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How COVID-19 Changes Our Understanding of Mental Health

The mental health syndemic gives us a mandate to prioritize mental health care.

Key points

  • The stress of dealing with COVID-19 has long-term implications for our mental health.
  • Burnout, depression, anxiety, PTSD, and other mental health issues are becoming more prevalent.
  • It's time to prioritize mental health care and reduce the stigma around getting help.
Polina Tankilevitch/Pexels
Source: Polina Tankilevitch/Pexels

In the early months of 2020, city after city, country after country, began to lock down; businesses were closed, schools shut down, and public events canceled. As each of us began an undefined quarantine, all of us were asked to drastically change our lives, often isolating us from critical support networks like close family and friends. Regardless of our level of privilege or security, we all took immediate and damaging hits to our psyche. There was so much fear in the unknown; even the experts had limited information on how the virus was transmitted, what the symptoms were, how to treat patients, and what interventions were most effective.

Our bodies physically responded to COVID-19 the same way we respond to any immediate threat, like an earthquake or flood: We went into survival mode. This adaptive response is beneficial in the short run, as the sequence of hormonal changes and physiological responses in our bodies prepare us to face the unknown.

But though survival mode may be useful in a car accident or a weekend encounter with a bear, it has a wealth of ill effects in a situation where we stay in survival mode for too long. Persistent adrenaline surges damage blood vessels and arteries, increase our blood pressure, and raise the risk of heart attacks and strokes. When that extra adrenalin and energy isn’t used up in fight or flight, we’re left nervous, jittery, and with a general sense of anxiety that is near impossible to shake. It also leads to insomnia or trouble sleeping, which, in turn, has its own far-reaching impact on our mental health.

The effects of COVID-19 on mental health

Beyond the clinical impact of the disease, the most immediate effect the pandemic has had on all of us, no matter what our background, is the toll it has taken on our mental health. As the pandemic progressed, we were able to quantify anecdotal evidence of increasing mental health conditions with data. According to the Kaiser Family Foundation, 4 in 10 adults in the U.S. have reported symptoms of anxiety or depressive disorder during the pandemic, a dramatic increase from the 1 in 10 figure reported from January to June 2019.

As the pandemic began to impact the economy and the layoffs, furloughs, and pay cuts were rife, many of us were hit with financial stress in addition to anxiety about our health and safety. Research from prior economic downturns shows that job loss is associated with increased depression, anxiety, distress, and low self-esteem. Aside from the financial impact of unemployment, many see their work as a fundamental part of their identity and struggle to find purpose and fulfillment during a time of isolation and few distractions.

Even those who have not been impacted financially or have experienced the loss or illness of a loved one have still had their lives disrupted and live with the daily uncertainty that the pandemic brings. In a CDC survey of 5,412 Americans during June 2020, 40.9 percent of respondents reported at least one adverse mental or behavioral health condition, including symptoms of anxiety disorder or depressive disorder (30.9 percent), symptoms of trauma, and stress-related disorder arising from the pandemic (26.3 percent).

Of course, different demographics have been affected in different ways by the pandemic. With the closure of schools and offices, parents were left to bear a particularly heavy burden, caring and calming children who had been locked out of their schools, all while struggling to transition to remote work. Single parents who worked on the frontlines had to make unbearable choices, leave younger children home alone or risk unemployment and a lack of income. Even parents who could continue to work while at home with school-age children and the ones that didn’t work at all felt the pressure—levels of stress, anxiety, and depression among parents are on a steady rise.

Health care workers have endured unimaginable moral trauma, risking their lives to care for COVID-19 patients, often without sufficient PPE. In return for their service, they have watched members of the public carelessly violate public health guidelines. For many months, they witnessed inaction by leaders and then tangibly experienced the impact as hospitals filled up with COVID-19 patients, which will undoubtedly contribute to their PTSD.

Young adults appear to have been hardest hit by loneliness, anxiety, and depression. A CDC online survey indicates that young people between the ages of 18-24 are more likely to suffer mental health problems during the pandemic than any age group. According to this survey, 63 percent of young people are suffering significant symptoms of anxiety or depression. Nearly a quarter of respondents reported that they had started or increased their abuse of substances, including alcohol, marijuana, and prescription drugs, to cope with their emotions. Many have been robbed of the critical developmental experiences that teenage and young adult brains are wired for.

While anxiety and depression have been frequent topics of discussion during the pandemic, less time has been spent analyzing how vulnerable many will be to developing post-traumatic stress disorder as a result of the pandemic. Perhaps this is because we are still deeply immersed in the crisis, that we are unable to anticipate future damage, or that we typically associate PTSD with military combat.

COVID-19 has created so many stressors, from strained finances to grieving the death of loved ones to the moral trauma of global leaders mishandling or ignoring the crisis. It is highly likely that an unprecedented amount of people have and will experience PTSD related to the effects of COVID-19. A recent study demonstrated the prevalence of PTSD in 30.2 percent of patients after acute COVID-19 infection, but it is not just the infected who will suffer.

Paying attention to mental health

However, with every crisis comes opportunity. The pandemic has played an important role in destigmatizing mental health issues, turning a spotlight on the need for more integrated care, where attention is paid to the physical, mental, and social needs of every patient. Issues like substance abuse and addiction and domestic violence are at the forefront of more conversations.

The syndemic of mental health conditions gives governments around the world a mandate to introduce unprecedented and ambitious mental health care policies. We need to be rapidly expanding the mental health care workforce to meet an influx of patients and protect providers against burnout. Concurrently, we need to look for opportunities outside traditional health care settings; we need to be investing in community health programs and start thinking about how to conduct screenings and provide support through schools, workplaces, religious groups, and other community organizations. Finally, we need to acknowledge the mental health impact of economic relief and social support policies; for some, easing financial stressors can be more impactful than therapies like counseling.

The psychological scars of COVID-19 will likely outlast the pandemic itself, and as we take steps towards recovery, we must be mindful of the multitude of mental health issues that have or will emerge. But by looking at mental health as the foundation of all health care and prioritizing it accordingly, we can emerge as a healthier society.

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