The COVID-19 pandemic has morphed into something much greater than a viral illness alone. The fear, uncertainty, social isolation and financial devastation that have come along with it are now creating the perfect storm for mental health issues, and a pandemic-triggered mental health crisis is expected.
The National Center for Health Statistics (NCHS), in partnership with the Census Bureau, has already set up an experimental data system known as the Household Pulse Survey to monitor changes in mental health due to the coronavirus pandemic.1
The data collection began in late April 2020 and is expected to continue for 90 days. Some of the survey questions are related to symptoms of anxiety and depression, and the results are already coming in, reiterating the fact that mental health problems are a growing concern.
34.4% of Americans Have Symptoms of Anxiety or Depression
The survey included a modified version of the two-item Patient Health Questionnaire (PHQ-2) and the two-item Generalized Anxiety Disorder (GAD-2) scale, which are questions commonly used to screen for anxiety and depression symptoms. The questions were as follows with only one selected answer allowed:
“Over the last 7 days, how often have you been bothered by … having little interest or pleasure in doing things? Would you say not at all, several days, more than half the days, or nearly every day?
Over the last 7 days, how often have you been bothered by … feeling down, depressed, or hopeless? Would you say not at all, several days, more than half the days, or nearly every day?
Over the last 7 days, how often have you been bothered by the following problems … Feeling nervous, anxious, or on edge? Would you say not at all, several days, more than half the days, or nearly every day?
Over the last 7 days, how often have you been bothered by the following problems … Not being able to stop or control worrying? Would you say not at all, several days, more than half the days, or nearly every day?”
Information was collected on symptoms that occurred over the last seven days, and the symptoms generally occurred more than half the days or nearly every day of the prior week.2 In all, from May 7 to May 12, 34.4% of adults reported symptoms of anxiety or depression, while 30% reported signs of anxiety and 24.1% reported symptoms of depression.
Rates varied by state, with more than 40% of adults in Illinois, Louisiana, Mississippi and Missouri, as well as Washington D.C., reporting depression or anxiety symptoms. Black and Hispanic adults also reported anxiety or depression more often than whites or Asians, and women, younger adults and people with lower education levels were also more likely to be affected.3
Numbers held steady in the following weeks, with 33.9% of U.S. adults reporting symptoms of anxiety or depression the week of May 14 to 19, and 34.3% reporting the same the week of May 21 to 26.
Stress Levels Continue to Soar
The American Psychological Association’s Stress in America 2020 survey, released in May 2020 and conducted in partnership with The Harris Poll, reveals stress levels are also soaring due to the pandemic.
High stress levels related to coronavirus are described as “the new normal” for parents, while people of color were also more likely than white adults to report that the pandemic was causing significant stressors in their life, particularly related to fears of getting COVID-19 and having access to basic needs and health care services.4
The average reported stress level for U.S. adults came in at 5.9, up from 4.9 in 2019, marking the first significant rise in stress since the start of the survey in 2007.5 Even as lockdowns are ending, stress over social isolation and quarantine are shifting to stress over financial losses due to the pandemic6 as well as uncertainties about venturing back out into the “new world.”
Not surprisingly, financial stress is a major concern, with 88% of Americans surveyed by the National Endowment for Financial Education (NEFE) saying that the COVID-19 crisis is creating stress for their personal financial situation.7 Fifty-four percent were particularly worried about having enough money saved for emergency savings or retirement, while another 48% were worried about paying bills.
Job security was another top stressor, cited by 39% of survey respondents. The U.S. unemployment rate may skyrocket to 32.1% in the second quarter of 2020, the Federal Reserve Bank of St. Louis predicted in March,8 surpassing the previous highest rate of unemployment in U.S. history — 24.9%, which occurred in 1933 during the Great Depression.9
Economic Fallout Predicts Mental Health Fallout
A strong connection exists between financial problems and mental health problems, including suicide. During the Great Depression, suicide rates reached an all-time high,10 and again during the Great Recession, when at least 10,000 additional “economic suicides” occurred between 2008 and 2010.11
Further, in a report by the Well Being Trust (WBT) and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, it’s estimated that up to 75,000 people may die during the COVID-19 pandemic from drug or alcohol misuse and suicide. These “deaths of despair” are expected to be exacerbated by three factors already at play:12
- Unprecedented economic failure paired with massive unemployment
- Mandated social isolation for months and possible residual isolation for years
- Uncertainty caused by the sudden emergence of a novel, previously unknown microbe
Signs of a coming mental health crisis are all around, including at a mental health hotline run by the Substance Abuse and Mental Health Services Administration. The hotline had a 1,000% increase in usage in April 2020 compared to 2019, with about 20,000 people texting for mental help in April 2020 alone.13
“Undeniably policymakers must place a large focus on mitigating the effects of COVID. However, if the country continues to ignore the collateral damage — specifically our nation’s mental health — we will not come out of this stronger,” Benjamin F. Miller, chief strategy officer of WBT, said in a news release.14
Prescriptions for Antidepressants Are on the Rise
One outcome of Americans’ increased stress, anxiety and depression is a rise in the number of certain prescriptions. Combined, weekly prescriptions filled for drugs for anxiety, depression and insomnia rose by 21% between mid-February and mid-March 2020, by which time stay-at-home orders had been issued for many parts of the U.S.
The report, released by Express Scripts, an employer-based pharmacy benefit management company, also revealed that prescriptions for anti-anxiety drugs rose 34.1%.15 Until now, the use of anti-anxiety drugs had been on the decline for the past five years, making the rise in anti-anxiety medications particularly striking, the report noted.
Also revealing, they stated, "More than three quarters (78%) of all antidepressant, antianxiety and anti-insomnia prescriptions filled during the week ending March 15 (the peak week) were for new prescriptions."16
Turning to medications when you’re having difficulty coping with a novel and uncertain time may be recommended by conventional doctors and other health care providers, but this is unfortunate, since such drugs are often ineffective and can cause side effects that may be worse than the condition you’re trying to treat.
Antidepressants, in particular, may lead to self-harm, violence and suicide, while anti-anxiety drugs can be addictive and cause fatal overdoses.
Substance Abuse, Opioid Overdose Deaths Surge
Faced with job losses and economic uncertainty due to coronavirus, rates of substance abuse and drug overdose may also increase. Economic recessions and unemployment are associated with rises in illegal drug use among adults, with the authors noting in 2017:17
"The current evidence is in line with the hypothesis that drug use increases in times of recession because unemployment increases psychological distress which increases drug use. During times of recession, psychological support for those who lost their job and are vulnerable to drug use (relapse) is likely to be important."
The economic toll, and the death toll, from the opioid epidemic is also set to rise even further now that it has collided with the COVID-19 pandemic. Some are now predicting that a historic rise in pandemic-induced mental health problems could overwhelm the already underfunded and fragmented mental health system in the U.S.
“That’s what is keeping me up at night,” Susan Borja, head of the traumatic stress research program at the National Institute of Mental Health, told The Washington Post. “I worry about the people the system just won’t absorb or won’t reach. I worry about the suffering that’s going to go untreated on such a large scale.”18
After weeks of extended isolation, many communities reported a rise in drug overdose deaths. Jacksonville, Florida, had a 20% increase in overdose emergency calls in March 2020. Four counties in New York also reported a rise in overdoses, while Columbus, Ohio, had a surge in overdose deaths, including 12 over a 24-hour period the first week of April.19
Use Positive Tools to Cope
If you’re feeling depressed or anxious due to the pandemic, recognize that these are normal reactions, and you’re certainly not alone in these feelings. Research also suggests that, due to the way your amygdala processes emotions, novel threats may raise your anxiety level more than familiar threats, simply for the fact that they’re shrouded in uncertainty.20
You can learn to control your fear, in part via preparation and knowledge. While fear is often perpetuated by misinformation that feeds into panic, balancing negative news with positive news helps to balance the situation and your emotions to go along with it. Toward that end, make a point to turn off negative news feeds or change your thoughts surrounding what you see and hear.
In the video below, Julie Schiffman demonstrates how to use the Emotional Freedom Techniques (EFT) specifically to address anxiety surrounding coronavirus. This can help you to clear negative thought patterns in just a few minutes.
Another option is the Neuro-Emotional Technique’s First Aid Stress Tool, or NET FAST. Firstaidstresstool.com provides an excellent printable summary with visuals of the technique,21 which even a young child can do. Here is a summary of the FAST procedure:
- While thinking about an issue that is bothering you, place your right wrist, palm up, into your left hand. Place three fingers of your left hand onto the area of your right wrist where you can feel your pulse.
- Place your open right hand on your forehead. Gently breathe in and out several times while concentrating on feeling the issue that bothers you.
- Switch hands and repeat steps 1 and 2.
Making sure you’re taking care of yourself physically — via healthy diet, exercise and proper sleep — is also essential to support sound mental health. However, if you feel severely depressed or anxious, or if you’re feeling suicidal, reach out to family, friends or any of the available suicide prevention services that follow:
- The National Suicide Prevention Lifeline (U.S.) — Call 1-800-273-TALK (8255)
- Crisis Text Line — Text HOME to 741741 to connect with a crisis counselor
- Lifeline Crisis Chat — Chat online with a specialist who can provide emotional support, crisis intervention and suicide prevention services at www.crisischat.org
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