Has COVID Worsened Our Mental Health Or Accelerated a Deterioration Begun Decades Before?
As a psychiatrist who studies the effects of social change on mental health, I was very interested to know how the COVID pandemic would affect our emotional well-being. The question here is not about being infected with COVID. Rather, it encompasses all of the effects on people’s lives as a result of the pandemic. I was among many experts who predicted significant increases in the entire spectrum of mental disorders as a result of COVID in affected communities. My own predictions included a further layer of negative consequences than those forecasted by my colleagues.
In general, I am sad to report that most experts were correct in predicting large scale increases in mental disorders and declines in well-being since the pandemic began. Depression was reported among three times as many Americans than in 2019, and anxiety problems were four times as high as 2019.
There were no numerical predictions, but it is safe to say that most experts are alarmed by the sheer sizes of the increases. This includes not only the depression and PTSD among those who actually had COVID, lost someone due to COVID, or witnessed COVID deaths. But among the general population, these concerns include increases in drug and alcohol abuse, an array of other distinct problems, including OCD, paranoid beliefs about the virus, and an inability to use normal coping mechanisms.
Briefly put, the predictions for worsening mental health did come true as the studies above demonstrate. But there is a larger context in which we should look at these changes. To begin, it must be noted that common mental disorders have been increasing in frequency or severity for almost a century (although at nowhere these rates). This is true across the developed world. In fact, some commentators have already observed that COVID has not brought change per se. But this has rather accelerated changes we already live with.
In my own view, there is an effect of modern life itself that makes us all more prone to mental illness. Studies have shown that the more modern society is, the more mental illness it will struggle with. By causing more social isolation and more dependence upon technology, COVID has intensified the most fundamental aspects of modern life (i.e. disconnection from others and use of technology). According to this theory, COVID should be producing more deterioration in any affected group’s mental health than expected by stress alone.
There are no numbers that can tell us which parts of the pandemic caused which mental health problems to increase. Scientists have already done a host of studies to begin to disentangle the pandemic’s effects. It is early in what will be a long psychiatric postmortem, and none of the current studies should be considered definitive. However, patterns have emerged that suggest the effects of COVID on aspects of modern life may be having an effect.
To study this, it makes sense to group people by their relationship to the pandemic. For instance: those who have or had COVID, people who have lost a loved one to COVID, frontline medical workers, and those suffering severe economic hardship are all under tremendous psychological duress. These are directly affected individuals. Depression and PTSD have been the unsurprising findings in this collection of affected individuals.
Although this group is sadly large and growing by the day, there is a much larger group of people who are affected at a distance. These are the people who are now isolated, either alone or with a small number of people, and are doing their jobs or schooling remotely via technology. This is the indirectly affected group. If people spent excessive “screen time” before, they are now spending much of their waking life on a computer.
Several factors point to problems with this latter, indirectly affected group. Within the group, rates of depression and anxiety have been worse in young people, particularly those with more screen time and more distance learning.
In China, where the virus originated, there has been extensive study of the mental health consequences of COVID on different groups. For example, children who must study at home suffered more than those who attended school normally, perhaps not surprisingly. In adolescent girls, home study proved especially harmful. And among young people who sought mental health treatment, there was a higher use of the internet in general as well as internet gaming in particular. One interesting study looked at altruism in students. In addition to being a virtue, altruism is a normal social practice that improves your state of mind by helping others. They found that those who were cut off from their abilities to help others were more likely to be depressed.
Other studies found more than just depression and anxiety. In the US deaths from opioids have increased dramatically since the pandemic began. In Japan and South Korea suicide continues to rise, mostly among younger women (but is unchanged in Australia). All studies were in the general population, not only people directly affected by COVID.
Some experts now believe that the mental health effects of COVID will be longer lasting than physical effects. Other areas we’ve long known about, like protracted grief or PTSD from an unexpected death; as mentioned above, have long, difficult courses often lasting years. There have already been calls for action to pay greater attention to the mental health toll of COVID-19.
Young people can be an important proxy for modernity, as they are more in touch with technology and other cultural changes, and more affected by them. With regard to COVID; they are unlikely to have severe COVID infections, are unlikely to have significant others who are ill or dying, and are still somewhat insulated from the financial effects of job loss. As we have already noted, the more modern a society becomes, the more mental illness it will have to contend with. Among the young, more screen time and social media use have already been linked with depression. These factors taken together suggest that, at least among young people, COVID’s forced intensifying of modern life produces more mental illness, over and above what we might expect. The data are not yet specific enough, but it would be a reasonable conjecture to propose that this effect occurs in all age groups.
The process of social disintegration and our dependence on complex technologies continues with no change in sight. What of the COVID-produced social changes? Will feelings of insecurity from dangerous infections, mistrust of public messaging, and damage to normal social interactions all return to their pre-COVID states? There is palpable hope that this is the case. Given what we have seen in young people from this combination of modernism and pandemic infection, this hope is well-placed.
COVID has not only wreaked havoc upon our communities. It has made us more of ourselves as moderns. In doing do it has shined a light on many facets of the modern world: severely inequitable healthcare, poor governance at the highest levels, and mental illness growing like weeds around our feet. Only by understanding the constituents of modern life and how we interact with them will we be able to heal these cracks in the edifice of society. Mental illness must be high on this list.