DIELLI EXCLUSIVE INTERVIEW WITH DR. BASHKIM KADRIU

COVID AND ITS IMPACT ON MENTAL HEALTH

Interviewed by Rafaela Prifti

“The impact of COVID-19 pandemic has affected all facets of society. Yet the toll is uneven for vulnerable individuals, those who struggle with chronic conditions, disabilities, and those with severe mental illnesses. My concern is that this impact will continue to be present in our lives in years to come.” 

Bashkim Kadriu MD, FACP, currently holds the position of Director, Clinical Leader, Neuroscience Experimental Medicine (Neuroscience Therapeutic Area) at Janssen Research & Development, La Jolla, California. Previously he has served as Acting Deputy Director at the Office of Clinical Research, and Clinical Fellow and Neuroscientist at the Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, NIH, Bethesda, being the first Albanian Physician-Scientist at the prestigious research institute.

After completing your medical school training at the University of Prishtina, Kosova, you relocated to Chicago. For nine years, you worked as research postdoc and scientist at Chicago’s University of Illinois and later at Albert Einstein College of Medicine, New York City where you completed your Psychiatry Residency training. You received a Fellowship at the National Institute of Mental Health, Bethesda. What were some of your previous interests? 

My work at the University of Illinois in Chicago focused on studying the epigenetic regulation of risk genes in diseases such as schizophrenia and mood disorders, while my later work at the National Institute of Health consisted on the neurological correlations on treatment-resistant mood disorders with an emphasis on discovering biosignatures that guide novel fast-acting therapies that help individuals suffering from depression and mood disorders. I was fortunate to work with some of the best leaders who mentored me through the years and guided me into publishing my work at high-impact reputable journals. I have published over 55 peer-reviewed journal articles, several book chapters and presented work at prestigious scientific journals and conferences in the field. 

You are certified by the American Board of Psychiatry and Neurology and have received numerous awards for exceptional clinical care and professional accolades including a recent NIMH Dr. Richard J. Wyatt Award for Translational Research and NARSAD Investigator Award from Brain and Behavioral Research Foundation. You were granted US citizenship through the path of exceptional accomplishments in science. Recently you relocated to the West Coast where you have accepted a new position. What was the adjustment like for you under the circumstances? What has been the focus of your work recently?

Yes, indeed I moved to Southern California in the last 2 months and I have been adjusting slowly but no without challenges. I recently moved to industry where I landed a job and my work currently focuses on early drug discovery in relation to mood disorders. This has been a tough time for everyone, especially at the height of an ongoing world pandemic. Personally, the biggest challenge of my moving to the West Coast was leaving my patients, although I still continue to provide care for some of them through the telemedicine platforms, which took off during this pandemic. Coming from academia to the industry takes some adjustment but the overall transition here has been smooth. It is my hope to continue the research of developing new and better treatments for patients who suffer from severe mental illnesses. 

Due to social restrictions and isolation regime imposed by the CDC guidelines, groups of individuals such as seniors and special needs are especially vulnerable. Particularly individuals with a compromised mental health are in a precarious situation. One tragic element is the number of suicides. According to studies done in the past on suicide prevention, you have stated that in the last 20 years there has been a 30% increase in the number of suicides in the US. What are some other findings of the study?

Unfortunately despite the research and advances in suicide prevention, the rates of suicide have seen an increase in the US over the years. Based on previous assessments, a large portion (~90%) of individuals who commit suicide have an ongoing mental illness. Aside from the devastating loss of life, the impact of mental health illnesses in America comes with a high economic cost of around 1 trillion dollars as a consequence of missing workdays, lower productivity and the expenses incurred by hospitalization and the treatment of such conditions. 

Self-isolation and the limiting of social interactions continue to have major impact on the mental health of the population. Have there been studies that focus on the topic? 

As a rule, major crisis have an enormous impact on the public health. Some of the examples is the financial collapse of 2008 or other critical disruptions of daily lives cause or are associated with a significant increase in mental disorders. Among the most exposed groups are the front line health workers, who deal with the pressures of increased workload in the number of patients that need medical care and attention but also the daunting levels of stress and exhaustion, physical, emotional and mental. Studies conducted in Asia, Europe and most recently in the US have shown that front line workers, the medical staff in charge of COVID patients have experienced and exhibited symptoms of serious depression, anxiety and sleep disorders. Some studies published in Lancet found that 50% of the patients that underwent ICU treatment due to Coronavirus experienced PTSD, amplified by the social isolation or quarantining before and after hospitalization. When it comes to general population, the health pandemic has impacted all facets of society. Yet the toll is uneven for the vulnerable population such as individual who suffer with struggle with chronic conditions, disabilities and those with severe mental illnesses.

What is your concern with respect to that particular segment of the population?

My concern is that the impact will continue to be present for years to come. We are already seeing the impact of loneliness, social isolation, disruption of daily routines and the lives caused by the pandemic. The latest numbers issued by CDC and NIMH show a staggering increase in rates of depression, anxiety, and suicide cases here in the US and elsewhere. I fear that these trends will continue to rise in months ahead as the pandemic effects continue to be present in our lives. 

You have stated that the symptoms experienced at this extraordinary time are not unlike the signs manifested by post-war societies in the post-conflict period. Drawing a parallel with the home countries like Kosova and Albania, you have shared your personal experience during the Kosova conflict and the isolation from the outside world. 

Even though there has been two decades since the days of the NATO bombings, the enormous impact of that experience is long lasting in the psychological and mental context. I made the analogy with the current situation in the sense of the repercussions and influence on the population. One positive outcome out of this situation is the lowering of the stigma associated with mental health as more and more people find themselves in similar circumstances and in need of dealing with post-traumatic stress disorders caused by a global pandemic. For medical personnel this could mean finding better ways to help those who are in need of treatment, without fear of being stigmatized. 

Can you elaborate on your analogy with the Kosova war in relation to mental health and well-being?

Well, although the two experiences are completely different, as someone who endured a long pre-war conflict and experienced 78 days of NATO air strikes in Kosovo, I drew a parallel with the pandemic-related isolation as well as the associated element of fear of uncertainty and ‘the fatigue’ people experience over time. As tough as it is, we are gradually adapting to the new normal, learning to deal with the unpredictability of our daily routine and inability to plan our future. The new vaccine in the horizon offers hope that we are seeing the beginning of the end of this pandemic that devastated many lives and ravaged many families. 

You have underscored the importance of being aware of one’s state of mind and emotions. What’s your advice to minimize the effects on mental health in terms of recognizing depression symptoms and take mitigating steps?

Some signs or indications of depression include increased anxiety, sleep disorders, fatigue and loss of interest or motivation. It is very important to set a goal and follow through with it. Under the current circumstances, when daily routines are disrupted, it is very helpful to have an activity that helps you stay energized which gives a sense of purpose and motivation for your general well-being. 

A study conducted by the University of Oxford found that 1 in 5 diagnosed with COVID have a subsequent psychiatric diagnosis in the following 14 to 90 days. The research compared patients recovering from COVID with those recovering from other medical events such as the flu. Can you explain the study for our readers?

I read that study, and the findings there seems staggering from many angles. This study measures the incidence and hazard ratios for psychiatric disorders, dementia, and insomnia, during the first 14 to 90 days after a diagnosis of COVID-19. Individuals affected and recovering from COVID compared to those of influenza (common flu) report significant increased rates of physical and mental fatigue, memory/concentration issues, headache, pain, insomnia, as well as higher rates of anxiety and depression. While these findings are worrisome in many aspects, controlled longitudinal designs studies are needed in the future to see if these findings hold for longer period of time and how they may affect our mental and physical health. 

The same study found that the relationship between mental illness and COVID-19 is actually bidirectional, people with psychiatric diagnosis were about 65% more likely to be diagnosed with COVID-19 than people without. What have you seen in your line of work?

In my line of research and expertise as specialized clinician, we do notice that individuals with severe mental illnesses have weakened immune system and increased rates of medical comorbidities such is obesity, hypertension, diabetes etc. There is also finding indicating that in a subset of patients who suffer from depression or bipolar disorder, there is an immune based  etiology triggering their individual symptoms. Thus, it is not surprising that individuals struggling from psychiatric illnesses have higher rates of COVID-19 incidence.

While most of us may experience fatigue or some sense of anxiety during the time of the pandemic, the study is talking about a diagnosis. Can you explain the difference?

Feeling some sense of anxiety, stress and being preoccupied with the future is often just a normal response, in fact it is the reason why we wake-up every day and get going to carry out our routines. This pandemic has taken a heavy toll on all our lives. So, experiencing heightened-level of stress and anxiety is normal. However, anxiety becomes pathological when it is excessive and disproportional to the situation, when it occurs most of the days and lasts over weeks to months. Generalized anxiety impacts personal health, daily routine, social interactions and other domains of daily life circumstances such as sleep, ability to focus and concentrate, feeling nervous or restless and even panic symptoms at times. If anyone experiences these symptoms, please pay attention to it and seek medical help to a local provider, therapist or psychiatrist.

And what is your message to the community?

To the Albanian community here in US and beyond, I say to focus on helping each-other and, being there for our loved ones, family, friends, and fellow countrymen. More than ever, we really need to raise awareness in our community about the detrimental impact that untreated mental illnesses may cause to our families and daily lives.

Thank you for the work that you do and for the interview!