Written by: Angela Aaron, Ph.D.
COVID-19 continues to cause devastation in many ways. The ravaging physical and medical effects are dramatic, both short- and long-term, and can in some cases lead to death. But the impact does not stop with medical and physical health, like a pebble tossed into a pond, the ripples of the Pandemic continue to expand. The detrimental effects of the virus have also permeated the mental health and well-being of sizeable segments of the U.S. and global population. Two personal examples automatically crowd my mind. First, a cousin’s wife lost her mother to COVID-19 very shortly after her mother was diagnosed. His wife lamented not being able to be with her mother during those last days and the missed time and lack of ability to care for her mother during her last hours continues to haunt her. She said she tries to respond evenly, trying hard to hold back anger and resentment, when a member in very small community, even family, proclaim COVID-19 is a hoax and refuses to wear a mask which was how her now deceased mother was exposed.
Right before this occurred, my own partner’s father became very sick from an unrelated medical condition. Due to COVID-19 restrictions, however, family and friends including her mother were prohibited from visiting him for weeks. It was not until my partner’s father was in Hospice, the last few days before he died, that only his wife was allowed at his bedside. By this time, however, he merely slipped in and out of consciousness with minimal lucidity.
Even though the nurses and physicians had been so caring and accommodating; even helping set up video chats so he could see his family and friends, nothing could substitute for the actual presence of family and friends in the weeks leading up to his death. My partner still struggles with grief compounded by not being able to be by her father’s side before he passed. Moreover, traditional funerals were prohibited and thus closure has been haltingly slow.
The primary focus of the Pandemic has been on the physically debilitating, sometimes deadly, effects of the virus. This is understandable given the effects COVID-19 has on the respiratory system and other bodily structures and processes. Little attention has centered on the direct and indirect effects of the virus on the mental health of COVID-19 patients, the general public, some with pre-existing mental health issues and those with none.
To better understand the impact of the Pandemic on mental health, it is important to explore how the effects have manifested diagnostically and symptomatically, identify those most vulnerable in our communities, and how to cope/prevent the emotional and mental anguish seemingly brought on by COVID-19.
There have been many articles that have linked the economic stress produced by Covid-19 to extreme worry and anxiety. As Covid-19 spread throughout the U.S. significant portions of the country began to lose jobs. Lack of jobs led to dire financial strain and insecurity, a need to downsize one’s residence, and homelessness for some. All of this financial stress was overlayed with more people becoming sick and with those who were not sick being in constant fear of contracting the virus. Many had relatives who had contracted or died from the virus. Lockdowns quickly brought a feeling of social isolation and loneliness soon crept in for many. Social distancing, necessary to help halt the spread of the virus started having visibly detrimental effects on mental health and emotional well-being.
A significant number of COVID-19 patients, already compromised by the virus, began describing significant levels of depressive and anxiety symptoms. Symptoms developed after contracting the virus and those previously diagnosed reported an increase in symptoms. For example, prior to the Pandemic, about 1 in 10 adults reported depressive or anxiety symptoms. Currently, however, as is noted in a 2021 copy of Issue Brief, it is believed that the numbers have increased to approximately 4 in 10 adults who described depressive and anxiety symptoms. Elevated levels of Post-Traumatic Stress Symptoms (PTSS) and Post-traumatic Stress Disorder (PTSD) symptoms are being reported reported as well as issues with insomnia, disordered eating, increased alcohol/drug use, and suicidal ideation.
COVID-19’s impact on mental health has not only been shaped by the significant amount of disease and death, but also indirectly through the impact of social distancing and stay-at-home orders. The popular press has highlighted some of these issues, however, certain factors appear to make some individuals and communities more susceptible to the development/exacerbation of mental health disorders.
Vulnerable individuals include females, workers who have experienced job loss, parents and children, communities of color, essential workers, those with poor overall health, and relatives of individuals diagnosed with COVID-19 especially unpaid caregivers. Young adults also made the list of the most vulnerable as thoughts of suicide skyrocketed following Pandemic-related consequences including the shutting down of colleges and universities, transitioning to remote work, and loss of income and jobs and the ensuing financial insecurities.
The statistics that are just beginning to roll in paint a very bleak picture, however; it is important to recognize that the symptoms that result from mental health disorders brought about by and or worsened by the Pandemic, can be lessened with the use of healthy coping skills. When dealing with symptoms like those connected to anxiety and depression, important areas of emphasis center on self-care and social connection.
Focus on Self-Care by:
- Getting enough sleep. Be sure and go to bed and wake up at the same time each day and stick to your normal routine as much as possible to decrease insomnia.
- Engage in regular physical activity, to lower anxiety and improve your mood, including enjoyable activities and sports, or just getting outside and going for a walk or a hike in the woods can significantly improve well-being (being mindful of maintaining social distance, of course).
- Wind down before bed. Try to avoid all screens (e.g., phone, computer, television, etc.) the last hour or two before bedtime. Soothing rituals can include light yoga and stretching, a short, relaxing walk (not anything strenuous), taking a shower in a dimly lit bathroom surrounded by the soft glow of tea lights, reading, etc.
- Eat a well-balanced diet. Anxiety and stress are often aggravated by refined sugar, junk food, and especially caffeine.
- Keep a regular routine. Predictability can increase a sense of control over one’s environment. During times of uncertainty, adhering to a schedule by eating and going to bed at certain times, setting aside a specific time to exercise, and maintaining consistent work/study schedules can help offset the anxiety and worry that uncertainty can bring.
- Enhance one’s spiritual life. Focusing on a belief system often helps one feel more connected and purposeful.
- Focus on gratitude and other positive thoughts. Gratitude is incompatible with negative emotions such as anger and sadness and can offset pessimism, especially if done consistently. A change in perception can make a significant difference emotionally and mentally.
- Create more manageable daily lists. Rather than creating a never-ending list of daily tasks that you can never accomplish in one day, narrow it to 3 or 4 tasks that can realistically be accomplished that day. Be sure and check them off as they are completed. This can produce feelings of accomplishment that can often help decrease anxiety and depressive symptoms.
Focus on Connectingby:
- Continuing to Make Connections. If you must stay home and distance yourself from others, do not let this turn into isolation. In today’s world, virtual connections abound through use of text, phone, FaceTime, WhatsApp, Instant Messenger, and other platforms for video chatting or audio only. If you are working remotely, take time to check in with a colleague and see how they are doing. Exchange ways of coping and perhaps set up a time to have a virtual coffee talk session.
- Do something for others. Being of service and helping others is a great way to “get out of your own head” and rather than ruminating on problems, the focus can shift to helping others. A call, e-mail, instant message, video call, or even a written letter (so rare nowadays) can be sent to an elderly neighbor or relative with COVID-19. A “porch drop” of a homemade hot meal, puzzles, or a book by their favorite author can buoy the spirits, theirs and yours.
- Join a virtual therapy group to help decrease mental and emotional stress and the loneliness that can ensue. (Information about group therapy is detailed below).
Dealing with life during a Pandemic and its aftermath requires a multi-faceted treatment approach and it is not a sign of weakness or failure to reach out for assistance. Family members and friends can provide support, but sometimes there is need for more than they can provide. In such times, who better to help minimize the symptoms of various mental health disorders than a mental health provider? Help can be provided in many ways. Formats include individual, couple, family and group therapies. If you are dealing with cognitive and/or emotion effects of Covid-19, psychological or neuropsychological assessment could assist in a variety of ways including determining a diagnos(es) that can inform treatment strategies. Mental health services can be provided in-person and in alignment with current COVID-19 guidelines and is some cases can also be completed via telehealth.
Teletherapy is a viable and increasingly popular option for many patients. Telehealth is not new, rather it has been utilized in medical settings for years. However, the use of tele-services grew exponentially during COVID-19. Teletherapy falls under this umbrella and can be another effective was to provide psychological treatment while simultaneously preventing potential exposure to the COVID-19 virus.
Treatment using teletherapy can help decrease the intensity of many psychiatric disorders such as depression and anxiety, alcohol/substance use disorders, insomnia, as well as trauma. Loneliness often precipitates prolonged social isolation and is frequently described by both COVID-19 patients and the general population. As well as grief from losing a relative or a friend to COVID-19 also warrant greater attention in mental health settings.
Group therapy is an important resource for many of the individuals previously described. The change that frequents occurs within a group setting is sometimes accelerated compared to individual therapy. Rather than having only one helper in the room, you have several. Group therapy is a way for members to not only receive information on coping skills but also a way to find commonality among one another. Details may differ but the emotions that can result are often identical.