The Psychological Impact of COVID-19

Source: Joy Osofsky, used with permission

The pandemic has affected us all in one way or another, but for some it may be difficult to identify just how much they have been impacted. In this interview, Dr. Osofsky shares some of her work on COVID-19 and how we can apply it to our lives.

Dr. Joy Osofsky is a psychologist and psychoanalyst and Professor of Pediatrics and Psychiatry at Louisiana State University Health Sciences Center in New Orleans. She is Head of the Division of Pediatric Mental Health. She is also an Adjunct Professor of Psychology at the University of New Orleans.

Jamie Aten: How did you first get interested in this topic?

Joy Osofsky: I have been working intensively on the psychological and social impact of disasters since I served as Clinical Coordinator for Child and Adolescent Initiatives for Louisiana Spirit, the Crisis Counseling Program following Hurricane Katrina in 2005, and as Co-Director of the Mental and Behavioral Health Capacity Project following the 2010 Deepwater Horizon Oil Spill. With the COVID-19 pandemic, I became interested in the similarities and markedly different impacts on adults, children, families, and communities from natural and technological disasters.

In studying the impact of COVID-19, it is striking how—similar to the effects of Hurricane Katrina and other major disasters—people with fewer economic resources to protect themselves (and their loved ones) and those with fewer opportunities are at higher risk of becoming sick, and if they do become sick, have a higher likelihood that the illness will be fatal. COVID-19 has once again strikingly highlighted the inequities in our cities, states, and country. Some of the more significant differences with COVID-19 compared to other natural and technological disasters is the continuing uncertainty. The stay-at-home requirements and social isolation to control the spread of the virus, unpredictable illness and death of loved ones, continuing impact on education for children, and the wide range of impacts across the country make it so that support cannot be provided by those in areas not affected.

JA: What was the focus of your study?

JO: I have lived in New Orleans, Louisiana, for over 30 years, originally being from the Northeast. While very much enjoying the “charm” of this southern city, I have wondered why Louisiana and Mississippi have consistently been ranked number one and two for poverty in the United States. A main focus of my professional career has been to help others through studying and gaining an understanding of the effects of trauma on individuals, including children, families, and communities.

I have had a long-standing interest and concern related to issues of social justice. I have asked knowledgeable colleagues that same question posed above, and the answer that I’ve received is “historical trauma,” meaning “the cumulative emotional harm of an individual or generation caused by a traumatic experience or event.” I have learned in my work over the years that trauma has a strong influence on a child’s physical, emotional, and cognitive development and that experiencing trauma early in one’s life has even more of an impact. And with cumulative traumatic experiences, especially when they begin early in a child’s life, that child as an adult may have more difficulty overcoming adversities than another individual who has not experienced trauma or who has had the opportunity to find the support needed to overcome adversities. I have also been interested in learning more about protective factors and promotive factors that contribute to resilience.

JA: What did you discover in your study?

JO: We found that the social and psychological impacts of COVID-19 are strongly influenced by the racial and socioeconomic inequities related to both COVID infections and deaths. In our earlier work following Hurricane Katrina, similar inequities were seen; however, these effects are even more apparent with the COVID-19 pandemic.

The commentary brings to the reader’s attention that COVID-19 is not only a public health pandemic but also is contributing to mental health issues that need to be addressed to support recovery. The pandemic has also exposed the significant health inequities that have contributed to increased numbers of infections in lower socioeconomic groups and Black communities. Services to support recovery should include Psychological First Aid to address expectable stress and anxiety, sleep problems, adjustment to social distancing, and the many changes for individuals and families. Self-care is crucial to support health and mental health, which starts with establishing regular routines for this “new normal” environment that include getting enough sleep, eating regular meals, exercise, and making connections virtually with family and friends.

JA: Is there anything that surprised you in your findings or that you weren't fully expecting?

JO: We originally thought, as others did, that with COVID-19, the greater impact would be on individuals labeled as more vulnerable related to age and underlying health conditions. Indeed, for older people with underlying health conditions, if they become ill, they are more likely to have more difficulties. However, we have also learned that socioeconomic status and race are also very important issues contributing to vulnerability.

Individuals with fewer resources and those who are Black do not receive the same general medical care and preventive medical care that contributes to better health. Therefore, with the COVID-19 pandemic, they, too, were much more vulnerable, resulting in more infections and deaths. Also, people of lower socioeconomic status have to work in “essential” jobs and cannot work remotely, allowing for fewer opportunities to stay safe, limit exposure to others, and prevent infections. When they become ill, their medical care may also be compromised.

JA: How might readers apply what you found to their lives during COVID-19?

JO: An important message from our paper is raising awareness of ways to support individuals and families during this difficult COVID-19 pandemic and ways to adjust and cope with this “new normal.” COVID-19 is both a public health and mental health crisis. Therefore, it is important to find ways to support individuals, children, and families, and those who may be supporting others while also recognizing the need for self-care.

Another important message is the recognition that COVID-19 is impacting individuals in different ways depending on socioeconomic status, race, ethnic group, and gender, with some groups experiencing much more disease and death than others. We hope that our findings broaden readers’ understanding of the ways that systemic racism impacts not only social and psychological issues but also health care and health outcomes. We hope that the readers will learn from the importance of working to create increased equity for health and mental health care.

JA: How can readers use what you found to help others amidst this pandemic?

JO: In supporting individuals impacted by the COVID-19 pandemic, it is important to recognize that we are not able to fully utilize the methods and strategies that have been successful in providing support during other natural and technological disasters. Because of the need for social distancing, we are more limited in our ability to reach out directly to others to provide support. This pandemic has taught us that in order to help others, it is important that we all develop increased sensitivity about ways to reach out and understand the needs of the individuals for whom we are trying to provide services and how they may perceive us.

We need to learn to be more sensitive, respectful, and non-judgmental of others who come from different backgrounds in order to provide help when needed. We also need to recognize and incorporate what we have learned from the effects of the COVID-19 pandemic into our thinking that is not just a public health but also a mental health crisis. We also need to listen to the needs of individuals are following the pandemic, just as we have been able to do after disasters, in order to be most supportive and helpful.

JA: What are you currently working on that you might like to share about?

JO: I am currently working on gaining more understanding about ways to provide support to adults, children, and families virtually to help with both adjustments and recovery given the life changes resulting from COVID-19. I am doing training and supervision to also help others who are providing virtual mental health services. I have been thinking about incorporating the interventions that were most successful in understanding and providing support after natural and technological disasters for which I have had much experience over many years and ways to adapt those strategies now for the pandemic.

While many clinicians are gaining more experience and expertise in providing support and services virtually, in my experience following other disasters, it is often difficult for individuals to ask for mental health support and help. We also know from our experience with other disasters that people often feel like they should be able to manage on their own. When we can reach out directly, we are able to provide support that is generally more acceptable.

We also are aware of the unusual situation that everyone is impacted to some extent by COVID-19, so the usual “helpers” from other states or regions of the world, who are usually not impacted, cannot be available to help others. With COVID-19, all people are impacted in one way or another, which can contribute to feelings of isolation and, sometimes, helplessness and hopelessness. It is crucial that mental health professionals try to be as available and flexible as possible in providing support to others at this time.