COVID-19 and Mental Health

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Classrooms are void of children. Massive stadiums sit empty. Refusing to wear medically advised face masks can signal a political statement. Financial indicators have crumbled, and millions face unemployment. Governmental leaders can’t unite to devise a solid plan going forward. Social distancing has left us socially isolated. Our minds labor under the fear that it’s not if you’re going to get it, but when. Many feel lost and hopeless.

Our new normal, a phrase we rarely voiced a few months ago, terrorizes us. And no one can predict an end. It’s our world as the villain of coronavirus, COVID-19, explodes onto the landscape. In the U.S., hundreds of thousands have it with more on the way, and more than 130,000 have died. But the underlying issue devastating millions more is the mental toll.

According to a survey conducted by the American Psychiatric Association, nearly half of Americans are anxious about the possibility of getting COVID-19, and nearly four in ten Americans are worried about becoming seriously ill or dying from coronavirus. The possibility of family and loved ones getting coronavirus haunts 62 percent. Most adults are concerned that their finances will suffer, while two-thirds of Americans believe the coronavirus will have a long-lasting impact on the economy. More than one-third of Americans say coronavirus is having a serious impact on their mental health.

“Some of the more common emotional issues seen in the general public are anxiety and depression. Families are finding themselves stressed about finances and possible loss of employment, potentially having to balance work and facilitate virtual learning for their children at home, and even personal or family health concerns,” noted Todd Orr, LMSW, school-based case management supervisor/QMHP, Tri-County Mental Health Services, Inc. “Children are adjusting to not having the same access to socializing with friends and classmates, weekly extracurricular activities or just a normal routine. These experiences as well as the inability to forecast what’s to come can greatly lead to feelings of anxiety and/or depression.”

The Pandemic and Mental Health
The website for the Centers for Disease Control and Prevention is packed with details on COVID-19 and recommendations for preventing its spread with proper handwashing, social distancing, masking, sanitizing liquids and more. But it also recognizes the intense levels of stress and emotional trauma Americans are enduring during this pandemic. According to CDC, it can move Americans to negative and destructive behaviors such as fear and worry about personal health and the health of loved ones, an individual’s financial situation or job, the loss of critical support services, changes in sleep or eating patterns, difficulty sleeping or concentrating, worsening of chronic health problems, worsening of mental health conditions and increased use of tobacco, alcohol and other substances.

Unfortunately, many of the protections put in place to stem the outbreak can be traced to intense negative emotions. Social distancing of at least six feet or stay-at-home orders can make people feel isolated and lonely, increasing stress and anxiety. The cordial handshake with long-time or new acquaintances is discouraged. Masks, the protective barriers to virus-filled droplets, offer a menacing appearance and inhibit conversation.

“Stress can increase negative mood. When people feel this stress for a long time, it causes wear and tear on the body. This actually reduces the body’s immune system. People tend to respond with isolating themselves and obsessive behaviors. People need to stay connected,” stated Rachel Downing, LCSW, youth community support services manager, youth crisis services manager for Tri-County Mental Health Services “This can be done with social platforms online or by phone. People thrive more when they feel needed. Individuals can find ways to support local efforts to help by donating food, or putting together care packages or making signs for nurses, etc.”

Take Care of You
Because of the precautions demanded by COVID-19, many individuals are undertaking additional or increased roles of caring for friends and family. While some may view it as a stress reliever, it must be balanced with care for yourself. You must remain the key focus to ensure the well-being of the entire family unit, especially when it comes to your children. Your youngsters may be experiencing high levels of anxiety or have other strong emotions. Work with them but don’t lose sight of your own well-being.

“Children will take notice if you are practicing your own healthy coping skills. Also talking to your children about how they are feeling is important,” stated Orr. “Creating a safe space to discuss the importance of feelings will allow your children to best be able to express their needs. Lastly, focus on the positives. We often spend too much time dwelling on the negatives. Your children are adjusting to everything that is happening in the world; show them that you see and appreciate their hard work and efforts.”

A recent analysis from the Well Being Trust, a national public health foundation, predicted as many as 75,000 people might die from suicide, overdose or alcohol abuse triggered by the uncertainty and unemployment caused by the pandemic. Predicting who will try or succeed at suicide can depend on a person’s life experiences. According to CDC, suicide risk is higher among people who have experienced violence, including child abuse, bullying or sexual violence. Feelings of isolation, depression, anxiety and other emotional or financial stresses are known to raise the risk for taking one’s life. People may be more likely to experience these feelings during a crisis such as a pandemic because they’re depressed. Because depression increases the risk of suicide, it’s important to seek help early before suicidal thoughts occur.

According to Dr. William Elsass, chief medical officer, Mind Spring Health, and Dr. Meredith Smith, director, Summit County Mind Springs Health, share that being sad or feeling grief during COVID-19 are normal, but they should not be overwhelming. Symptoms to keep an eye on include feelings of hopelessness; problems sleeping; lack of appetite; trouble concentrating; lack of interest in usual activities; low or no energy; feelings of worthlessness; and agitation and irritability.

Remember that only one symptom probably should not set off alarm bells, but several of these together must be scrutinized and professional help sought. Access to in-person or virtual counseling or therapy can help with suicidal thoughts, and suicide telephone hotlines can also be accessed.

Moral Injury for the Health Care Community
How you react to a stressful situation can depend on your background, social support, financial situation, community safety nets and much more. However, workers on the front lines of the pandemic such as health care professionals can be impacted by the extreme strain of caring for those who are ill. In many cases, it can lead to moral injury, described as an action or lack of action that goes against core moral beliefs and causes great guilt, anger and, at its worst, shame. Normally, it presents itself after the individual has time to reflect and emphasize with those who have been negatively impacted by the disease. Moral injury can be described as intense internal sufferings, a wound to the conscience, but it is not a mental health disorder.

During the opening months of the pandemic, health care workers found themselves fighting to save lives with too few resources to treat the many patients desperately needing care. First responders and health care workers were forced to decide who was placed on a ventilator and who was not. One health care provider described the situation as being required to give up on patients that normally they wouldn’t give up on. It can be compared to the triage process that many military medical personnel may be forced to make in the aftermath of battle: ensuring available medical resources, which can be limited in a combat zone, treat the greatest number of casualties.

“It happens especially under high stakes situations where no good choice is possible or when emergency situations require rapid responses by instinct or training with no time to weigh a decision,” said Dr. Rita Brock, senior vice president of moral injury and director of the Shay Moral Injury Center, Volunteers of America.

What’s Ahead for COVID-19 and Us
As if the current news isn’t bad enough, the outlook for the fall and winter is particularly worrisome. The scientific and medical communities are warning that the latter part of the year will bring another massive round of infections. Many leaders warn that COVID-19 and its horrific effects will be with us until a vaccine is discovered and approved for use by the public. Yet, there are ways to help us face the unknown.

“When we can anticipate upcoming struggles, an effective tool to use is Cope Ahead from dialectical behavior therapy. This skill emphasizes using breathing with imagining how a person will get through it,” advised Downing. “We need to also think about things that will get in our way of coping and how we will manage those barriers. Staying active with exercise, eating healthy, avoiding alcohol and substances to cope with distress and maintaining a healthy sleep cycle are also very important parts of managing our emotional health.”

For most, COVID-19 causes only mild illness, but for others, they become very ill or die. Older people and those with high blood pressure, heart problems, diabetes or other pre-existing health issues appear to be more vulnerable. But make no mistake, this disease is with us and impacts the world through its destruction of life and debilitating effect on our economic systems. During this period, everyone must ensure they are taking the time to take care of their own physical and mental health, alongside family, friends and work colleagues.

“No one is immune to the wide-spread effects of fear, anxiety and changes to how we do things. It is important to be real with ourselves and others that this is a huge event in our lives, and we are not going to progress through it by ignoring its impact,” noted Downing. “Being honest with ourselves and others on how it has affected us is a necessary component to coping and thriving through it. Even if we haven’t experienced much anxiety from it, others around us have. We have all experienced losses from this pandemic. Get help from a professional if depression, severe anxiety or thoughts of suicide are present in your life.” ■

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To help manage stress levels, the CDC recommends:
• Take breaks from watching, reading or listening to news stories, including those on social media. Hearing about the pandemic repeatedly can be upsetting.
• Take care of your body.
• Take deep breaths or stretch.
• Try to eat healthy, well-balanced meals.
• Exercise regularly.
• Get plenty of sleep.
• Avoid excessive alcohol and drug usage.
• Make time to unwind. Try to do some other activities you enjoy.
• Connect with your community or faith-based organizations. While social distancing measures are in place, consider connecting online, through social media or by phone or mail.