Emotional Distress of Dealing With COVID-19 May Hike Risk of Depression and Anxiety

Almost all Americans will experience emotional distress — some more than others — in the psychological fallout from the COVID-19 pandemic and its economic aftermath.

The emotional distress increases the risk of psychiatric disorders such as depression and anxiety, according to a new article published in the New England Journal of Medicine.

That’s why it’s important for health care providers to monitor the psychosocial needs of their patients, as well as themselves and fellow health care workers, during this time, according to Dr. Carol North, a crisis psychiatrist at UT Southwestern in Dallas, who has studied survivors of disasters, including the 9/11 terrorist attacks and Hurricane Katrina.

“Almost everyone may experience some distress — some more than others,” said North, a member of UT Southwestern’s Peter O’Donnell Jr. Brain Institute, who wrote the article with Betty Pfefferbaum, M.D., a psychiatrist at the University of Oklahoma College of Medicine.

While conditions arising from COVID-19 do not meet the criteria for trauma required to diagnose post-traumatic stress disorder (PTSD), depression and anxiety could result from this pandemic, according to the researchers. In fact, some people may even become suicidal, they say.

Shortages of resources needed to treat patients, uncertain prognoses, and public health measures such as shelter-in-place orders — along with the resulting financial upheaval — are among the “major stressors that undoubtedly will contribute to widespread emotional distress and increased risk for psychiatric illness associated with COVID-19,” the researchers said in the paper.

Certain groups will be more highly affected, including people who contract the disease, those at heightened risk including the elderly and people living with underlying health conditions, and those with preexisting psychiatric or substance abuse problems, the researchers claim.

Health care providers are also especially vulnerable to emotional distress during the pandemic, given their risk of exposure amid shortages of personal protective equipment, long work hours, and involvement in the “emotionally and ethically fraught” need to allocate scarce resources when treating patients, the researchers continued.

A recent review of the effects on quarantined people and health care providers in earlier disease outbreaks found stress, depression, insomnia, fear, anger, and boredom, among other problems, the researchers noted.

While not directly comparable, many who went through other catastrophic events, such as 9/11 or 1995’s Oklahoma City bombings, developed depression, as well as PTSD, according to North.

After 9/11, 26 percent of the attack’s survivors developed a new episode of major depression, according to an earlier study she co-authored.

But COVID-19 is new territory, she said.

“We haven’t studied depression in pandemics,” she said.

The pandemic is creating a multilayered disaster, North added.

“There is the fear of being exposed and getting sick and dying, as well as loss of the lives of friends and relatives,” she explained. “Then there are secondary effects — lost paychecks and the economic woes. Rates of suicide go up in populations when economic times get bad. People get stressed more in general when times are bad.”

First responders and health care professionals should be trained to evaluate the psychosocial issues surrounding COVID-19, and health care systems need to pay attention to the stress levels of their workers and change assignments and schedules if needed, the researchers advised.

Health care workers should ask patients about COVID-19-related stress factors, such as an infected family member and any depression or anxiety, and also check for vulnerabilities like a preexisting psychological condition, the researchers continued. While some patients will need a referral for mental health care, others may benefit simply from support to improve their ability to cope or suggestions for stress management, they noted.

Because parents often underestimate their children’s distress, they should be encouraged to have open discussions to address their children’s reactions and concerns, the researchers added.

People in quarantine or sheltering at home should try to reach out to loved ones electronically, North said. And avoid following the COVID-19 news if that adds to stress, according to North.

“Most people are resilient. Most people don’t develop psychiatric illness after even horrible things, and most people who develop psychiatric illness can recover,” she said. “After 9/11, only a third of the people directly exposed developed PTSD.”