POV: Coronavirus Is Taking a Toll on Mental Health
What we need to do to address the issue now and after the pandemic has passed
By Sandro Galea
We are living in unsettling times. The ongoing COVID-19 outbreak is in many ways unprecedented, in the scale of this challenge, the scale of public health response, and the historical context in which all this is unfolding. COVID-19 is the first global pandemic of the social media age, the first of the “alternative facts” era, and is occurring at a moment when politics and society seem to be in a state of accelerated flux.
All this can weigh on mental health. I have long argued that mental health is public health, and we should address mental health with the same level of care we apply to the health of our bodies. This is no less true during the challenge of COVID-19. As our community adjusts to the measures we have collectively adopted to mitigate the spread of the disease, it is important to prioritize mental health, even as we take steps to minimize the infectious threat. Earlier this month, Ilana Schlesinger, wellness coordinator for BU’s School of Public Health, reached out with some best practices for emotional well-being. I urge everyone to take a look at these steps, to take time to prioritize mental health in the coming months. I also encourage everyone to attend our March 26 virtual seminar on COVID-19 and mental health. The event will be the first of a series of online seminars addressing the unfolding pandemic and how it intersects with other issues of contemporary concern for public health.
With this in mind, some thoughts on how we can support mental health in populations, both in the near term, and in the months and years after this pandemic has passed.
For all that is new about COVID-19, the disease still behaves like any number of prior epidemics. It is, for example, similar to the 2003 severe acute respiratory syndrome (SARS) outbreak, an event that created a number of lessons for our present moment. SARS was, in many ways, the best-case scenario for responding to a global infectious threat. The spread of SARS was contained fairly quickly by public health efforts, chiefly through the widespread use of quarantine. But even this relative success still had consequences for health. In 2004, I worked with colleagues on a study of SARS control and the psychological effects of quarantine in Toronto, Canada. We found among quarantined persons a high prevalence of psychological distress, including symptoms of depression and post-traumatic stress disorder (PTSD). A key takeaway: even if we can halt the physical spread of a disease through the expeditious use of quarantine and social distancing, we will still have to contend with its mental health effects in the long term.
This is a message that is frequently forgotten. The mental health effects of COVID-19 can shape health for many years, long past the events that precipitated them. We have been focusing, correctly, on saving lives and mitigating the short-term consequences of COVID-19, but the long-term consequences may be equally, if not more, important. While it can be difficult to take the long view when the events of the moment are so compelling, it is necessary if we are to ensure the steps we take now are in the best interest of public health once this pandemic passes and our task moves from one of response to one of recovery.
To envision how this long-term future may unfold, it helps to look to the past, and not just to past epidemics. Protests, riots, mass uprisings, and natural disasters can also teach us much about how large-scale disruptive events can shape mental health. What do we know about the consequences of such events?
In a study published earlier this year, I worked with colleagues to investigate the mental health effects of protests, riots, and revolutions. Our work looked at the immediate effects of these events, as well as their long-term consequences. We found that the prevalence of depression and PTSD among populations after collective actions like protests and riots is comparable to levels experienced after natural disasters and terrorist attacks. This was the case for populations directly and indirectly affected by such events, suggesting a “spillover effect,” as anxiety over a disruptive event ripples through communities. We see similar effects after natural disasters, where mental health consequences can include depression, PTSD, and substance use disorders.
Then there are the economic effects of such events. In the case of COVID-19, we have already seen traces of these effects in the falling stock market, but the fortunes of Wall Street do not reflect what may be the true cost of this pandemic. With so many eyes focused on the stock market, it is possible to miss that the economic brunt of COVID-19 will likely be borne by low-wage hourly workers, who can ill-afford the time away from work that containing the disease may necessitate. This will have consequences for health. Income is closely linked to health — physical and mental. There is, for example, a 10- to 15-year difference in life expectancy between Americans at the very bottom of the economic ladder and those at the very top, and income inequality has been linked with depression risk. COVID-19 could deepen this inequality over the long term, even as in the short term it undermines the peace of mind necessary for robust mental health, and compounds the challenges of people already prone to mental health struggles.
Given the potential for long-term mental health consequences extending well beyond the duration of this epidemic, what steps can we take now to safeguard mental health? First, it is important to disseminate accurate, up-to-date information on COVID-19, to counter the misinformation that can lead to undue fear.
Second, we can care for populations at special risk of stress. These include people with preexisting mental health conditions, such as depression and anxiety, and children.
Third, we have a special responsibility to ensure that we are responsive to the mental health needs of people acting as first responders and care providers for populations affected by the pandemic. In times of challenge for health, it is especially necessary to support those who work so hard to support us. This means supporting their mental health.
Fourth, we have to ensure that we are ready to support the longer-term wave of poor mental health that can follow the COVID-19 pandemic. This will require alertness in our clinical systems and deployment in efforts such as stepped care approaches that we have found to be effective after other mass traumatic events.
Finally, we need to realize that we are all in this together, that no one should ever have to feel alone. As we continue to use social distancing in the coming months, we should also reach out in whatever safe ways we can, letting the ones in our lives know that, although perhaps physically isolated, they remain embedded in a web of care and concern. Our health, both physical and mental, is linked. When trauma strikes a society, it does not just strike a group of individuals who happen to live in the same place. It exposes how connected we are, and want to be. This is true within our school, within the wider community, and at the global level. It is compassion and simply looking out for each other that will support health — physical and mental — in the days to come.
Acknowledgement: I am grateful for the contributions of Eric DelGizzo to this Dean’s Note.