version of the Social Thermometer (June 2020), whose previous versions were aimed at measuring the temperature of the social outbreak and constituent process.

	The Social Thermometer 3 (ST3) is a nationally representative survey (n=1078), which attempts to obtain an x-ray of the perceptions, feelings and beliefs of Chileans in the current context. The ST3 is a telephone survey of individuals from all social strata and regions [more details here]. One of its results shows that 35% of those who admit to having been in contact with one or more confirmed cases of coronavirus since 16 March are mainly people belonging to families whose income is less than £538 per month, i.e. segments of the population that face difficulties in obtaining income due to loss of employment (52% of this group), or difficulties in accessing food (34%) and have been unable to comply with quarantine measures. In fact, 44 percent of the respondents believe that one of the main obstacles to containing the advance of the pandemic is the inability to stop working for a living.

	In terms of perceptions of the future, people assign a high probability of occurrence to reduced income (29%) and increased debt (35%). Chileans also show a high degree of uncertainty regarding the probability of events such as a reduction in working hours, becoming unemployed or the bankruptcy of the company where they work.

	- What probability do you assign to the following events occurring in the next 3 months?
	Among people who declare that someone in their family lost their job after 16 March (almost 33% of the sample), 93% report that it was a direct or indirect consequence of the coronavirus health crisis.

	On the other hand, when asked about the impact of the current context on psychological well-being, half of the participants stated that their state of mind is worse or much worse than before the isolation and quarantine measures, which mainly affects women (56% women vs 43% men). The results also show that today the emotional tone of Chileans is dominated by anger (30%), fear (27.4%) and sadness (2.83%). Disaggregating these emotions by income level, we note that in people living in households with a monthly income below £538, fear (29%) and sadness (27%) predominate, while in the more affluent sectors anger (37%) predominates. In other words, our emotions are not independent of our material living conditions.

	- How many times during the last two weeks have you felt any of the following discomforts?
	Quarantine has distanced us physically, but not necessarily isolated us from others: only 13% of participants reported experiences of isolation or loneliness. On the contrary, our quality of sleep is profoundly affected: 3 out of 5 people say they have problems sleeping and 1 out of 5 says that these problems occur every day. This is a worrying indicator, as sleeping difficulties are an important predictor of the development of mental disorders in the short and medium-term [see study].



	COVID-19, ECONOMIC INSTABILITY AND MENTAL HEALTH
	The results of the ST3 show that the current health crisis is producing a high degree of financial and employment uncertainty among Chileans. As some international studies show, these are conditions associated with higher levels of stress, anxiety and depression. The ST3 shows that currently, around 18% of Chileans would present depressive symptoms, while 23% would present anxious symptoms. Although these are prevalences observed in previous epidemiological studies, it is highly likely that the presence of these symptoms will increase as the current crisis context persists over time.

	In Chile, some studies have shown that the feeling of insecurity related to health and work is associated with an increased presence of depressive symptoms [see study]. Indeed, anxious and depressive symptoms are associated with an experience of vulnerability or "positional inconsistency" shared by a large number of Chileans. This experience refers to the perception that places and social trajectories are unstable and highly permeable to precarisation.

	In fact, in a good part of the middle sectors, there is an intense fear of falling from the social position they have reached in recent decades. According to OECD estimates, more than half of all Chileans are at risk of falling into poverty if they do not receive their salary for three months. Within OECD countries, Chile is where a person in the fourth quintile (the second-highest income segment) is most likely to fall back into the first quintile (the lowest income segment) within four years.

	How can we explain this high vulnerability? Very simply: in Chile, the median monthly income (around £398) is very close to the poverty line. This reality also translates into high levels of household debt, which has a corrosive effect on people's mental health as it is associated with higher levels of financial stress, anxiety and depressive symptoms [see study].

	In countries with high inequality, such as Chile, social gaps coexist with a variety of material deprivations and weaknesses in the social protection system that negatively affects mental health. Faced with this scenario, the responses cannot be only health-based. As envisaged in the recently reached "COVID Agreement", measures aimed at protecting family and worker incomes and job support schemes are needed, but at the same time security about what will happen in the future, in order to reduce uncertainty and anxiety. Therefore, the most effective mental health responses are those that reduce uncertainty arising from job insecurity, provide safety nets against loss of income, ensure the protection of those workers who become unemployed and prevent over-indebtedness. But international experience also suggests that in situations of social conflict, health crisis and economic recession, social policies aimed at restoring social links and strengthening social cohesion become very important to mitigate the effects on mental health.

	We need a syndemic perspective to understand the impact of this triple social, health and economic crisis on mental health, a dimension of life that will be affected for much longer than physical health. As stated in the National Mental Health Strategy developed by the University of Chile, "mental health is one of the keys to surviving this pandemic".

	-o-