Plan Now to Address the COVID-19 Mental Health Fallout

Lalasa Doppalapudi, MD; Steven Lippmann, MD

May 13, 2020

COVID-19 affects the physical, psychological, and social health of people around the world. In the United States, newly reported cases are rising at alarming rates.

As of early May, more than 1.3 million people were confirmed to be COVID-19 infected in the United States and more than 4 million cases were reported globally.

According to new internal projections from the Centers for Disease Control and Prevention, by June 1, the number of daily deaths could reach about 3000. By the end of June, a draft CDC report projects that the United States will see 200,000 new cases each day.

COVID-19 undeniably harms mental health. It gravely instills uncertainty and anxiety, sometimes compounded by the grief of losing loved ones and not being able to mourn those losses in traditional ways. The pandemic also has led to occupational and/or financial losses. Physical distancing and shelter-in-place practices make it even harder to cope with those stresses, although those practices mitigate the dangers. The fears tied to those practices are thought to be keeping some patients with health problems from seeking needed care from hospital EDs. In light of the mental health crisis emerging because of the profound impact of this pandemic on all aspects of life, clinicians should start working with public health and political leaders to develop plans to address these issues now.

Known Impact of Previous Outbreaks

Previous disease outbreaks evidence a similar pattern of heightened anxiety as the patterns seen with COVID-19. For example, during the 2009 swine flu outbreak, 36 surveys of more than 3000 participants in the United Kingdom found that 9.6%-32.9% of the participants were "very" or "fairly" worried about the possibility of contracting swine flu. The 1995 Ebola outbreak in the Democratic Republic of the Congo produced stigmatization tied to the illness. That outbreak provided many lessons for physicians.

The metaphors ascribed to different diseases affect communities' responses to it. The SARS virus has been particularly insidious and has been thought of as a "plague." Epidemics of all kinds cause fears, not only of contracting the disease and dying, but also of social exclusion. The emotional responses to COVID-19 can precipitate anxiety, depression, insomnia, and somatic symptoms. Acute stress disorder, PTSD, substance use, and suicide can emerge from maladaptive defenses intended to cope with pandemics.

Repeated exposure to news media about the disease adds to this stress. Constant news consumption can result in panicky hoarding of resources such as masks, gloves, first-aid kits, alcohol hand rubs, and daily necessities such as food, water, and toilet paper.

Who Is Most Affected by Outbreaks?

Those most affected after a disease outbreak are patients, their families, and medical personnel. In one study, researchers who conducted an online survey of 1210 respondents in 194 cities in China during the early phase of the outbreak found that the psychological effects were worst among women, students, and vulnerable populations.

Meanwhile, a 2003 cross-sectional survey of 1115 ethnic Chinese adults in Hong Kong who responded to the SARS outbreak found that the respondents most likely to heed precautionary measures against the infection were "older, female, more educated people as well as those with a positive contact history and SARS-like symptoms."

Negative mental health consequences of a disease outbreak might persist long after the infection has dissipated. An increased association has been found between people with mental illness and posttraumatic stress following many disasters.

Political and healthcare leaders should develop plans aimed at helping people cope with pandemics. Such strategies should include prioritizing treatment of the physical and mental health needs of patients infected with COVID-19 and of the general population. Screening for anxiety, depression, and suicidal thoughts ought to be implemented, and specialized psychiatric care teams should be assigned. We know that psychiatrists and other physicians turned to telemedicine to provide support, psychotherapy, and medical attention to patients soon after physical distancing measures were put into place. Those kinds of quick responses are important for our patients.

Fear of contagious diseases often creates social divisions. Governments should offer accurate information to reduce the detrimental effect of rumors and false propaganda. "Social distancing" is a misleading term; these practices should be referred to as "physical distancing." We should encourage patients to maintain interpersonal contacts—albeit at a distance—to reach out to those in need and to support one another during these troubled times.

Dr Doppalapudi is affiliated with Griffin Memorial Hospital in Norman, Oklahoma. Dr Lippmann is emeritus professor of psychiatry and also in family medicine at the University of Louisville (Kentucky) Doppalapudi and Lippmann disclosed no conflicts of interest.

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