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Commentary Coronavirus Health

The mental health epidemic hidden in the COVID-19 pandemic

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By Mark Lusk

The pandemic that is raging through the United States is killing nearly one American a minute.  With no unified or coherent public health response at the national level, we can expect that it will be at the center of the country’s attention until widespread vaccinations begin to take effect.  

Relatively unnoticed in the midst of this mass contagion is a hidden epidemic – the widespread emergence of a mental health crisis associated with anxiety and depression.

Mark Lusk

The deadly toll of the pandemic has been extraordinary, with the infection of multiple millions, the death of over a 1.3 million globally, including well over 250,000 deaths in the United States, numbers that the Centers for Disease Control say may underestimate total COVID-19 deaths by as much as 50%. 

The human costs of the pandemic have been disproportionately felt in the United States, which leads internationally in both total infections and deaths. The multitude of fatalities over such a short period of time is historic and the consequential losses to families and friends of the deceased are immeasurable.  Coupled with unprecedented job losses, financial setbacks, interrupted schooling, and disruptions in food security, recreation, religious practices, family activities and access to health care, the negative effects on personal wellbeing are substantial. The mental health of the population is being threatened by all of these factors, which converge to expose individuals and families to unparalleled stress, fear, and anxiety. 

Growing evidence indicates that the rapid emergence and global contagion of the COVID-19 pandemic has had significant adverse effects on the mental health of Americans. The Centers for Disease Control found that the American population has experienced elevated adverse mental health conditions as a result of the pandemic. In addition, the sale of alcohol has increased significantly, as well as the frequency and volume of alcohol consumption.  

The pandemic, by virtue of the need to self-isolate, shelter in place, avoid social gatherings, and maintain social distance, is reducing the frequency and quality of social interactions, with the result that the population is experiencing widespread loneliness, which is associated with increased depression and suicidal ideation.

It has become clear that the psychological impact of the pandemic is being felt differentially and that certain social and economic groups are at higher risk.  At particular risk are younger adults, essential workers, racial and ethnic minorities, health care providers, and unpaid adult caregivers, all of whom reported worse mental health outcomes and disproportionately higher rates of anxiety, depression and substance use.

Symptoms of mental disorders and substance use problems among Americans have significantly increased during the pandemic. The CDC reported that among all Americans, 25.5% report anxiety symptoms, 24.3% indicate depressive symptoms, and 10.7% had given serious consideration to suicide in the previous 30 days. As a result of the extraordinary increases of deaths related to COVID-19, families, friends, and survivors are confronted with extraordinary levels of grief, emotional pain, and bereavement that may become prolonged and interact with existing comorbidities such as substance use, anxiety and depression. 

There are also differential impacts on socially vulnerable groups such as prisoners, older adults, sexual minorities, refugees, and undocumented people. In addition, physicians, health care providers, hospital employees, mental health professionals, and health care student trainees are vulnerable due to the high levels of stress associated with the nature of their work and the elevated risk of infection.

High rates of anxiety, depression and suicidality were identified among lower income individuals, those with less than a high school education, the unemployed, and among individuals who were unpaid caregivers for adults. During the pandemic, Hispanics have reported substantially higher rates of anxiety (35.5%), depression (31.3%), increased substance use (18%), and suicidal ideation (26%).

The pandemic has produced significant economic effects, including high unemployment, business closures, loss of income, depletion of personal savings, eviction from homes and residences, and loss of health insurance, all of which negatively affect mental health. In addition, personal and household activities have been altered by changes in work, schooling, curfews, and restrictions on travel. Children and families have been affected by school closures and are challenged by the difficulties associated with remote learning, access to technology, and long periods of confinement in their households. 

The prevalence of anxiety disorder symptoms is now about three times as high as it was in 2019 and the rate of clinical depression is about four times as high as last year. Elevated levels of mental disorder, substance use, and suicidal ideation should concern us all. 

As the nation struggles to control the COVID pandemic through infection control and investment in health care access, it is crucial that we also address the widespread repercussions the pandemic is having on mental health. Investments in the prevention and treatment of mental disorders during the pandemic should be a national priority, particularly for the most vulnerable and at-risk groups. 

Mark Lusk is professor emeritus of social work at the University of Texas at El Paso.

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