A bill to provide resources and programs to improve mental health and prevent healthcare worker suicide has been introduced in Congress with bipartisan support.

The Dr. Lorna Breen Health Care Provider Protection Act addresses longstanding mental health woes in healthcare that have been compounded by the coronavirus pandemic. According to the office of principal sponsor U.S. Sen. Tim Kaine, D-VA, the bill:

  • creates grants to train students, residents, or healthcare professionals in techniques to improve well-being and prevent suicide, burnout, mental health conditions, and substance use disorders;
  • identifies best practices for reducing and preventing suicide and burnout among healthcare professionals, teaching these techniques, and promoting their mental and behavioral health and job satisfaction.
  • creates a national education and awareness campaign to encourage healthcare professionals to seek mental health support and treatment;
  • creates grants for employee education, peer support programs, and mental and behavioral health treatment (providers in COVID-19 hotspots are prioritized);
  • begins a comprehensive study on healthcare professional mental and behavioral health and burnout, including the effects of the COVID-19 pandemic.1

The bill is named after Lorna Breen, MD, an emergency physician at NewYork-Presbyterian Allen Hospital who died by suicide last year after contracting COVID-19. Breen contracted the virus treating patients as New York City was overwhelmed by the first wave of the virus. Her sister, Jennifer Breen Feist, JD, who has formed a foundation in Breen’s name and supports the federal legislation, told how COVID-19 changed her sister at a press conference last year.

“Lorna was always tough and smart, and very active,” Feist said. “She always wanted to be an emergency physician in Manhattan. For the first 49 years and six months of her life, she showed no signs of depression or anxiety. That changed after she got COVID.”

Does COVID-19 Cause Suicidal Ideation?

While we do not know the medical details of Breen’s case, a researcher in New York is studying the effects of SARS-CoV-2 infection on the brain. One emerging theory is the virus can cause suicidal ideation if it breaks the blood-brain barrier and attacks cognitive function.1 This might be preceded by an inflammatory immune response, a severe cytokine storm that disrupts the blood-brain barrier and allows the coronavirus access to the brain, explains Maura Boldrini, MD, PhD, director of the human neurobiology lab at Columbia University Irving Medical Center and the New York State Psychiatric Institute.

“Also, in the vascular [system], there are these angiotensin-converting enzyme 2 (ACE2) receptors that the virus uses to get in,” she says. “That can be an access point, [then] the virus induces alterations in the capillaries in the brain, which can result in little strokes.”

This damage may occur even in mild cases, meaning COVID-19 severity is not necessarily a predictor of the threat of damage to the brain. “The patients we see who have brain symptoms are not necessarily those who were intubated or were severely compromised,” Boldrini explains. “It is not about the lungs — it is about the immune response to the virus and how it goes into the brain.”

The condition can manifest across a spectrum of symptoms and behaviors. Some patients in the hospital suddenly become paranoid, although they never displayed the condition before in their lives.

“There been a few recent cases of suicide after COVID,” she says. “People who had mild COVID then had some brain symptoms. There was a case of the owner of a restaurant chain. He had COVID and recovered. He had tinnitus, and all of a sudden he killed himself. We had a case in our hospital in an ER doctor early on in the pandemic. She [contracted] COVID, recovered, and then came back to work. She also killed herself. The family in both cases said they didn’t have a history of psychiatric illness.”

The lack of a history of psychiatric problems suggests the SARS-CoV-2 virus in the brain can cause damage, triggering suicidal ideation.

“Someone in San Francisco reached out to me this week,” Boldrini says. “There was a similar case of a college student who killed himself after a mild COVID infection. This reminds me of what has happened to the football players with CTE [chronic traumatic encephalopathy]. CTE is a neurodegenerative disease linked to repeated blows to the head. This is a different mechanism — the brain damage is due to a combination of inflammation and micro-strokes. These can go in any area of the brain, and depending on what region it affects, people may change their behavior.”

A Neurological Condition

To clarify, Boldrini is describing something distinctly neurological and a chemical alteration — not just general depression caused by dealing with the pandemic and infected patients.

“The fear of the pandemic and getting the virus is another level of stress,” she says. “That is not enough by itself for most people to [consider suicide]. There is something happening at the chemical level where the brain cells cannot communicate with each other in the right way.”

REFERENCES

  1. Kaine leads colleagues in bipartisan, bicameral legislation to support health care workers’ mental health amid COVID-19. March 4, 2021.
  2. Boldrini M, Cannoll PE, Klein RS. How COVID-19 affects the brain. JAMA Psychiatry. March 26, 2021. doi:10.1001/jamapsychiatry.2021.0500