Mental Health Realities (almost) post-COVID

Mental Health Realities (almost) post-COVID

Our world is now in the sixteenth month of the COVID-19 pandemic crisis. Just as we began to unmask, head back to workplaces, and open venues for sport and entertainment, another surge of cases and hospitalizations has made its way to many communities across the United States. Although we don’t know when we will see the true end of this pandemic, it is worthwhile to pause and recognize where we have been as a country and evaluate the mental health impact on our families and neighbors.

The National Institute for Mental Health (NIMH) cites a CDC report showing that rates of self-reported mental health concerns have nearly doubled over what would have been expected before the pandemic. The greatest impact included symptoms of anxiety and depression, new or increased substance abuse, stress-related symptoms, and serious thoughts of suicide. This report cites risk factors for this increase in symptoms as food insufficiency, financial concerns, and loneliness. Most of these statistics align with prior research on the mental health impact of general disasters and epidemics. NIMH suggests that most people will recover from these experiences and symptoms over time, and a fraction of those affected will develop chronic symptoms of post-traumatic stress disorder (PTSD) or major depressive disorder (MDD). Those with more risk factors and less external support are more likely to have longer recovery time and more lasting impact on mental health.

For those who have contracted COVID 19, there can be additional mental health challenges as a result of the virus itself. According to a recent article from UpToDate, COVID 19 can affect the functioning of the central nervous system. Symptoms can include dizziness, headache, or impaired consciousness. For those with acute respiratory distress syndrome, neurologic or psychiatric features can include agitation and other neuropsychological impairment. A study of patients who had been hospitalized reported symptoms of anxiety, depression, delirium, headache, insomnia, myalgias (muscle, ligament, or soft tissue aches or pains), and dysgeusia (altered taste).

Financial concerns, job instability, and illness can have a major impact on marriages as well. The 2020 American Family Survey looked at many factors from the last year when polling families on the state of family life and marriage. Surprisingly, the majority of respondents indicated that their marriages were either about the same or getting stronger, a similar trend of past surveys. It seems that people are valuing their partners and families more in the face of uncertainty and struggle. In addition, there was a 5% increase in those living with extended family members in the recent survey. During the pandemic, parental identity seemed to strengthen as people refocused on “what matters most”.

Those living with serious mental illness experienced some of the strongest impact as access to resources and services became more limited as clinicians and providers worked to move services to telehealth. Those with very serious mental illness are more likely to contract and/or die from COVID 19 because of issues that arise from handwashing, distancing, and other safety practices. The rate of opioid overdose rose substantially in 2020 as well.

It can be argued that those experiencing the greatest impact from the COVID 19 pandemic are our more vulnerable children and adolescent populations. Similar to adults, longer-term impact is dependent on vulnerability factors including pre-existing mental health conditions, economic disadvantage, special needs, educational status, and developmental age. In general, children and adolescents grow and develop well with structure and routines, as promoted and utilized in our educational system. Routines are essential for growth and development, as well as for regular coping with stress and health challenges. When these norms and routines of daily life are interrupted for a long period of time, the emotional and social development of our children can be impacted. According to a review from the National Institute of Health, children ages 3-6 are more likely to experience clinginess and fear related to the change in routines. Children ages 6-18 experience inattention, isolation, uncertainly, and can become fearful. Parents can see resulting sleep disturbance, poor appetite, agitation, and separation anxiety. Anecdotally, clinicians across the country are seeing a rise in referrals for children and teens experiencing these symptoms for the first time as well as increased difficulties for children who were already experiencing mental health issues. Mental health therapists are seeing a rise in anxiety levels in children as uncertainty continues about their own health, the health of their families, and the return to school and related activities.

Many aspects of the pandemic have caused people to reevaluate the way they want to live their lives and spend their time. Time at home has brought new perspectives, and for many, a reorienting or realignment with core values has been the outcome. One result of the many changes to our way of living has been what some are dubbing “The Great Resignation”. The Labor Department indicates that 4 million people quit their jobs just in April of this year. Many are indicating a variety of reasons for the mass exodus including wanting more income, more flexibility, and a greater sense of happiness. For many, according to a recent NPR article, there is a greater value placed on their time including time commuting to and from work. For others, they have evaluated time spent performing a job that they don’t love, one that comes with a toxic work environment, or a lack of feeling valued in their role. In addition, workers evaluated their workplaces and the priorities of the company by the way they were treated during the pandemic, and for many, this brought them to a breaking point.

For the first time in a long time, many people have had the time, space, and mental bandwidth to evaluate their own values, goals, and priorities. They may have even had time to think outside the box and dream a bit about what they truly want their lives to look like. They’ve evaluated the needs of their children and families and how they really want to invest their time. As some have been required to come back in person to the office, they have been forced to make tough decisions about how to navigate childcare and health/safety concerns. Oftentimes, necessity pushes for a decision that may otherwise be put off.

The impact of COVID 19 on the mental, emotional, and relational health of our country has been fairly widespread. Most of us know someone who has been directly impacted by COVID 19 infection if we haven’t ourselves. We have all been impacted by the implications of the global pandemic in one way or another. It is important to recognize the signs of emotional distress in ourselves and our loved ones.

Common symptoms of depression include a persistent feeling of sadness or hopelessness, a loss of interest in things that were once central to one’s life, as well as significant changes in sleep or appetite. Less recognizable symptoms include increased alcohol or drug use, fatigue, forced happiness, irritability, agitation, difficulty concentration, distractibility, and physical pains that seem to have no other cause. Common symptoms of anxiety include a persistent feeling of nervousness, restlessness or tension, rapid breathing, and trouble concentrating. Less common symptoms of anxiety include fatigue, stomach aches, indecisiveness, avoidance, and difficulty dealing with stress.

It is difficult to diagnose yourself or your loved one, but you can observe the signs of distress. Seeing several from the list without other medical explanations may indicate that you or your loved one could use professional help in getting back to feeling more like oneself. Conversations with loved ones about these difficulties could reveal a need for extra support from social relationships, economic resources, or spiritual guidance. For mild symptoms, you or your loved one may benefit from learning coping strategies like meditation or mindfulness. There are several helplines available to support and connect people with help and resources.

Some of these include the Disaster Distress Helpline, the Crisis Text Line, and the Suicide Prevention Lifeline. You can also reach out to your family doctor for assistance and to be connected to a mental health professional in your area. It is especially important to talk with your pediatrician about any emotional and behavioral changes you are seeing in your children. Behavior is the way children communicate when they haven’t acquired the proper language to describe what they are feeling. Change in behavior and the inability to adequately regulate emotions could indicate a need for intervention. Poor behavior can often mask a deeper issue that discipline may not solve. See the following article from the American Academy of Pediatrics to assist in recognizing signs of stress in your children.

Even through the challenges of this global pandemic, there has been much emphasis on supporting one another in safe ways and linking arms to come through the uncertain times. We can all equip ourselves with knowledge and empathy to see our loved ones and neighbors in need and offer support in ways that we are able.

Rebecca Maxwell is a licensed marriage and family therapist in Jacksonville, Florida. She can be reached at