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The Mental Health Impact of COVID-19

Lessons from 1918 and the Stoics.

It would be interesting to know more about the mental health consequences of the 1918 pandemic, but there is little data. Historically, it was the end of World War I; the mental health impact of the war, too, was poorly studied. Alfred Crosby’s 1976 book Epidemic and Peace addressed the kind of "cultural amnesia" that followed in the wake of the pandemic. Crosby’s book was later republished in 1989 with the title America’s Forgotten Pandemic: The Influenza of 1918.

Greg Eghigan, Ph.D., is a professor of the history of psychiatry and mental health at Penn State University who addressed some of the mental health issues from the 1918 pandemic in an article in the Psychiatric Times entitled “The Spanish Flu Pandemic and Mental Health: A Historical Perspective.” Eghigan cited the work of Norwegian researcher Svenn-Erik Mamelund, Ph.D., who reported that there was an increase in first-time psychiatric hospitalizations in the six years following the 1918 pandemic. Mamelund also reported that mental health conditions identified in Spanish flu survivors included sleep disturbances, depression, mental distraction, dizziness, and difficulty coping at work.

Eghigan also indicated there was a significant increase in suicide rates in the United States following the pandemic. A significant increase in neurological conditions was also reported in patients recovering from the influenza including depression, neuropathy, neurasthenia, meningitis, degenerative changes in the nerve cells, and compromised visual acuity.

Professor Ephigian also mentioned that many survivors reported states of chronic helplessness and anxiousness. Dealing with the loss of loved ones was a major factor as well. In November 1918, in New York City alone, 31,000 children had lost one or both parents from the pandemic. The children experienced a mixture of guilt, fear, anger, confusion, and abandonment.

As to the impact on the health professionals that survived, many reported that they were haunted for years by a sense of frustration and grief.

A Need for Mental Health Training

While there remains little research on the mental health consequences of pandemics, the existing literature suggests that the impact is profound. Studying healthcare workers caring for patients during the SARS outbreak of 2003, Chong et al., (2004) reported that 72.4 percent had mental health issues including anxiety, worry, depression, somatic symptoms, and sleep problems.

In a recent Nature article, Alison Abbott points to ongoing global data collection on the mental health effects of the COVID-19 pandemic. So far, the studies have consistently shown that young people are the most vulnerable to increased psychological distress. Young women, people with young children, and those with a previously diagnosed mental health condition are at particularly high risk for experiencing mental health issues.

It’s interesting to note that in a recent U.K. survey by Fancourt mentioned in the Nature article, the high levels of anxiety and depression found in the early weeks of the pandemic actually reduced during the lockdown. Perhaps the decrease was due to an increased sense of health safety or a feeling that government and health officials were focused on solving the COVID crisis.

One of the main factors identified as negatively impacting mental health in a pandemic is isolation. According to Baumeister and Leary (1995), a lack of interpersonal attachments is linked to poor physical, emotional, and mental health outcomes. They emphasize the importance of setting up regular phone contact with family, friends, and colleagues to help compensate for the lack of physical interaction. We are lucky to have the option to make use of video calls today. We make good use of the technology in telemedicine. Unfortunately, mental health professionals have little training in responding to and delivering specific pandemic health crisis services.

In 2019, U.S. Congressman Levin drew attention to the need to consider recovery from the negative impacts of the COVID-19 pandemic stating that plans must include addressing the mental health issues of both the public and healthcare professionals. These plans call for public health surveillance so that an adequate response can be anticipated and executed to address the plethora of COVID-19 related mental health issues.

How Do We Cope? Lessons from the Ancient Stoics

The Roman emperor and philosopher Marcus Aurelius led his country through two wars and the Antonine plague that killed between 10 and 18 million people. Aurelius, Seneca, and other philosophers of the Stoic school emphasized that as humans, we are often confronted by situations that we have little control over; however, we have the opportunity to control how we respond.

Many of the principles of Stoicism have been incorporated into modern principles of psychotherapy in the traditions of Jungian psychology, cognitive behavioral, and rational emotive therapy. Some of the ancient teachings included such ideas as living each day as a separate lifetime; perceiving that the present is all we have; and consistently acting with truth, courage, and integrity. Perhaps an appreciation of the ancient Stoic teachings will lend us courage and strength as we confront our current adversities, and may be of particular value to our heroic frontline healthcare workers as a tool for combating burnout, compassion fatigue, vicarious trauma, and emotional exhaustion.

Research shows there is little known about the scope of the mental health impact of the 1918 worldwide pandemic that took 50 million lives—including 675,000 from the United States. In 2009, the H1N1 virus, thought to have been of avian origin, infected one-third of the world’s population according to Usher et al. (2020). COVID-19 is thought to be of the same family as SARS and Middle East Respiratory Syndrome coronavirus (MERS-CoV), which are zoonotic infections transmitted from birds and bats. Given the psychological fallout of the global shutdown, it is likely the mental health impact of the current pandemic will surpass that of 1918. Accurate mental health data may be difficult to ascertain.


Alfred W. Crosby (2003). America’s Forgotten Pandemic: The Influenza of 1918. Cambridge: Cambridge University Press.

Alison Abbott. “Covid’s Mental Health Toll: How Scientists Are Tracking A Surge in Depression”. Nature, February 2, 2021.

R.F. Baumeiseter & M.R. Leary (1995). The Need to Belong: Desire for Interpersonal Attachments as a Fundamental Human Motivation. Psychological Bulletin, Vol. 117, No. 3, 497-529.

Chong, et al. (2004). “Psychological Impact of Severe Acute Respiratory Syndrome On Health Workers in A Tertiary Hospital”. British Journal of Psychiatry. Published 2004 Aug;185:127-33.doi: 10.1192/bjp.185.2.127.

Greg Eghigan, PhD. “The Spanish Flu Pandemic and Mental Health: A Historical Perspective”. Psychiatric Times, Vol 37, Issue 5, Volume 37, Issue 5. May 28, 2020.…

Kim Usher, Joanne Durkin, & Navjot Bhullar (2020). “The Covid-19 Pandemic and Mental Health Impacts.” Int. J. Ment Halth Nurs. 2020: 29 (3): 3150318. Published online April 10,2020. Doi: 10.111/inm.12726.

James F. Zender, PhD (2020). Recovering from Your Car Accident: The Complete Guide to Reclaiming Your Life. New York: Rowman & Littlefield.

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