Mental Health During the COVID-19 Pandemic

Over the last year, the COVID-19 pandemic has touched the lives of every American, either directly or indirectly. The effects of COVID-19 can be felt in many ways. Whether through direct infection with COVID-19, caring for a loved one with COVID-19, the isolation due to lockdowns, unemployment, or being constantly reminded of the pandemic in the news and social media, we are all in this together.

Mental health during the COVID-19 pandemic has been a topic on everyone’s minds, and rightly so. Pre-COVID-19 estimates of depression and anxiety range between 6-18%; however, the rates of anxiety and depression in the general population during the pandemic range from 28% to 33.7%.^1,2 In fact, a separate survey conducted during the COVID-19 pandemic confirmed these estimates by showing a depression prevalence rate more than 3 times higher during the COVID-19 pandemic than before the pandemic.³ Based on data collected from over 1.5 million people during January – September 2020, Mental Health America (MHA) reported a 93% increase in people taking anxiety screens and a 62% increase in people taking depression screens from their website. Additionally, the percentage of people with positive screens for moderate-to-severe anxiety or depression was 80%, which is increased from previous years.⁴ Also, people with pre-existing mental health conditions may be at a higher risk of their symptoms worsening during the pandemic. ²  Worry about the pandemic, isolation and quarantine, frequent unemployment, and worry about contracting the virus, all contribute to the higher than normal rates of anxiety and depression in the general population. ¹

People who become infected with COVID-19 experience increased rates of anxiety, depression, and post-traumatic stress disorder (PTSD) over the general population.⁵ In fact, the rates of developing a new mental health condition within 6 months of a COVID-19 diagnosis are 12.84%, according to one study.⁶ When comparing the odds of receiving a psychiatric diagnosis with COVID-19 infection to those seen with influenza infection, COVID-19 patients were 81% more likely to have a new onset mental health disorder than those with influenza.⁶ Further, patients experiencing hospitalization and more severe COVID-19 symptoms, show even higher rates of mental health disorders during infection and within 3-6 months.^6-9 Additionally, many patients experience long-term neurological symptoms of COVID-19 including “brain fog”, poor concentration, and fatigue.¹⁰ Many clinicians may decide to run laboratory tests to determine if there are other causes for these symptoms, such as thyroid changes or anemia.

Healthcare workers are not immune to the negative effects of the pandemic on mental health. While personal protective equipment (PPE) can protect healthcare workers from getting COVID-19, it cannot protect them from the mental consequences of long hours, lack of sleep, and trauma. In fact, the prevalence rates of anxiety and depression were very similar to those seen in the general population (anxiety 26% and depression 25%).² During previous epidemics and pandemics, PTSD in healthcare workers was reported in up to 51% of respondents. In contrast, during the current COVID-19 pandemic, up to 73% of healthcare workers reported diagnosable PTSD.³

With the availability of vaccines, we might be seeing a light at the end of the COVID-19 tunnel. However, the long-term effects of the COVID-19 pandemic on mental health may not be felt for months, or even years, to come. If you or a loved one are experiencing mental health concerns, please speak to your healthcare professional or local mental healthcare provider.

References

1. Salari N, Hosseinian-Far A, Jalali R, et al. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Global Health 2020;16(1):57. DOI: 10.1186/s12992-020-00589-w.
2. Luo M, Guo L, Yu M, Jiang W, Wang H. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public - A systematic review and meta-analysis. Psychiatry Res 2020;291:113190. DOI: 10.1016/j.psychres.2020.113190.
3. Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galea S. Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic. JAMA Netw Open 2020;3(9):e2019686. DOI: 10.1001/jamanetworkopen.2020.19686.
4. Reinert M NT, Fritze D. 2021 State of Mental Health in America. Mental Health America.
5. Mukaetova-Ladinska EB, Kronenberg G. Psychological and neuropsychiatric implications of COVID-19. Eur Arch Psychiatry Clin Neurosci 2021;271(2):235-248. DOI: 10.1007/s00406-020-01210-2.
6. Taquet M, Geddes JR, Husain M, Luciano S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. The Lancet Psychiatry 2021. DOI: 10.1016/s2215-0366(21)00084-5.
7. Mazza MG, Palladini M, De Lorenzo R, et al. Persistent psychopathology and neurocognitive impairment in COVID-19 survivors: Effect of inflammatory biomarkers at three-month follow-up. Brain Behav Immun 2021. DOI: 10.1016/j.bbi.2021.02.021.
8. Writing Committee for the CSG, Morin L, Savale L, et al. Four-Month Clinical Status of a Cohort of Patients After Hospitalization for COVID-19. JAMA 2021;325(15):1525-1534. DOI: 10.1001/jama.2021.3331.
9. Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. The Lancet Psychiatry 2021;8(2):130-140. DOI: 10.1016/s2215-0366(20)30462-4.
10. Graham EL, Clark JR, Orban ZS, et al. Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 "long haulers". Ann Clin Transl Neurol 2021. DOI: 10.1002/acn3.51350.