MENTAL HEALTH IN THE AGE OF COVID-19

MENTAL HEALTH IN THE AGE OF COVID-10

HIDDEN EFFECTS OF THE PANDEMIC

By AREEHA KHALID EJ BECK

As the novel coronavirus, COVID19, is transmitted rapidly around the globe, the physical health of vulnerable populations is naturally foremost on people’s minds. However, the spike in pandemic-related mental health problems—especially for individuals who were already experiencing mental illnesses or substance abuse issues—merits just as much concern.

World-wide catastrophes caused by diseases, natural disasters, and economic crises have been historically been associated with increased rates of suicide, depression, and anxiety. Moreover, in the case of the COVID-19 pandemic, the very interventions designed to slow the spread of the virus (social distancing, closure of schools and businesses, etc.) are linked with declining mental health. This contradictory effect is related to a multitude of factors, such as anxiety over the future, financial stress, job loss, and isolation, all of which have been linked with poor mental health.

Social isolation and loneliness in particular are known to have many negative effects on mental and physical health, especially for groups already vulnerable to mental illness. Older adults, for example, have a high risk for developing depression, which, in this population, often remains misdiagnosed or untreated. Older adults also have a high risk of suicidal ideation or death by suicide, accounting for one in five (9,102 out of 48,344) suicide deaths in 2018, according to the CDC. This high risk of death by suicide is linked to loneliness, grief over losing loved ones, and illnesses associated with aging. During the COVID-19 pandemic, older adults make up one of the populations most at risk of death from the virus and may have decreased contact with loved ones, which can, in turn, lead to an increase in anxiety and fear about the pandemic, as well as a greater risk for depression.

Children and adolescents make up another major population at risk for mental health problems during the pandemic. About 12% of individuals aged 12-17 in the U.S. are believed to have depression and anxiety, and though suicide is the tenth leading cause of death overall in the U.S, it constitutes the second leading cause of death for this age group. As the COVID-19 pandemic causes long-term school closings, the CDC predicts children and adolescents will lose access to key mental health resources and support systems provided by friends and teachers, which may lead to a spike in depression and anxiety.

Furthermore, the practice of quarantining after potential contact with the virus may also cause negative effects on mental health. Past studies of individuals in quarantine (due to illnesses such as SARS, Ebola, H1N1 influenza, etc.) reveal a strong correlation between quarantine and post-traumatic stress disorder (PTSD), confusion, and anger. These effects may be caused by a number of stressors present during quarantine, including fear of infection, loss of routine, and inadequate information about why the quarantine period is necessary. Even after the quarantine is over, stressors such as financial insecurity (due to the inability to work while in quarantine) and stigma against those quarantined may still be in effect, stalling or slowing down mental recovery.

During these uncertain times, mental health professionals have been advised to keep in close contact with patients already struggling with mental illnesses that may be worsened by the pandemic. Many psychiatrists

have continued to provide care to patients remotely through telemedicine, where appointments can still occur via secure one-to-one videoconferencing technology. Telemedicine has been available to physicians for almost three decades, but the advent of the COVID-19 pandemic has motivated healthcare professionals to utilize this technology with their patients.

Call centers, such as that of the National Alliance on Mental Illness (NAMI), have experienced a drastic increase in volume of callers, as people call to express

their feelings of depression, anxiety, and loneliness. As the vice president of NAMI in Hillsborough, Florida put it, “The coronavirus isn't causing mental illness, it's causing a mental health challenge that's affecting everyone.” This mental health challenge is only exacerbated by the loss of loved ones to the virus, and the cancellation of events such as weddings, proms, funerals, and graduations.

In addition to their free nationwide helpline, local branches of NAMI have begun to combat the mental health crisis by setting up emotional support hotlines and support groups over platforms such as Zoom, which serve to create a sense of community for those who feel alone.

Unfortunately, the increase in panic, depression, anxiety, and other feelings of distress during the COVID-19 pandemic only serve to increase the strain on primary care workers and the healthcare system overall during the pandemic. As the crisis continues with no clear end in sight, healthcare professionals working on the front lines of the COVID-19 pandemic are also at risk for deteriorating mental health.

Healthcare professionals treating COVID-19 patients are seeing high volumes of COVID19 patients die from the virus, oftentimes unable to connect these patients with their families due to standard isolation procedures. This leads to acute psychological stress and feelings of helplessness, which can have disastrous effects of mental health.

On April 26, Dr. Lorna Breen, an ER doctor from Manhattan, died by suicide. Her father, Dr. Phillip Breen, gave a statement to the New York Times, saying that his daughter did not have a history of mental illness, but was killed by the job she loved as she watched patient after patient die of the virus, sometimes before even being removed from the ambulance and brought into the hospital. Dr. Breen’s heroism during the pandemic will be remembered, and her story raises important questions about how doctors and healthcare workers are coping as they find themselves surrounded by the chaos caused by the novel coronavirus.

The psychological stress of healthcare workers is amplified by their inadequate access to personal protective equipment (PPE) such as masks, gloves, and hand sanitizer due to worldwide shortages. Furthermore, each COVID-19 patient requires high volumes of PPE, resulting in a constant, often unmet, demand. Without access to fresh PPE, healthcare workers have a high risk of passing the virus from one patient to the next, as well as contracting the virus themselves or passing it onto loved ones at home. It is possible that healthcare workers are being fired or acted against at their jobs for voicing concerns over the lack of safety equipment, as revealed by reports sent to the American Nurses Association (ANA) by alarmed nurses, only adding to feelings of distress.

The COVID-19 pandemic poses serious problems for short-term and long-term mental health of all individuals affected, from people self-isolating at home to healthcare workers on the front line. Some mental health facilities and resources are doing their best to respond to this challenge, while others struggle to meet the demand of both new and old patients seeking care.

The CDC reminds people to practice coping strategies (such as taking breaks from news stories,

remembering to connect with others, etc.), reading and sharing accurate information about COVID-19, and reaching out to one’s healthcare provider for assistance if/when needed.

If you or someone you know about are feeling overwhelmed with feelings of sadness, depression, or anxiety, call 911; reach out to the Disaster Distress Helpline at 1-800-985-5990, or text TalkWithUs to 66746; or reach out to the National Suicide Prevention Helpline at 1-800-273-8255.

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