- A new meta-analysis examining data from three coronavirus pandemics, including COVID-19, found that individuals most impacted by mental health issues were infected/recovered individuals, followed by healthcare providers.
- Treatment for patients with a severe case of COVID-19 puts them at a higher risk of developing PTSD.
- Clinicians are helping recovered individuals disentangle physical from emotional well-being, and recommend group therapy to help with recovery.
A year into the pandemic, COVID-19’s physical symptoms, such as shortness of breath and fatigue, are well-documented. But how does the virus affect mental health?
To address this question, program evaluator Matthew T. Boden, PhD, approached his colleagues at the Veterans Health Administration in Palo Alto to organize a meta-analysis of multiple studies to identify overarching trends.
Since the data on COVID-19 is in its infancy, the study sought to make predictions on the virus’s mental health impact using data from two other recent coronavirus pandemics—SARS and MERS-CoV, along with existing COVID-19 data. “Everybody’s impacted,” Boden tells Get Meds Info, but with this study, “we now know that infected/recovered people are impacted most” in terms of mental health.
Researchers found that one in five adults developed pandemic-related mental disorders. A pre-print version of the paper is available on the medRxiv server, posted in December, while the article undergoes peer review.
What This Means For You
If you contracted COVID-19 and are experiencing lasting, mental health issues, reach out to a mental health professional about treatment. Group therapy with others who went through the same experience can be particularly helpful. Even if you haven’t contracted the virus, you may be experiencing challenges with your mental health due to the pandemic, and therapy can be a first step in seeking help.
Boden and his colleagues analyzed trends in 60 publications looking at a total of 66,190 participants. Overall, the most commonly reported mental disorders were unspecified psychiatric morbidity (undistinguished disorder, 32%), post-traumatic stress disorder (PTSD) (21%), depression (17%), and anxiety (12%).
Unspecified psychiatric morbidity refers to conditions where symptoms characteristic of a mental disorder are prevalent but do not meet the full criteria for any specific mental disorder.
The rate of PTSD is noteworthy, Boden says. All that goes into treating patients with severe cases of COVID-19—isolation, extremely invasive treatments such as intubation, heavy sedation, and various medications—are risk factors for PTSD. Mechanical ventilation in particular has been linked to PTSD symptoms in ICU survivors.
The individuals most impacted by mental health issues were infected/recovered individuals (30%), followed by healthcare providers (20%), adults in the community (16%), and quarantined adults (12%).
The authors also found that patients who recovered from SARS or MERS presented higher rates of mental illness as compared to those who recovered from COVID-19. This, Boden says, could have to do with the differences in mortality rate; MERS and SARS could be more fatal than COVID-19, but it’s hard to judge because they haven’t affected nearly as many people, and the global contexts were different.
“It must be noted that the number of people impacted by COVID-19 and the range of stressors, traumas, and threats that any one person might encounter is magnitudes higher than for SARS or MERS,” Boden says. “Thus, the overall number of people with adverse mental health outcomes will also be magnitudes higher.”
For those with psychiatric histories, “pretty much any disorder might be impacted” by the most recent pandemic, Boden says. As for new disorders, it’s mostly speculation now, but in the years to come, we could also see upticks in anxiety and substance abuse.
“People use substances as coping mechanisms,” Boden says. “This is especially going to be the case when we have things like shelter-in-place when substances are the only ways people can find pleasure or cope with the pandemic.” Because of this, “there’s a clear need to get data on substance use in the pandemic,” he says.
Regardless of COVID-19 status, Boden anticipates seeing a rise in depression and anxiety disorders. “The economic impact is going to be the factor that affects most people, especially among populations that are disproportionately affected by the economic downturn that has happened and is continuing to happen,” specifically for those with limited economic means, those who work in “essential,” public-facing jobs, and black and indigenous people of color.
“To adequately address this pandemic, federal and local government, healthcare systems, and individual treatment providers will need to dedicate resources to assess for and treat adverse mental health outcomes in these vulnerable populations,” he says.
Mental Health Help for COVID-19 Patients
When the pandemic started, Brittany C. LeMonda, PhD, a clinical neuropsychologist in New York, provided telehealth to patients in recovery from COVID-19. Based on her work, LeMonda tells Get Meds Info that mental health patterns seem to depend on the severity of infection and age. That is, patients with more severe infection show symptoms of PTSD, anxiety, and psychiatric illness, but also tend to be older. Patients with less severe cases show depression and tend to be younger.
“We know that there’s a link between mental health and immune system function,” LeMonda says, so older individuals, who tend to have more compromised immune systems are also more likely to struggle with mental health. Regardless, she says, these struggles are significant no matter a patient’s age or severity of infection.
“The common theme among severely infected patients was that COVID symptoms and anxiety overlapped,” she says. Lab results could be coming back normal for patients, indicating that they no longer had the virus, yet some would say they still felt like they were recovering. “They were still feeling trouble breathing, tenseness, and chest tightness,” LeMonda says. “Those are also symptoms of anxiety.”
LeMonda’s less-severely infected patients presented with mental fog, concerns about returning to work, and said that they just didn’t feel as “sharp” since before contracting the virus. So she found herself asking clients, “Is this a reaction to the pandemic, or is this a true neurological complication of COVID?”
Disentangling Physical From Emotional Well-being
In addressing this difference, LeMonda recommends reaching out to a neuropsychologist to help tease apart what’s going on. “A neuropsychologist is well-equipped in performing the assessment aspect of it,” she says. “We ask, is this neurological or primary mood disorder?”
They can help to identify if something injured the brain, such as hypoxia, a lack of oxygen to brain tissue. If the individual is seeking therapy for issues following COVID-19 recovery, “that initial neuropsychological assessment is really useful,” just so that everyone’s clear on brain health before addressing emotional health.
Afterward, LeMonda recommends group therapy. Especially if the individual received intense treatment in the hospital—involving intubation, isolation, and hospital chaos. “If you didn’t go through it, you don’t understand, so I really think that group therapy is ideal for these severely affected folks,” she says. And for recovered individuals dealing with PTSD symptoms, Boden recommends evidence-based therapies such as prolonged exposure, cognitive processing therapy, and Eye Movement Desensitization and Reprocessing (EMDR).
Since the pandemic not only implicates sickness, but earth-shattering changes in employment, financial status, relationships, and daily life, LeMonda says, individual therapy is also an option, even if you haven’t contracted COVID-19.
A Path Forward
Will the universality of the pandemic aid us in coping? Boden says it’s still unclear. “However, evidence has accrued, for example, through studies conducted by George Bonanno and colleagues, that most people are resilient and do not suffer from traumatic stress disorders when exposed to traumatic events,” he says.
Additional research is needed, but most people do not develop a traumatic stress disorder. Still, those who are most vulnerable—due to financial status, race, gender identity, pre-existing condition, age, or any combination of these factors—need more attention and help.
Jonathan Rogers, MRCPsych, a psychiatrist based in Britain, wonders whether public health messaging has been too narrowly-focused by only emphasizing the importance of social distancing. “It would probably be helpful to have broader messaging, emphasizing the importance of physical exercise, good diet, keeping a routine, and regular contact with friends/family, even if only virtual,” Rogers says. “All these are known to support good mental health.”
In addition to these daily practices, Rogers recommends governments take part in public health through policy. “I think many people are struggling with the uncertainty of what is due to happen next,” Rogers says. “Some things are difficult for governments to control, but other things, such as unemployment benefits, can be planned ahead to give people some certainty.”
On top of clearly-defined financial assistance, “mental health services need to be properly supported so that they can help those who are psychiatrically unwell,” Rogers says.
The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.