COVID-19: Mental Illness the 'Inevitable' Next Pandemic?

Megan Brooks

April 15, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's  Coronavirus Resource Center.

Although social distancing is slowing the spread of COVID-19, it will undoubtedly have negative consequences for mental health and well-being in both the short- and long-term, public health experts say.

In an article published online April 10 in JAMA Internal Medicine on the mental health consequences of COVID-19, the authors warn of a "pandemic" of behavioral problems and mental illness.

"COVID-19 is a traumatic event that we are all experiencing. We can well expect there to be a rise in mental illness nationwide," first author Sandro Galea, MD, DrPH, dean of the School of Public Health, Boston University, Massachusetts, told Medscape Medical News

"Education about this, screening for those with symptoms, and availability of treatment are all important to mitigate the mental health consequences of COVID-19," Galea added.

Anxiety, Depression, Child Abuse

The COVID-19 pandemic will likely result in "substantial" increases in anxiety and depression, substance use, loneliness, and domestic violence. In addition, with school closures, the possibility of an epidemic of child abuse is "very real," the authors note.

As reported by Medscape Medical News, a recent national survey by the American Psychiatric Association showed COVID-19 is seriously affecting Americans' mental health, with half of US adults reporting high levels of anxiety.

The authors suggest that three steps, taken now, can help prepare for the coming mental health problems and associated problems that will result from the pandemic.

The first step is to plan for the inevitability of loneliness and its sequelae as populations physically and socially isolate and to find ways to intervene.

To prepare, the authors suggest the use of digital technologies to mitigate the impact of social distancing, even while physical distancing. They also encourage places of worship, gyms, yoga studios, and other places people normally gather to offer regularly scheduled online activities.

Employers can also help by offering virtual technologies that enable employees to work from home and schools should develop and implement online learning for children.

"Even with all of these measures, there will still be segments of the population that are lonely and isolated. This suggests the need for remote approaches for outreach and screening for loneliness and associated mental health conditions so that social support can be provided," the authors note.

Need for Creative Thinking

The authors note the second "critical" step is to have mechanisms in place for surveillance, reporting, and intervention, particularly when it comes to domestic violence and child abuse.

"Individuals at risk for abuse may have limited opportunities to report or seek help when shelter-in-place requirements demand prolonged cohabitation at home and limit travel outside of the home," they write.

"Systems will need to balance the need for social distancing with the availability of safe places to be for people who are at risk, and social services systems will need to be creative in their approaches to following up on reports of problems," they say.

Finally, the authors note that now is the time to bolster the US mental health system in preparation for the challenges posed by the COVID-19 pandemic.

"Scaling up treatment in the midst of crisis will take creative thinking. Communities and organizations could consider training nontraditional groups to provide psychological first aid, helping teach the lay public to check in with one another and provide support," they write.  

"This difficult moment in time nonetheless offers the opportunity to advance our understanding of how to provide prevention-focused, population-level, and indeed national-level psychological first aid and mental health care, and to emerge from this pandemic with new ways of doing so."

Invaluable Advice

Reached for comment, Lloyd I. Sederer, MD, psychiatrist and adjunct professor, Columbia University Mailman School of Public Health in New York City, described the article as "invaluable" noting that it "clearly and concisely describes the mental health consequences we can expect in the wake of the COVID-19 pandemic — and what can (and needs) to be done to mitigate them."

Sederer added that Galea has "studied and been part of the mental health responses to previous disasters, and is a leader in public health, including public mental health. His voice truly is worth listening to (and acting upon)."

Sederer offers additional suggestions on addressing mental health after disasters in a recent perspective article published by Medscape Medical News.

Galea and Sederer have reported no relevant financial relationships.

JAMA Intern Med. Published online April 10, 2020. Full text

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