MILAN — Elena, a single mother of three living in northern Italy, nearly lost her life to the coronavirus — without ever being infected.
Even before the pandemic, Elena found that financially supporting her family was a delicate balance. She worked a mix of odd jobs, often paid off the books, that left her with little to spare.
That balance tipped into disaster in March, when Italy’s economy shut down in March to rein in the virus’ spread. For months, Elena had no income. She watched her bills stack up and struggled to pay for her weekly food shopping. The future looked bleak and uncertain.
Then one afternoon in early May, as the governments started to lift some restrictions, her eldest son found her unconscious on her bed. She had ingested poison and tried to take her own life.
She was rushed to the hospital in time to save her life, said psychologist Damiano Rizzi, president of the Soleterre Foundation, a nonprofit organization working with doctors and patients in the COVID-19 wards and in intensive care at the San Matteo hospital in the northern Italian town of Pavia. He is helping Elena’s family, fragile and exhausted by the anguish brought on by the pandemic, to recover and chart a way forward.
“The little ones have the ability to be resilient, it’s the adults that struggle the most” — Maria Grazia Masulli, primary school teacher in Pavia
Elena’s case is not an isolated one. Since March, Italy has seen 71 suicides and 46 attempted suicides related to financial stress. It’s a stark increase compared with the same period in 2019. Experts attribute it to the pandemic.
With a coronavirus vaccine not expected until next year at the earliest, psychiatrists gathered for an international conference on suicide in Rome earlier this month. They raised the alarm that the pandemic is taking an increasingly heavy toll on people’s mental health.
Beyond the well-documented difficulties of managing the initially strict confines of life in lockdown, people are now struggling with different, more long-term problems: managing the effects of the global crisis on their finances and other stressors caused by prolonged social distance, grief and illness. In some cases, these difficulties are also worsening pre-existing psychological disorders.
According to experts, thousands in Italy are experiencing spikes in anxiety, depression and even symptoms of post-traumatic stress as a result of the pandemic and the changes it has wrought on their daily lives.
In Italian media, some have embraced a hopeful mantra of, “We’ll come out better on the other side.” But for many, six months into a crisis that shows no signs of having an easy resolution, that seems like an increasingly fanciful idea. They are asking: Will we really?
“This is too big of a question to answer,” said Rizzi. “It is certain that the pandemic has changed the way people and families live.
“The next few months could be even more delicate from a psychological point of view, because the negative effects that the health emergency will have on the economy could become worse,” he warned.
In Italy, for example, the social safety nets that have been keeping people afloat will be removed in November, meaning many are likely to lose their jobs. The most vulnerable, from a mental health standpoint, risk “collapse,” said Rizzi.
Only those with sufficient economic resources — and enough understanding of mental health issues to set aside the stigma many still attach to it — are likely to seek help, according to Rizzi. “Others are often left alone,” as public resources are slim: Budget cuts to the field mean Italy spends only 3.2 percent of overall health expenditure on mental health resources, compared with a European average of 5 percent.
The pandemic has left no one untouched: nurses and doctors, patients, workers, parents, children, the elderly. And for some, as Italy’s economy struggles back to life and children head back to school, the emotional toll of what they went through in the first months of the crisis is only now hitting home.
“The children are full of enthusiasm, they had a great desire to go back to school and to meet up with each other,” said Maria Grazia Masulli, a primary school teacher in Pavia. “They already accepted the new rules and made them their own. The little ones have the ability to be resilient, it’s the adults that struggle the most.”
September has been a month of reckoning for a lot of people, according to Giulio Costa, a psychologist and psychotherapist who works with the hospitals in Lodi, Codogno and Casalpusterlengo, municipalities that were hard-hit early on in the crisis.
Italy was struck hard by the coronavirus back in March 2020 | Antonio Masiello/Getty Images
“Now the emotions experienced and memories that belong to March and April are being processed,” he said. “In between, there was the summer that suspended everything.”
Some health workers, even if they do not want to be thrust back into the trenches, are experiencing what Costa calls “the post-COVID blues” — a form of depression brought about by post-traumatic stress.
“While they were in the eye of the storm and in the hyperactivity of having to save others — and the media talked about them as ‘war heroes’ — some emotions of fragility and fatigue were frozen,” Costa said.
When the immediate emergency ended, the spotlight dimmed and “tiredness, fatigue and anxiety and in some cases a feeling of uselessness” set in. Some even feel nostalgic for that time of urgency, Costa said, because they no longer feel useful and carry “a strong sense of inadequacy” around with them, the feeling that they could have done more. He said he remembers scenes of doctors and nurses crying in the hospital hallways.
Gaia, a nurse who works at a major hospital in Milan, said that, before going to sleep, she sometimes thinks about what her patients were trying to tell her from under their oxygen masks and all the words she couldn’t make out. She still feels guilty, she said, that she couldn’t always help them communicate with the wives, sons, sisters who were at home waiting to hear from their sick.
“I still have all the frightened eyes of those people impressed in my mind, and I just tremble at the idea of having to repeat what I saw in March” — Gaia, nurse who works in Milan
People are also increasingly gripped by worries of what may be yet to come.
If Italy is not yet talking about a second wave, the steep increase in numbers elsewhere in Europe — including in France and Spain — is sparking fears of another lockdown and a surge in deaths during the winter.
“I still have all the frightened eyes of those people impressed in my mind, and I just tremble at the idea of having to repeat what I saw in March,” said Gaia.
In the public at large, now more aware of how the virus works, many are afraid “that others will contaminate them, that others are a possible threat,” said Rizzi, the president of Solterre. “People are afraid to go back to work, to take public transportation, they are afraid of being infected.”
“If there is one thing that this pandemic has done, it is to have confronted us with the idea of [our own] limits — of mortality and of the fact that we don’t control everything,” said Costa.
“We are a society that has avoided failure, pain and loss,” he added. “Let’s put it like this: This is a small, painful reminder.”