The Surprising Mental Toll of COVID

Published in BrainHQ Brain Fitness News: November 2020. This article was initially published under “The Mental Toll of COVID-19” in Scientific American 323, 6, 25 (December 2020) doi: 10.1038/scientificamerican1220

The rise in depression and anxiety is even worse than expected, especially among young adults.By Claudia Wallis | December 2020 issue of Scientific American

It didn’t take a crystal ball to predict that the COVID-19 pandemic would devastate mental health. Illness or fear of disease, social isolation, economic insecurity, disruption of routine, and loss of loved ones are known risk factors for depression and anxiety. Now studies have confirmed the predictions. But psychologists say the findings also include surprises about the vast extent of mental anguish, how media consumption exacerbates it, and how much it has affected young people.

For example, a report from the U.S. Centers for Disease Control and Prevention, released in August, found that anxiety symptoms tripled and depression quadrupled among 5,470 adults surveyed compared to a 2019 sample. Similarly, two nationally representative surveys conducted in April, one by researchers at Boston University School of Public Health and another by Johns Hopkins University, found that the prevalence of depressive symptoms (BU) and “severe psychological distress” (Hopkins) was triple the level measured in 2018. “These rates were higher than what we have seen after other large-scale traumas such as September 11, Hurricane Katrina, and the Hong Kong riots,” says Catherine Ettman, lead author of the BU study.

Some of the most affected groups in these studies were people with pre-existing mental health issues, low-income people, people of color, and people close to someone who suffered or died from COVID-19. However, in Ettman’s study, the group in the United States with the most significant increase in depression, which increased fivefold, was Asian. In an accompanying commentary, psychiatrist Ruth Shim suggested that the growth could reflect the impact of racism and insults related to the origin of the pandemic in China.

One unexpected finding in all three surveys was the enormous toll on young adults. In the CDC survey, 62.9 percent of 18- to 24-year-olds reported having an anxiety or depressive disorder, a quarter said they used more drugs and alcohol to cope with pandemic-related stress, and a quarter said they had “seriously considered suicide” in the previous 30 days. In an unusual real-time study, young adults were also the most affected age group that tracked the rapid rise in “acute distress” and depression by three points between mid-March and mid-April. “We expected the opposite because it was already clear that older people were at higher risk” of the virus, says lead author Roxane Cohen Silver, a psychologist at the University of California, Irvine.

Silver suspects that young people “may have had more disruptions to life events: graduations, weddings, senior year of college and high school. All those transitions and school and social connections were disrupted, which we know are very important for young people.”

Their study, which involved 6,500 people, points to a significant factor contributing to anxiety for people of all ages: increased engagement with media coverage of the outbreak. But that angst seems to take them more to the media. Especially problematic is exposure to contradictory information. Silver, who has studied the psychological consequences of events such as Sept. 11 and the 2013 Boston Marathon bombing, says fixation on media coverage is a known risk factor: “If people engage with many media, they’re more likely to expose and report distress. It’s a cyclical pattern that it’s hard to get out of yourself.”

Silver and others who research mass trauma have suggestions for maintaining mental balance in difficult times. One is limiting media consumption (TV, internet) and avoiding sensational reporting. Maintaining social contacts — via Zoom, phone, or other COVID-safe methods — is also vital, says psychologist James Pennebaker of the University of Texas at Austin. “Unlike any other disaster I’ve studied, people are actively less close to friends and community,” says Pennebaker, who is examining the pandemic’s impact on mental health by analyzing posts on the social media platform Reddit.

Fewer hugs and less shared grief may help explain why people don’t seem to adjust to the new normal, Pennebaker says. “This is not Sept. 11 or an earthquake, where something big happens, and we’re all back to normal pretty quickly.” Her other tips are maintaining healthy sleep habits, exercise, food, and drink habits. Keep a journal. Research shows that expressive writing helps people process difficult emotions and find meaning; she says, “If you worry too much about COVID, try writing about it.”