The State of Mental Health

The troubling reports and dire predictions about mental health began just months into the novel coronavirus pandemic:

• “Study Finds Increase In Psychological Distress In Adults With No Prior Mental Condition During Pandemic.”[1] - Baltimore citybizlist, August 19, 2020
• “…mental health in the U.S. continues to get worse and many states are ill-prepared to handle this crisis…”[2] - Mental Health America, October 20, 2020
• “We are facing a national mental health crisis that could yield serious health and social consequences for years to come.”[3] - American Psychological Association (APA), October 20, 2020
• “There are no government bailouts for peace of mind, no future gift cards for therapy. Despair doesn’t hibernate.”[4] – Boston Globe, December 31, 2020

While hope is on the horizon with the distribution of COVID-19 vaccines, the pandemic and its fallout are far from over. It is more important than ever to examine the impact of the virus on the mental health of our nation and our world in 2020, and what lessons we can apply to improve mental wellness in the new year.

Stress From Every Direction

Once COVID-19 took hold worldwide early last year, its mental effects quickly began to emerge. There were strong emotional reactions to the virus, particularly fear, uncertainty, and grief. Shutdowns affected societies everywhere; families and friends were separated, and individuals spent weeks or months alone. Those who contracted COVID-19 worried about how ill they would become; if they didn’t survive, they usually died alone rather than with their loved ones. Students of all ages missed school, workers lost their jobs or were overwhelmed, and milestones were never celebrated. Divides developed between those who complied with recommendations or restrictions and those who did not, especially in our country.

Surveying more than 3,400 adults and 1,000+ teens last August, the APA heard first-hand that the effects of COVID were wreaking mental havoc. Seventy-eight percent of responding adults said the virus was a significant source of stress, and 67 percent reported experiencing increased stress over the course of the pandemic. However, the majority of adults said health care, mass shootings, and climate change were also top stressors. Half cited rising suicide rates, immigration, sexual harassment reports, and the opioid epidemic as significant sources of stress as well. So COVID basically “piled on” to all the other issues that threaten our mental wellness on a daily basis.[5]

No Demographic Has Been Spared

Looking at our youngest children, COVID-19 has replaced the safety and routines they expect from the adults in their lives with unpredictability and overwhelming change. Some now suffer from food or shelter insecurity (or both), as well as the loss of socialization so important to their mental development. It’s also very difficult for parents or guardians to hide their own reactions to the pandemic from perceptive little ones…or to protect them from daily pandemic news.

The APA survey found that the stress and trauma of the pandemic holds particularly serious consequences for older kids, known as Generation Z (teens currently 13-17 years old and young adults 18-23), with many already depressed and/or anxious. Gen Z adults had the highest average level of stress in the month before the survey, compared with millennials, Gen Xers, boomers, and older adults. Half of the Generation Z teenagers reported that COVID-19 has “seriously disrupted” their plans for the future, with slightly more feeling that it makes planning seem impossible. Among Gen Z college students, 87 percent say their education is a “significant” source of stress in their lives.[6]

Our oldest generations have been dealt with both physical and psychological blows by the novel coronavirus, with those 65+ accounting for at least 80 percent of the U.S. COVID deaths.[7] Many living in assisted living or long-term care were infected where they likely felt the safest. Some saw roommates die, while they were spared. Independent seniors, either living alone or with a spouse or friend, became isolated from their support network…or chose to take the risk of continuing to live their “normal” lives with few adjustments. Not surprisingly, an August KFF tracking poll found that nearly one of every four older adults said they had depression or anxiety, a huge leap from the one in ten reporting these mental disorders in 2018.[8]

Black, Hispanic and Asian populations in the U.S. have experienced greater risks to their mental health during the pandemic, partially due to cultural taboos attached to revealing or discussing psychological issues. But many other factors have contributed to their vulnerability. In Psychiatric Times, Tresha Gibbs. M.D. et al. highlight the mental health disparities among Black Americans, saying, “The COVID-19 pandemic has disproportionately affected people of color due to legal, social, and economic inequities.”[9] KFF’s August poll found that older Hispanic adults were depressed or anxious at rates higher than older White, Black, and Asian adults.[10] Because of the origins of the novel coronavirus, Asian Americans — and in particular Chinese Americans — have experienced racism and associated mental health repercussions. A study of Chinese American parents and youth by Charissa S.L. Cheah et al. published in the November issue of Pediatrics, discovered that “COVID-19-experiences of racial discrimination were associated with higher levels of reported generalized anxiety and depressive symptoms, consistent with previous studies on daily discrimination.”[11]

Healthcare workers and their families encompass all these groups, yet have their own particular mental health risks. They continue to walk into the COVID-19 line of fire every day. Physical stresses from overwork, lack of sleep, poor nutrition, and no exercise, along with the rapid spread of the virus, very quickly started to take their toll on health workers’ psychological well-being. Mental Health America’s screening from June through September 2020 revealed that 93 percent of responding health care workers were experiencing stress, 88 percent anxiety, 77 percent frustration, 76 percent exhaustion and burnout — and 75 percent were “overwhelmed.”[12]