An underrepresented consequence of the COVID-19 pandemic is, in fact, another pandemic, one of mental health. The Centre for Addiction and Mental Health (CAMH) reported that half of all Canadians were experiencing worsening mental health to some degree due to the pandemic. In June 2020, the number of adults experiencing depression in the UK doubled from the year prior (19%); in December 2020, there was a reported 4-fold increase (42%) in adults reporting anxiety or depression in the US.
Mental health, in general, is highly nuanced, let alone when put into a direct relationship with COVID-19. An international clinical trial conducted on 73 countries in late 2020 found that an average of 10% of the population was experiencing extreme mental illness, while 50% reported moderate mental health disturbances during the pandemic-induced lockdown. However, a systematic review in 2020 concluded that people affected by the COVID-19 pandemic tended to experience various mental health problems, including anxiety, depression, substance abuse, repercussions from domestic violence, and post-traumatic stress disorder. The review found these problems were more likely to occur in younger people, women, and those with poor living conditions or pre-existing health conditions. Social support, education, and psychological flexibility were primary predictors of the measured outcomes of stress, depression, affect, and wellbeing.
Half of those who experienced job or wage loss during the pandemic reported negative mental health issues and worried about long-term financial stability. In the US, citizens more frequently experienced financial pressures by specific populations: lower-income adults, Hispanic, Black, and Asian American adults, and people under 30 were more likely to report increased debt or missed payments during the pandemic. Financial support is also inconsistent across countries, as are workplace compensation and paid sick leave, meaning that many people were not given adequate relief from this economic duress.
For those who remained employed, COVID-19 altered the workplace environment substantially. For many, the workplace is a huge component of life and often brings a sense of accomplishment, purpose, social interaction, and challenge. However, the forced new normal of work-from-home removed many positive aspects of work while burdening employees with new challenges. 60-95% of the working population of Canada reported increased fatigue, workload, emotional disturbances, severe stress, and worsening mental health. The inability to leave work, well, at work seems to have deteriorated many people’s mental capacities.
Hospitals and other healthcare operations experienced a rapid increase in activity during the pandemic. A systematic review in December 2020 found that over 68% of hospital staff experienced mental disturbances during the pandemic, mainly depression, anxiety, and severe stress. These rates were highest among female workers and younger staff and in areas with the highest infection rates. All workplace environments shifted very quickly, demanding that employees adapt just as fast, often to their detriment.
A regrettable consequence of lockdown, especially during the first wave, was the increase in domestic violence. Strict lockdown rules trapped many victims in the same living environment as their abuser, removing any semblance of safety on top of general pandemic stress. The consequences to the mental health of the victim are insurmountable and likely have exacerbated already terrible trauma. Domestic abuse victims tend to be female, as women are disproportionately affected by domestic violence from a current or previous male partner. On average, women’s calls to domestic violence hotlines increased 7.5% during the initial wave of COVID-19. Many community support facilities closed, leaving victims few avenues to safety and further growing physical and mental trauma.
On the other hand, reports on the incidence of child abuse during the pandemic are inconsistent save for the trend of overall abuse decreasing, with the severity of the abuse increasing. For example, one study conducted at an unnamed county in California found that reported cases of suspected child abuse fell by 29% during the pandemic. Yet, the severity of alleged child abuse cases rose by 30%.
In general, mental health support programs suffered, and many found themselves using potentially harmful strategies to quell their persisting cognitive decline. The WHO reported that the pandemic directly disrupted or halted clinical mental health services in 93% of countries worldwide, despite a rapidly increasing demand for these services. Substance abuse is mainly on the rise in North America. For example, CAMH found that 25% of Canadians between 18 and 54 increased their alcohol consumption due to the pandemic, potentially creating a whole host of addictive mental health issues. They also reported similar increases in the use of other substances, such as opioids. Meanwhile, in San Francisco, fatal overdoses rose 50% during the pandemic, while the CDC reported a 38% rise in drug overdose deaths from 2019.
Regarding suicide rates post-COVID, reports seem to be inconsistent across populations, with research geared towards high-income countries, likely due to their ability to record suicides on national databases. CAMH reports that recent projections range from 418-2,114 excess deaths by suicide in Canada from 2020 through 2021 because of the various stressors accompanying the pandemic. Multiple studies have found that, in general, overall suicide rates have not risen to those pre-COVID. However, certain data can draw cautious conclusions that specific populations within these countries indeed are showing increased rates of suicide. One report from March 2021 in The BMJ analyzed the documented suicides from upper-middle- and high-income countries and reported increased suicide rates in ‘vulnerable populations,’ namely young people, Black people, and women.
Overall, it seems that this mental health epidemic will be a prolonged consequence of COVID-19. Trends suggest that, on average, people are experiencing increased mental disturbances. The long-term effects on mental health are unknown, yet CAMH compares this pandemic to the 2003 SARS outbreak, which produced long-term consequences to affected individuals’ mental health. At the time, 29% of those quarantined in Toronto during the outbreak showed symptoms of PTSD, while 31% experienced worsening depressive symptoms. Further, the 2008 global financial crisis was found to be associated with increased mood and anxiety disorders, as well as increased rates of suicide. The financial crisis from the COVID-19 pandemic, some say, closely mirrors the major crisis of 2008, and we may be expecting similar long-term ramifications to individual wellbeing.
Ideally, countries would implement government initiatives to make mental health services much more accessible soon. Specific workplaces have extended benefits coverage and are actively working on employee mental health, which is a start but not universal. Even though mental health is such a hot topic of discussion these days, it is still often stigmatized and underappreciated when acting. Ideally, countries will focus on prioritizing post-pandemic mental health support. However, only time will tell how much of a long-term impact this pandemic will have on the mental health of individuals around the world.
References
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- Appa A, Rodda LN, Cawley C, et al. Drug Overdose Deaths Before and After Shelter-in-Place Orders During the COVID-19 Pandemic in San Francisco. JAMA Netw Open. 2021;4(5):e2110452. doi:10.1001/jamanetworkopen.2021.10452
- Kathirvel N. Post COVID-19 pandemic mental health challenges. Asian J Psychiatr. 2020;53:102430. doi:10.1016/j.ajp.2020.102430
- Belkin, G. Reimagining mental health systems post COVID-19. The Lancet. 2021; 5(4); https://doi.org/10.1016/S2542-5196(21)00037-1
- Pirkis, J. et al. Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries. The Lancet Psychiatry, Volume 8, Issue 7, 579 – 588
- Bradbury-Jones, C. and Isham, L. (2020), The pandemic paradox: The consequences of COVID-19 on domestic violence. J Clin Nurs, 29: 2047 2049. https://doi.org/10.1111/jocn.15296
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- Swedo E, Idaikkadar N, Leemis R, et al. Trends in U.S. Emergency Department Visits Related to Suspected or Confirmed Child Abuse and Neglect Among Children and Adolescents Aged <18 Years Before and During the COVID-19 Pandemic — United States, January 2019–September 2020. MMWR Morb Mortal Wkly Rep 2020;69:1841–1847. DOI: http://dx.doi.org/10.15585/mmwr.mm6949a1external icon.
- Tucker, P, Czapla, C. Post-COVID Stress Disorder: Another Emerging Consequence of the Global Pandemic. Psychiatric Times. 38(1);1
- Panchal, N., Kamal, R., Cox, C., and Garfield, R. “The Implications of COVID-19 for Mental Health and Substance Use.” KFF. https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/. July 10, 2021.
- Mental Health in Canada: COVID-19 and Beyond. CAMH Policy Advice. CAMH. https://www.camh.ca/-/media/files/pdfs—public-policy-submissions/covid-and-mh-policy-paper-pdf.pdf. July 10, 2021.
- Overdose Deaths Accelerating During COVID-19. CDC Newsroom. Centers for Disease Control and Prevention. https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html. July 9, 2021.
- COVID-19 disrupting mental health services in most countries, WHO survey. WHO. https://www.who.int/news/item/05-10-2020-covid-19-disrupting-mental-health-services-in-most-countries-who-survey. July 9, 2021.
Claudia Ritzker
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