The Psychological Toll of COVID-19
Introduction
As COVID-19 continues to spread in countries worldwide, the physical symptoms of the disease remain the focus of media and government attention. However, with the increasing reports of healthcare workers committing suicide (such as the high-profile death of New York City emergency physician Dr. Lorna Breen) and recent studies that document surges in feelings of anxiety and depression among the general public, it is clear that the pandemic is taking a substantial psychological toll.
Given the history of stigma and lack of government intervention associated with mental health, as well as the unprecedented challenge of dealing with a pandemic, we see that COVID-19 is revealing both existing and new flaws in current mental health treatment. We must design new ways to respond to the increasing need for psychological help globally.
In this article, we will explore the impacts this pandemic is having on mental health, the reasons behind these effects, and what we can do about them.
The Psychological Toll of the COVID-19 Pandemic
Mental health is defined as “a person’s condition with regard to their psychological and emotional well-being” [Oxford Language, 2020]. It is important to note, then, that feelings of stress and uncertainty are a natural response to the outbreak of a new, infectious disease. However, when people must live in this state of fear for prolonged periods and as their years-long lifestyles become severely disrupted by government policies, psychological trauma can set in. This is especially the case in areas that are hard-hit by COVID-19, such as the United States, Italy, and China.
Numerous surveys have already linked this pandemic to an increase in negative mental health outcomes. For example, in the United States, a survey conducted by the Kaiser Family Foundation (KFF) as early as March 11 to 15 found that 32% of American adults believed that worry or stress related to the coronavirus has had a negative impact on their mental health. Just a week later, from March 25 to 30, an updated KFF poll found that percentage to be 45%.
Evidence of the rise in symptoms of anxiety and depression during this time is also being seen in data from healthcare providers. A federal emergency hotline for emotional distress saw a 1000% increase in texts during April 2020 compared to the same time last year [Substance Abuse and Mental Health Services Administration, 2020]. Talkspace, an online counseling service, reported that by early April, they had seen a 65% increase in clients since mid-March. Similarly, the Crisis Text Line found that from March 30 — April 6th, 24% of users voiced concerns about COVID-19. Most recently, data from the U.S. Census Bureau in mid-May revealed that roughly one-third of Americans are showing signs of clinical anxiety or depression; 50% of Americans reported being “bothered by feeling down, depressed, or hopeless” at least several days a week.
Government officials are warning that this surge in troubling psychological symptoms is likely to cause an increase in rates of substance abuse, self-harm, and suicide.
The Roots of An Unfolding Mental Health Crisis
This increase in emotional distress is rooted in a variety of sources. Examining these sources can help reveal which groups are most at risk for experiencing a mental health condition during this time.
The most basic cause of pandemic-related mental distress is the fear of contracting COVID-19. Given developments that establish the virus as painful and highly infectious, many people are worried about themselves or their loved ones getting sick. This is especially true for those at higher risk of severe illness, such as the elderly or people with chronic conditions like HIV, asthma, or diabetes. People who are currently diagnosed with COVID-19 also stress over the possibility of complications and the trauma of hospital stays.
Healthcare providers and other essential workers are also reporting higher rates of anxiety and depression symptoms during the pandemic. A study of 1,257 doctors and nurses across 34 hospitals in China during the country’s coronavirus peak earlier this year, for example, found that 50% had depression, 45% had anxiety, and 34% had insomnia [Lai 2020]. These front-line workers face the daunting task of balancing their health with the duty to serve others — often without proper personal protective equipment — which also puts them at risk for burnout. The suicide of 23-year-old EMT John Mondello in New York City is just one example of this.
Given government-mandated closures of non-essential business in many parts of the world to curb the spread of COVID-19, millions of workers are grappling with detrimental economic impacts. Estimates state that over 20 million jobs were lost in the United States in April, and even those who did not lose their jobs experienced pay cuts and reduced hours. Studies from the 2007 to 2009 U.S. Great Recession have correlated unemployment to increased rates of suicide, which is why it is necessary to weigh government economic policies with their expected impact on mental health [Reeves, 2012].
Those who suffered from mental health conditions before the pandemic also account for a considerable portion of COVID-19’s psychological toll. Consider the thousands of students who rely on school-provided services for counseling; college students are particularly at risk because for those who study out-of-state, licensing rules often bar treatment past state-lines. Many community behavioral centers, struggling with funds, have been shut down. New shortages in antidepressants are being reported. Therapists worldwide are finding it hard to adapt to the world of telehealth. For the elderly and those who live alone especially, mandated social distancing guidelines and lockdowns can exacerbate pre-existing struggles with loneliness.
Mental Health Moving Forward
Everyone deserves to have access to free, quality mental health treatment. However, there are reasons to care about mental health resources in the time of COVID-19 beyond them being fundamental human rights. If this rise in negative psychological outcomes continues, it can overwhelm hospital emergency rooms with patients seeking help for self-harm, suicide, and overdoses. As workers become uneasy about returning to work, the already debilitated global economy will experience further distress.
It is crucial, then, for governments to take a proactive stance in combating the declining state of mental health. In many countries, such as the United States, the mental health system is already underfunded and difficult to access; of the trillions of dollars allocated for the CARES Act passed in March 2020, only $425 million was set aside for psychological resources [Coronavirus Aid, Relief, and Economic Security Act, S. 3548, 2020, pg. 276].
Governments must be committed to tracking data related to mental health trends in their countries; this is the first step to making informed policy decisions. Looking at the psychological tolls from past outbreaks of infectious disease can provide estimates of what these numbers might look like. For example, a 2006 study looked for symptoms of depression in 549 hospital staff in Beijing after the 2003 SARS outbreak in the city. A reported 9% were determined to have high depressive symptoms [Liu, 2006].
Policymakers should carefully weigh the lengths of quarantines and shelter-in-place orders against their possible impact on their citizens’ mental health. The effectiveness of voluntary quarantines should be studied; especially in western countries, for instance, restrictions on freedom can be detrimental to emotional well-being.
The role of the media must also be brought into question. Misinformation and a lack of information fuel uncertainty, which can cause anxiety. Effective and rapid communication from authority figures is essential. Employing an appeal to altruism in government and news transmissions could also be an effective technique to counteract the negative feelings that social distancing and quarantines can elicit in people.
Now more than ever, technology is an invaluable tool to combat the pandemic’s psychological effects. From the use of virtual platforms for counseling to apps that collect data on user feelings, new solutions are constantly being developed to improve access to treatment.
As COVID-19 cases rise daily, we must be innovative in addressing these newfound challenges to mental healthcare in countries across the globe.
How to Find Help
If you or someone you know is experiencing a mental health crisis, there are plenty of resources available to find help. You are not alone.
Visit Crisis Text Line (crisistextline.org) for free access to a crisis counselor anytime. If you are located in the United States, text HOME to 741741.
References
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