Mental Health: The Impact of COVID-19

SARS-CoV-2, the virus that causes COVID-19, has not only affected physical health, but the mental health of individuals. It is important to recognize and acknowledge the impact this virus has on mental health to be able to better understand and help those affected.

SARS-CoV-2, the virus that causes COVID-19, has not only affected physical health, but the mental health of individuals. It is important to recognize and acknowledge the impact this virus has on mental health to be able to better understand and help those affected.

Children & Adolescents
Although children and adolescents have been less affected by the physical health complications of COVID-19, this group has still been greatly impacted. In order to slow the spread of the virus, governments all over the world implemented school closures, social distancing, and quarantining at home, leading to social isolation and disruption to daily routines (1). The concern of this prolonged isolation from school and peers and indefinite change in routine may have a negative psychological impact on children.

A rapid systematic review conducted a study to determine the associated impact of social isolation and loneliness on the mental health of children and adolescents (1). The rapid systematic review examined 63 studies and “found a clear association between loneliness and mental health problems in children and adolescents” (1). Depression was the most commonly found association but it is to be noted that elevated depression symptoms were more commonly found in females and elevated social anxiety was more commonly found in males. Loneliness is also associated with future mental health problems for up to 9 years later with a length of loneliness to be a predictor of future mental health problems of individuals. One study in the review examined mental health problems of children who had been quarantined in past pandemics, revealing that children who had experienced prolonged isolation in the past were five times more likely to require mental health services and have higher levels of post-traumatic stress disorders (1). Although it is too early to determine the long-term effects of this pandemic it may serve as a predictor for the future. Emerging studies from China are also noting anxiety symptoms, such as clinginess, distraction, fear of asking questions about the pandemic and irritability, in children 3-18, showing early signs of anxiety disorders (1).

Although there is no clear end to this pandemic, one thing that can help with the mental health of children is prioritizing communication. The article “Protecting the psychological health of children through effective communication about COVID-19” discusses the importance of communication in order to help them deal with isolation and emerging mental health problems (2). Although some parents may feel that it is better to shield their children from these topics, research shows that children as young as 2-years-old are aware of changes to their environment and routine (2). Even if adults aren’t talking to their children about the pandemic, children are still exposed to media and conversations of the outbreak, and are exposed to high levels of stress and anxiety from adults around them (2). “An absence of emotion-focused conversations might leave children anxious about the emotional state of the adults around them. This anxiety can inadvertently result in children's avoidance of sharing their own concerns in an attempt to protect others, leaving children to cope with these difficult feelings alone” (2).

When discussing information about the virus and pandemic with children it is important to provide the information in an honest but age-appropriateage appropriate way. This may vary depending on the age of the child but also on the child’s ability to understand the illness and the implications of the illness (2). When information is not shared with young children, they attempt to make sense of these changes on their own which can lead to anxiety. Children may also blame themselves for the illness of others and see the illness as punishment forof their own bad behaviors. When discussing the current pandemic with your children it is just as important to listen and ask them what they know or believe regarding the virus and everything that has been happening.

When initiating this discussion with your children, it is important to be honest about the uncertainty of the situation and to acknowledge their fears. This honesty will provide a clear explanation for all the changes that your child may have observed. By having open conversations with your children, it will allow them to feel comfortable to talk with you when they are uncertain or scared. One of the most helpful things to do for your child is to acknowledge their emotions and normalize the emotional reaction to this isolation- this will help the child feel supported and understood (2).

Health Care Workers
One group that has been on the front lines of this pandemic are health care workers and there is concern for the mental well-being of these individuals. In April, a physician named Lorna Breen committed suicide after working in an emergency room in New York. She had worked long hours with COVID-19 patients and contracted the virus herself, only to return to work a week and a half later to continue working to help patients. (3) Her suicide serves as a warning of the mental stress that health care providers are under during this pandemic.

During this pandemic, health care workers have experienced drastic changes in their health care systems. Many have worked long hours in high-pressure environments, and “may have been exposed to trauma and/or faced moral dilemmas relating to challenges in the delivery of high-quality care, possibly due to a lack of experience or equipment, or as a result of low staffing levels” (4). Other factors comprising the resilience of health care workers are the fear of getting sick themselves and avoiding family and friends out of fear of infecting them. This avoidance can lead to social isolation and loss of social supports which are critical in times of stress (5). The combination of these factors puts health care workersproviders at an increased risk for mental health problems such as: post-traumatic stress disorder (PTSD), depression, anxiety, insomnia, substance misuse or suicide (4). Literature on the psychological consequences of trauma exposure indicatesindicate that lack of post-trauma support and exposure to stressors during recovery from trauma are likely to lead to long-term mental health problems (4).

Acknowledging that these professionals are at risk for developing mental health disorders is the first-linefirst line defense to help them cope. Support needs to be provided by management to help health care workers deal with the trauma and distressing circumstances caused by the pandemic. According to “Mental health of health-care workers in the COVID-19 era” there are six key ways that management and supervisionsupervisions can help identify early signs of mental distress (4). The first item is thanking and acknowledging the challenges that health care workers have faced. This can help foster a sense of resilience, which has been seen across the country with people cheering for the health care workers and thanking them on social media. The second item is checking in on employees and co-workers who call out of work- avoidance of trauma is an early sign of mental health problems. The third item to help health care workers is having supervisors conduct ‘return to normal work’ interviews. During these interviews, they will speak with employees about their experience during the pandemic and given them an opportunity to express any mental distress they’ve experienced and provide them support. The fourth item is related to the interviews, but focuses on high-riskhigh risk groups of individuals, such as new or less experienced staff, who may have had to work above their expected level of competence. The additional stress of working outside the normal or expected scope can increase the level of distress one experiences. The fifth item is closely monitoring those staff members who have undergone higher stress events throughout the pandemic and helping them identify early signs of mental health decline. The final item is acknowledging that most staff may have been exposed to morally distressing circumstances and helping them make sense of these incidents. “Being able to develop a meaningful narrative that does not blame themselves or others for what happened during the crisis is likely to reduce the risk of them suffering psychological harm” (4).

General Public
Besides the physical health tolls that COVID-19 can have on one’s health, there is also the concern of the effect of COVID-19 on one’s mental health. Loneliness, depression, anxiety, and post-traumatic stress disorder (PTSD) are the top mental health problems linked to COVID-19. Social isolation, worry related to COVID-19 health concerns, financial concerns such as remote working or job loss, stress over being able to pay the mortgage/rent, as well as not knowing when the pandemic will end has increased the likelihood of developing a mental health disorder. “Factors Associated with Depression, Anxiety, and PTSD Symptomatology During the COVID-19 Pandemic: Clinical Implications for U.S. Young Adult Mental Health”, a cohort study, found that at least one-third of young adults had increased levels of depression, anxiety, and PTSD symptoms within a few weeks of the pandemic and quarantine starting (6).
“Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis” analyzed existing research related to the prevalence of stress, anxiety, and depression in the general public related to the COVID-19 pandemic. The conclusion of this analysis is that COVID-19 can impact the mental health of individuals and is important to help develop and offer interventions that can help improve the mental health of individuals during this time (7). Acknowledging the impact that this pandemic has on mental health and knowing what resources are available are important steps in providing proper care for individuals.


Resources for Mental Health
As research develops, so will the interventions that can be offered to individuals to help with their mental health. At this time, The Centers forof Disease Control and Prevention (CDC) has a list of ways that individuals can help with their own stress and anxiety (8). Some of these tips include:
- Know what to do if you are sick and concerned about COVID-19
- Know where and how to get treatment including counseling and therapy
- Take care of your emotional health
- Take breaks from watching, reading and listening to the news stories and stories on social media
- Take care of your body through stretching, deep breathing, eating healthy meals, getting plenty of sleep and exercise
- Take time to unwind with activities you enjoy
- Connect with others through social media, phone calls, email, online chats, and social distancing measures
- Reach out to emergency hotlines or find a health care provider near you to help deal with the stress, anxiety, and depression caused by COVID-19

The following link will connect you to the CDC website. This website includes links to find a health care provider or treatment for your mental health, emergency contact numbers previously mentioned, and other resources to help adults, health care workers, and children deal with the emotional competent of COVID-19:

https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html