The Mental Health Impact of Covid-19

Here’s the latest from Practicing Mental Illness:

As we fail to fully reopen schools and the economy due to the Covid-19 pandemic, a wave of mental illness and deaths of despair is swelling. While deaths from Covid-19 steal the headlines, the mental health effects of economic disruptions and shutdowns last for years.

The most significant negative factor in past pandemic responses such as the SARS, H1N1, Ebola and MERS pandemics was when the shutdown end date came and was then extended. That has already happened several times during the Covid-19 pandemic.

The impact on mental health of our response to coronavirus, sadly, is staggering but predictable. An extended excerpt from a study published by the National Library of Medicine is telling:

The coronavirus disease 2019 (COVID-19) pandemic has been associated with mental health challenges related to the morbidity and mortality caused by the disease and to mitigation activities, including the impact of physical distancing and stay-at-home orders. Symptoms of anxiety disorder and depressive disorder increased considerably in the United States during April-June of 2020, compared with the same period in 2019 (1,2). To assess mental health, substance use, and suicidal ideation during the pandemic, representative panel surveys were conducted among adults aged ≥18 years across the United States during June 24-30, 2020. Overall, 40.9% of respondents reported at least one adverse mental or behavioral health condition, including symptoms of anxiety disorder or depressive disorder (30.9%), symptoms of a trauma- and stressor-related disorder (TSRD) related to the pandemic† (26.3%), and having started or increased substance use to cope with stress or emotions related to COVID-19 (13.3%). The percentage of respondents who reported having seriously considered suicide in the 30 days before completing the survey (10.7%) was significantly higher among respondents aged 18-24 years (25.5%), minority racial/ethnic groups (Hispanic respondents [18.6%], non-Hispanic black [black] respondents [15.1%]), self-reported unpaid caregivers for adults§ (30.7%), and essential workers¶ (21.7%). Community-level intervention and prevention efforts, including health communication strategies, designed to reach these groups could help address various mental health conditions associated with the COVID-19 pandemic.

Things have only gotten worse since these results were published. In an update to the NLM report published in December, researchers note that rates of anxiety have increased to 50.9%, depression to 48.3%, and PTSD to 53.8%. 81.9% of the population is reporting a level of stress that is negatively impacting their daily functioning and health. Before the pandemic these rates, 6.33% for anxiety, 14.6% for depression, 7% for PTSD and 8.1% for stress, were much lower. Much lower.

Unfortunately, we’re less prepared to deal with this mental health burden than we were before the pandemic. According to the WHO, the pandemic has led to widespread disruptions in mental health services in developed countries. From their report:

  • Over 60% reported disruptions to mental health services for vulnerable people, including children and adolescents (72%), older adults (70%), and women requiring antenatal or postnatal services (61%).

  • 67% saw disruptions to counseling and psychotherapy; 65% to critical harm reduction services; and 45% to opioid agonist maintenance treatment for opioid dependence.

  • More than a third (35%) reported disruptions to emergency interventions, including those for people experiencing prolonged seizures; severe substance use withdrawal syndromes; and delirium, often a sign of a serious underlying medical condition.

  • 30% reported disruptions to access for medications for mental, neurological and substance use disorders. 

  • Around three-quarters reported at least partial disruptions to school and workplace mental health services (78% and 75% respectively).

People in mental healthcare are valiantly struggling to keep up services in the face of overwhelming need. Yet even as we vaccinate the population and look forward to the date when the virus becomes manageable, the mental health crisis will drag on.

A study published in The Lancet summarizes a number of research reports which investigated populations who lived through shutdowns. For many, it was a bad experience with repercussions lasting long after the shutdown ended.

In the three-year period following a pandemic, incidence of PTSD in the quarantined population was four times that of people who were not affected. As many as 60 percent of those who experienced quarantine reported symptoms of depression.

Even more troubling is the experience of people put out of work due to pandemic-inspired government mandated shutdowns and the unemployment and business failures that result.

In these crises, people who are out of work and lack purposeful, in-person relationships with others – which are often forged through work – kill themselves at alarmingly high rates.

Deaths of despair are defined as suicides and drug overdoses. In 2018, the rate of deaths of despair was 55.5 per 100,000 people, or 101,686 lives lost in the United States. An average projection of unemployment as a result of the Covid-19 crisis of 15 percent will result in an increase in the suicide rate of 27% over the next 10 years.

This projection does not include suicides and overdoses sure to result from cuts in services that will inevitably follow the reduction in public funds caused by lower income, business and sales tax revenues to the local governments that provide so many behavioral health services.

Unemployment and budget cuts will impact those in lower income brackets much more severely than people with higher incomes and more access to private mental healthcare. People in this lower socioeconomic group also have fewer opportunities for virtual social connections and telemedicine mental healthcare than those in higher income brackets. This group, underrepresented and often left out of policy decisions, bears the largest burden of deaths of despair.

It appears the estimates of increases in deaths of despair caused by the poor handling of the pandemic and the contradictions from state and local governments about reopening the economy may be conservative.

Calls to the National Suicide Prevention hotline in April 2020 were up 891 percent over April 2019. In November 2020 the Crisis Text Line received 180,000 conversations, up from 30,000 in October and 78,000 in November.

Fear and anxiety, social isolation and lack of work lurk behind most suicides. Our inability to confidently reopen schools and the economy greatly contributes to these factors. In fact, government avoidance of reopening makes the fear felt by so many seem strangely inevitable and acceptable. But upward spiraling deaths of despair and skyrocketing rates of mental illness are not inevitable nor acceptable.

As we coordinate our response to the pandemic and plan for life post-pandemic, we must keep in mind the people with lives decimated by our halting, inconsistent and poorly communicated response to the coronavirus, as a greater pandemic, one of poor mental health, drags on indefinitely.

If you are thinking of suicide, please call the National Suicide Prevention Lifeline at 800-273-8255.

Strategies for managing anxiety caused or aggravated by the pandemic can be found in my book Resilience: Handling Anxiety in a Time of Crisis.

Meditation

I’m Catholic, so I’m very fond of ritual. I’ve taken a long detour into Zen, as have many Catholics, and have found that the practice of Zen does not contradict the core teachings of the Catholic church. And Zen services and monasteries are full of ritual. In fact, I find the candles and bells and chanting at the Zen centers where I’ve done retreats to be comfortably familiar. The bows and the ritual and the talk by the retreat leader or abbot are not unlike a Catholic a Mass.

At the center of many Zen services is the chanting of the Heart Sutra. In my first newsletter I linked to the heart sutra chanted in a Korean monastery, but I’m most familiar with the Sino-Sanskrit version chanted at Japanese monasteries and at most Zen centers in the US. The sutra, seemingly impenetrable, contains the core philosophy of the Mahayana tradition. I attended a retreat on the sutra with Zen teacher and writer Brad Warner, and we used Red Pine’s translation of The Heart Sutra as a text. It has line by line commentaries and a stellar translation.

Here, Brad Warner talks a bit about the sutra and chants it. Enjoy: