Prevalence of Stress, Anxiety, and Depression Among the Population During the COVID-19 Pandemic

By Haya Harris

With the COVID-19 pandemic, fear and anxiety about the disease and what could happen can be overwhelming and cause strong emotions in adults and children. Public health actions, such as social distancing, can make people feel isolated and increase stress and anxiety. Millions of people around the world are coping with the job losses caused by coronavirus. Whether it's temporary or permanent, unemployment also can lead to stress, anxiety, depression, and other mental health challenges. Uncertainty related to the pandemic only adds to the angst. However, these actions are necessary to reduce the spread of the disease. Coping with stress in a healthy way makes the people and the community stronger. A wide range of psychological outcomes have been observed during the virus outbreak affecting different groups of people at levels varying from villages to globally [1].

COVID-19 has led to psychological changes in the medical worker, instigated by fear, anxiety or depression [2]. The rapid spread of the disease has created challenges for healthcare systems and forced healthcare workers to grapple with clinical and nonclinical stressors, including shortages of personal protective equipment, mortality and morbidity associated with the disease, fear of bringing the virus home to family members, and the reality of losing colleagues to it. Evidence from previous outbreaks suggests that these events have significant short and long term effects on the mental health of healthcare workers. All healthcare stakeholders should create plans to support the mental health of workers during and after the COVID-19 pandemic.

A public health/community strategy is critical to protect the health care system from becoming overwhelmed. Such a strategy is founded on the knowledge that recovery from loss is greatly facilitated by social support and the maintenance of individual, family, community, and national cultural traditions regarding death and grieving. Social distancing increases isolation and disrupts these practices, taking away chances to say goodbye to the deceased. Similar processes affect children and adolescents who experience sudden losses of a parent or a grandparent to COVID-19. The child’s sense of the world as safe and predictable and caretakers as a “protective shield” may be disturbed. Caregivers may also be unable to modulate their children’s fears and sadness. In such contexts of crisis, it is easy to lose sight of the emotional distress experienced by the grieving child. Clinicians can help bereaved families find creative ways to safely honor traditions, memorialize the deceased, and improve social support. Clinicians can also support the bereaved through education about grief and its variable course and by creating an empathic space for mourning patients to share their story [4]. Prevention depends on what is done prior to death. Every effort must be made to support end-of-life care decision-making with family members, educate about COVID-19 to lessen self-blame and survivor guilt, facilitate the process of saying goodbye to the deceased, and find creative ways to build social support. Technology could be leveraged to connect grieving children and adults with their extended family and community. Families and communities must make special effort to reach out to grieving individuals, particularly those who live alone. Public health campaigns and public policy initiatives could be created to support the implementation of these preventive strategies.

Even as some places start to open up again after months of lockdown, the end may still seem a long way off. People have lost their jobs, are struggling financially, and are worrying about if and when the economy will pick up. Many are grieving the loss of loved ones, the life they knew before the pandemic, or feeling frustrated and cut off by continued social distancing.

Outward signs of mental health issues are often behavioral. Individuals may appear extremely quiet or withdrawn. Or, they may randomly burst into tears, have excessive amounts of anxiety, or sudden outbursts of anger [3].

It is always best to be open-minded if a loved one is struggling with a mental health issue. They may be equally concerned and confused about their behavior and unsure of what to do. Discuss these behaviors with a healthcare professional and work with them to develop a plan to cope with these behaviors, should they return.

Spending time alone is very important. This can help put things back into perspective and increase the amount of patience and compassion available for coping with or helping a loved one who is struggling with their mental health.

Early identification of individuals in the beginning stages of a psychological disorder, such as alcohol and/or drug abuse, major changes in eating habits, and suicidal thoughts, makes the intervention strategies more effective.

With appropriate psychological strategies, techniques, and interventions, the general population's mental health can be preserved and improved. There is hope for recovery, and with proper treatment, many people with mental health problems can return to a meaningful and fulfilling life.

References

1. Hall RC, Hall RC, Chapman MJ. The 1995 Kikwit Ebola outbreak: lessons hospitals and physicians can apply to future viral epidemics. Gen Hosp Psychiatry. 2008;30(5):446–52.

2. Xiang Y-T, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry. 2020;7(3):228–9.

3. Zhang J, Lu H, Zeng H, Zhang S, Du Q, Jiang T, et al. The differential psychological distress of populations affected by the COVID-19 pandemic. Brain Behav Immun. 2020;87:49–50.

4. American Psychiatric Association. Considerations for family and other personal losses due to COVID-19–related death. Accessed September 8, 2020. https://www.psychiatry.org/File%20Library/Psychiatrists/APA-Guidance-Death-Dying-Personal-Bereavement.pdf