The impact of COVID-19 on diseases of despair
By Nico van Zyl and Paul Edwards
Hannover Re
Understandably, there has been a focus in medicine and among governments on dealing with the devastating impact of the pandemic. However, there is less comment about the psychological effects of social isolation, the tsunami of grief as people cope with losses – all dovetailing with financial chaos, unemployment, and business closures. So how might all of this fuel a rise in diseases of despair? And what are the considerations for the insurance market on possible impacts on claims?
What are diseases of despair?
In 2015, economists Anne Case and Angus Deaton revealed their analysis of US mortality trends between 1983-2013, divulging shocking results. Historically, mortality trends were improving, but for certain groups – particularly white middle-aged Americans without a university education – the reverse was true. These results showed that, for the first time in a century, mortality rates were rising. Case and Deaton attributed this increase to rises in ‘diseases of despair’ – deaths and ill-health caused by drug poisoning, particularly opioid-related abuse, alongside rises in alcoholic liver disease and suicide.
Mental health
Mental health, encompassing depression and anxiety as well as other conditions, has understandably seen an impact in correlation to the pandemic – and this is the same for many regions around the globe.
While initially, the UK Mental Health Foundation reported that in August 2020, 64% of people were coping well or very well with the pandemic, this rate of ‘resilience’ appeared to diminish with time, falling to its lowest level in late November 2020. More so, the Office for National Statistics (ONS) COVID-19 study shows a rate of moderate-severe depression at 19.2% versus a rate of 9.7% in the 9 months before the pandemic onset. Still, it is notable to mention that the University College London’s COVID-19 Social Study shows an overall conclusion of a decrease in depression and anxiety scores, a pattern repeated across every subgroup.
This is a just glimpse of various mental health research efforts carried out during the COVID-era, but the extent of the impact so far remains unclear, and the effects on mental health and wellbeing are likely to continue to make themselves known over time.
Suicide
The impact of the pandemic on suicide and suicidal thoughts, the most severe indicator of psychological hardship, is also starting to emerge.
In the UK, the Mental Health Foundation survey indicated that 8% of respondents felt suicidal in April 2020, rising to 12% by the December 2020 lockdowns. Yet, UK’s ONS registered 10.3 suicides per 100,000 people between January and March, equivalent to 1,262 registered deaths; and 6.9 suicide deaths per 100,000 people between April and June, equivalent to 845 deaths. This data suggests a fall, however, not all suicides are investigated by a coroner, and it often takes around five months to hold an inquest before a death can be registered.
Elsewhere around the globe, the picture is mixed. Several case studies have suggested elevated numbers of suicides have occurred as a direct result of the pandemic in India, China, Saudi Arabia, Germany, and Italy.
Although suicide reports are globally different, it’s noteworthy to recall that during hard times, such as with previous recessions, a time lag between the effects of economic shock and its impact on suicide rates is not without precedent.
Alcohol misuse
Another indicator of mental and physical health is alcohol use, and initial research has been conducted to assess whether drinking may have been utilized as a coping mechanism over the past year during the pandemic. According to a BBC survey in the spring of 2020, 30% of respondents reported drinking more to cope with stress; in addition, the British Liver Trust reported a 500% rise in calls to its helpline.
However, a study by Anderson and colleagues looking at purchase patterns in the UK showed only a modest 0.7% increase in alcohol purchased. Similarly, an Australian survey noted that while a fifth of respondents said their consumption fell, around a quarter stated that it increased – and of those ~8% markedly so.
It’s important to highlight that those with pre-existing alcohol troubles may have encountered a more significant impact. In the US, rates of hospitalization for alcoholic liver disease have increased by 30-50% since March 2020.
Drug abuse
One of the cornerstones of the disease of despair concept when it was initially coined was the explosion in drug-related overdoses in the US.
The pandemic seems to have exacerbated an already existing problem; the US Centers for Disease Control reports some 81,000 drug-related deaths in 2020, the highest-ever recorded figure. However, in the UK, drug-related deaths were at their highest before the pandemic and the rate of growth seems to be flattening, according to a Mental Health Foundation survey.
Along with a falloff in demand, the leveling result could be related to a fall in supply – reflecting the collapse as international travel combined with stricter border controls.
Conclusion
It is reasonable to conclude that the phenomenon of ‘diseases of despair’ is indeed real; however, the impact and extent differs by nationality but also crucially by demographics within nations.
And as for the impact of COVID-19, overall, societies seem to be resilient, but we must recognize the increased rates of alcoholic liver disease, drug use and thoughts of suicide heightened in parts of the global community already blighted with problems of unemployment, poverty and inequality.
Insurance claims directly attributable to COVID-19 have undoubtedly risen, death claims being the most obvious, but coma and intensive care claims on critical illness, and of course IP for COVID-19-related work absences are likely to rise too. However, claims from the indirect impacts of the pandemic, which would include diseases of despair, are largely yet to emerge. We may see a rise in suicide claims on our mortality books as the financial impact of the crisis takes hold, or in CI claims for heart attack for example – perhaps related to stress or liver failure.
Therefore, the insurance industry needs to be vigilant to detect any such emerging trends while also ensuring an approach that is fair and sympathetic towards claimants.
Dr. Nico van Zyl, MBBCh, MSc
Vice President & Chief Medical Director, Hannover Re
Nico has been with Hannover Re Group since 2011. He joined the Hannover Re US in 2017, moving across from his previous role as Chief Medical Officer within Hannover Re’s South African subsidiary. Nico’s work focuses on innovation projects including automated underwriting systems and the use of new technology in clinical and insurance medicine. Nico holds a medical degree from the University of the Witwatersrand Johannesburg, South Africa and a Master of Health Informatics degree from the University College London (UCL).
Paul Edwards
Underwriting Research and Systems Development Manager, Hannover Re
Paul Edwards runs the Underwriting Research and Systems Development team in the Hannover Re Life UK. The team works closely with actuarial colleagues on Biometric and epidemiological research related to Critical illness and mortality and is responsible for the local content of the UK version of Hannover Re’s underwriting manual Ascent and underwriting rules engines. He has worked at a number of companies both in the direct and reinsurance sectors.
