The Lasting Impact of COVID-19: How Will It Affect Our Mental Health?
Millions of Americans will be impacted by COVID-19-related illness, loss, grief, anxiety, isolation, and PTSD. And, perhaps counterintuitively, some of us will come out stronger. Experts weigh in on what we can expect from living through a global pandemic.
"What comes next?"
That’s what everyone wants to know. "What’s going to happen with the economy? With my job? My health? The country? Will anything ever go back to normal?"
These are important questions — real questions. And the truth is no one knows the answer. Not Donald Trump, not Anthony Fauci, MD, not America’s boyfriend–New York Governor Andrew Cuomo.
We have never lived through a time like this before. Yes, there have been moments — after the Great Depression, or World War II, or Vietnam. Periods of collective despair, misery, and suffering. But they had precedence. People had survived wars. They understood recessions. They knew what it was like to live through uncertainty.
The closest traumatic events within our lived experience were 9/11 and the marathon bombing in Boston. A survey published in 2011 in American Psychologist of US citizens one month after 9/11 reported that 9.7 percent had a major depressive disorder five to eight weeks after the attacks and 12.4 percent had one within the first six months after.
But even these events, monumental as they were, are not comparable.
“The difference is that 9/11 and the marathon bombing in Boston were more time compressed. This is months and months,” says Laura Garelick, MD, chief of family medicine and director of the peer support program at Beth Israel Deaconess Hospital Needham in Massachusetts.
The little research that does exist on the aftermath of a pandemic comes from the Spanish Flu of 1918, an event distinctly outside of most people’s frame of reference.
In that research (PDF), which was presented in Denmark in 2010 at a workshop entitled “Historical Influenza Pandemics: Lessons Learned,” Svenn-Erik Mamelund, PhD, a historical demographer at the Oslo Metropolitan University in Norway, researched asylum hospitalizations in Norway attributed to the Spanish flu pandemic of 1918 and found that the number of patients hospitalized for the first time for psychological disorders (attributed to the flu) increased by an average annual factor of 7.2 for six years after the pandemic.
That population of survivors also reported depression, dizziness, sleep impairment, mental distraction, and work difficulties. Mamelund also noted a higher suicide rate between 1918 and 1920.
Will the aftermath of COVID-19 follow this pattern? Maybe; we don’t know. The world is a different place. Too many variables have changed. For better or for worse (or both), the path ahead of us is all new. Here’s what the experts we interviewed said about the likely challenges and unexpected benefits that likely lie ahead of us.
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Boxed In Episode 1: 'Anxiety and Depression in the Time of COVID-19'
Thwarted Grief and Mourning Under Social Distancing
On April 12, Valerie Smaldone’s 93-year-old mother, Frances Smaldone, died. She was not tested for COVID-19, but it was presumed her underlying medical conditions were exacerbated by the virus. She had been living in southern Westchester County, New York, in an assisted living facility — a type of institution particularly vulnerable to spread of the virus — and dealing with dementia when she fell ill. She was gone within days, a scenario that has played out repeatedly across the country.
“The mental anguish that people are experiencing — not being able to be with loved ones in crisis, and not being able to properly mourn them with family and friends in community after they pass — is excruciating,” says Smaldone, a media personality in New York City. “It’s unlike anything you can imagine. Death and loss are bad enough. But this is truly debilitating. The details of removal and burial are somewhat gruesome,” says Smaldone. “The visual of how she was buried is not leaving my head.”
Claire Bidwell Smith, author of Anxiety: The Missing Stage of Grief, expects to hear hundreds of similar stories.
“There’s mass grief, the likes of which our generation has not seen before, but that grief is complicated by the traumatic circumstances of not being able to say goodbye to loved ones who died in nursing homes and hospitals, of not being able to hold memorials and funerals, and of having to grieve in isolation,” says Bidwell Smith.
Bidwell Smith says the fallout is strained relationships and extended periods of grieving. But she also predicts that the scope of the losses, and the shared nature of the experience, will ultimately create understanding that could prompt a new conversation, perhaps even a new vocabulary, around grief, as well as virtual ways of coping and processing that are only now being explored.
“Grieving has always been lonely business, and while in isolation that loneliness is heightened,” she says. “But there is also something comforting about knowing that so many other people are grieving with you,” she says.
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A Potential Surge in Mental Health Diagnoses
Experts predict that the increased stress and negative emotions caused by (but not limited to) unemployment, financial disaster, loneliness, grief, and fear may trigger mental illness.
“During the crisis, individuals, depending on circumstances, may experience anger, anxiety, avoidance, boredom, confusion, decreased concentration, depression, detachment, emotional exhaustion, insomnia, isolation, grief, guilt, sadness or other symptoms,” says Michael Morgenstern, MD, who is board-certified in both neurology and sleep medicine by the American Board of Psychiatry and Neurology. “The severity of these feelings, and our ability to cope with them so that they don’t interfere with our daily function, is important. Unfortunately, some individuals may be impaired in the short term, and a subset of these individuals may have to confront longer-lasting psychological impact.”
Dr. Morgenstern says he envisions increased rates of alcoholism, anxiety, depression, panic disorder, and post-traumatic stress disorder (PTSD) in the wake of COVID-19 pandemic.
Statistics available thus far bear him out. In a recent PiplSay poll of 66,908 Americans, for instance, 31 percent said they’re sleeping less due to COVID-19 related anxiety. The American Psychiatric Association reports that 36 percent of Americans said that the pandemic has had a serious impact on their mental health. Suicide prevention hotlines across the country are reporting an uptick in coronavirus-related calls.
According to Total Brain, a neuroscience-based mental health and wellness platform, 58 percent of U.S. employees feel anxious about COVID-19, and 35 percent of U.S. employees said their anxiety over COVID-19 interfered with their workplace productivity.
“People are suffering losses that are life-altering,” says David H. Rosmarin, PhD, the founder and director of the Center for Anxiety in New York City, noting that referrals to the center are up more than 50 percent. “A lot of people are facing a lot of grim realities. Who knows what the fallout is going to be? We have to be very caring and supportive and provide support for individuals who are really going to buckle in the wake of this crisis.”
Boxed In Episode 2: 'Managing Grief in the Time of Covid-19'
Chronic Stress — and the Opportunity to Learn How to Mitigate It
One thing that’s clear is that just about everyone is stressed these days. Stress can sometimes be a good thing; certain types of stress kick us into action, for instance. Stress also makes us realize that we’re in danger — like, say, when your life depends on wearing a mask and staying at least six feet away from other people.
Brief bouts of stress, even severe ones, can be tolerated. One can bounce back.
“Tolerable stress, what I call allostatic load, can be an acute life event — the death of a loved one, the loss of a job, an accident, things that make a person feel a loss of a sense of control,” the late Bruce McEwen, PhD, an internationally acclaimed expert on the impact of stress on the body and mind, told Everyday Health for its United States of Stress Special Report. “The events may be severe, but if you have a good sense of internal support, good self-esteem, and external social and emotional support, you can weather the storm.”
But when stress doesn’t let up and is paired with the feeling that we have little to no control over the circumstances that are creating it, it’s called chronic stress. And that is not good. In fact, over and over again, research points out that prolonged, unremitting stress exacts a toxic toll on the body, brain, and mind, “weathering” our insides, damaging neural pathways, sapping brain power, and skewing judgment.
Unrelenting stress also compromises the immune system and taxes the heart, kidneys, liver, and brain.
One large and looming question then, is: How will we tolerate this lengthy bout of stress caused by a phenomenon distinctly out of our control, and that has caused so many other elements of life — jobs and economic security, for example — to reel out of our grasp, as well?
Do we — can we — cultivate the internal support Dr. McEwen speaks of, and will it mitigate the mental and physical effects of the pandemic?
Andrew Rasmussen, PhD, an associate professor of psychology at Fordham University in the Bronx, New York, believes we can take comfort in the communal actions we’ve already seen during this period.
“There’s a positive message in that we as a nation have responded so quickly,” he says. “Most folks have heard what the public health experts have said. People have been staying home as prevention — that’s a communal act, if that can be built upon. The idea that we’re all in this together. I think if that can be maintained there can be real options for a communal growth.”
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Post-Traumatic Growth: What Doesn’t Kill You Can Make You Stronger
Post-traumatic growth, while not a buzz word that’s hit the masses yet, is a phrase increasingly used within the confines of meetings among psychologists and psychiatrists. “It's the premise that people grow in profound ways following a trauma,” says Heidi Horsley, PsyD, executive director and cofounder of the Open to Hope Foundation, a nonprofit organization that supports people experiencing grief and loss.
“This pandemic has thrown us into an existential crisis, it has put much of what we have believed into question,” says Dr. Horsley. “We are living in traumatic times, and trauma can also bring about growth.”
One of the ways in which experts predict growth are in learning to cope with uncertainty.
Most of us like to think we have a modicum of control over our destinies. And almost all of us have difficulty living with situations we can’t control and that have no clear end. But the enormity of the COVID-19 pandemic has forced most of us to admit that almost everything is out of our hands (except, perhaps, washing them).
Dr. Rosmarin believes many people will develop a new ability to withstand this uncertainty. “We have to accept life on life’s terms,” he says. “Right now is a time to consider the fact that this is a crisis, it is what it is, we’re going to do whatever we can but the rest is not in our hands,” he says. “If we see the reality as something that we have tolerance to accept and to be okay with whatever’s happening, that could be a very positive thing.”
Experts also anticipate that Americans will ultimately embrace the slower pace of life the pandemic has forced upon them, and to use their newfound equanimity and time to reevaluate their priorities
A crisis of this magnitude forces people to explore parts of ourselves that have been dormant, or to discover new areas we never knew existed. Some people think it might herald in a higher level of consciousness and awareness — to reexamine what’s truly important to us and what we can do without. In Buddhist terms, people are questioning their attachments. They’re asking what’s necessary and what isn’t.
“There’s a lot of us sitting on the sidelines, deprived of our usual lifestyles and social connections, a lot of things we may not have appreciated that gave us a lot of pleasure,” says Margaret Moore, coauthor of Organize your Emotions, Optimize your Life. “We thought we needed manicures, pedicures, haircuts, certain clothes, going to certain places — all the things that went with our prepandemic identity. ‘This is who I am, this is what I do, this is what I like to do.’ All of that got ripped up. The longer we’re pausing from normal life the more we’re reorganizing our internal worlds,” says Moore.
“I think people will appreciate things quite different than they did before,” says Garelick. “We all tend to get into habits, and particularly in American culture, we don’t take the time to examine or reflect upon those habits. A new perspective is mostly a good thing. This has been an opportunity to notice and maybe change that.”
Recognizing that life is really so fleeting, experts also predict that some people will end up leaving their spouses in search of “true love.” (Divorce filings reportedly increased in China post quarantine, according to an article published in Bloomberg Businessweek.) While others will take their relationships to the next level. Still others might quit their jobs, or change fields, or seek meaning in other ways than they had in the past.
“Many of us will eventually grow in profound ways,” predicts Horsley. “We will no longer take much of our lives for granted, we will be more aware of how we are treating the environment, we will value friends and family more, we will have a deeper appreciation for life, and we will question the meaning and purpose of our own lives, which may cause us to change our career trajectory, spend more time with friends and family, be more appreciative of nature, get more in touch with our spirituality. We will get through this horrific moment in our history, and we will eventually go onto not only survive but to thrive.”