How Do We Tackle the Mental Health Fallout of COVID-19?

The data is clear. The numbers are worrying, experts say. And the outlook is uncertain.?

Since the onset of the COVID-19 pandemic, researchers across the U.S. have been sounding the alarm on a different kind of crisis: rising rates of?depression ,?anxiety , and?poor mental health ?in general.?

An?ongoing survey ?of Americans conducted earlier this year shows more people are experiencing depression, anxiety, and thoughts of suicide than ever before recorded.

The COVID States Project?survey , a joint effort between researchers from Northeastern, Harvard, Northwestern, and Rutgers Universities, found 28% of people surveyed report levels of depression that would typically trigger a referral for evaluation and treatment; these numbers have diminished slightly compared to their peak of 30% in December 2020 but remain about three times those observed in the pre-COVID era, and elevated compared to the low of 25% in late June 2020.

Rates of anxiety also remain elevated at 25%, but down from 28% in December 2020. In addition, 23% of respondents still say they thought of suicide at least occasionally, similar to the rates observed in December.?

Of those surveyed, young adults were the hardest hit, with 42% meeting at least moderate depression severity criteria, followed by 25-44 year olds at 32% and 45-64 year olds at 20%. Respondents age 65 and older reported the least impact, on average, with 10% meeting criteria for moderate or greater depression.

“Younger adults have lives that are more dynamic than older adults,” David Lazer, professor of political science and computer sciences at Northeastern and one of the researchers who conducted the study, said in a statement. “They’re finishing school, getting a job, starting a family, all things that are more likely to be disrupted by the pandemic.”

Among those more likely to have their lives disrupted by the pandemic are children and adolescents,?a group researchers also say?is experiencing mental health concerns at an increased rate.

In a?study published in April , researchers at the Children’s Hospital of Philadelphia found that while emergency department visits decreased during the pandemic, the proportion of pediatric patients coming in for mental health emergencies increased. Of the children seen in the emergency department, a higher percentage needed to be admitted to the hospital for mental health services than in pre-pandemic times.

That increase has Dr. Polina Krass worried.

“This is very concerning,” Krass, the lead author of the study and a pediatrician at the Children’s Hospital of Philadelphia, said.?

“Prior to the COVID-19 pandemic, youth mental health conditions were increasing in prevalence and severity, and there were extreme shortages in access to mental healthcare. COVID-19 may further exacerbate these trends.”

Since her study was published, more research has come out pointing to an increase in the number of emergency department visits for mental health conditions for certain age groups, especially adolescents, Krass said.

“There are also stark inequities in access to mental health care for youth from minority communities,” she noted. “We know that COVID-19 has impacted these populations disproportionately, and they might be even more at risk for mental health challenges as a result.”

Where do we go from here?

While the need for and strain on mental health services is worrisome, there is hope that people’s mental health will improve as we begin to move past the pandemic, said Susan Borja, chief of the National Institute of Mental Health’s?Dimensional Traumatic Stress Research Program .

Most people who are exposed to a mass disaster or widespread traumatic event will experience some symptoms initially, but those symptoms typically diminish in the following weeks and months as part of natural recovery, Borja said.

“Increased symptoms exist along a continuum,” she said. “Many people may experience symptoms, but those symptoms may not consistently rise to the level of severity or impairment required for a diagnosis. Although natural recovery is the norm, a significant minority may continue to experience symptoms, and some may benefit from treatment to achieve full recovery.”

On an individual level, Borja says people may find it helpful to play an active role in aiding the recovery effort from a traumatic event. Actions like wearing a mask, practicing physical distancing, and getting vaccinated are all things people can do to help reduce the duration of the pandemic and give them a sense of control over their personal risk. Engaging in healthy ways to cope with?stress—such as maintaining a routine, eating healthy when you can, exercising, and getting enough sleep—can help people support their mental health over both the short and long term, she said.

In addition to personal behavior, policy changes in the works could help more people access mental healthcare, including:

• More investment to increase mental health services through SAMHSA block grants to states, which supplement Medicaid, Medicare, and private insurance services
• The Promoting Effective and Empowering Recovery Services in Medicare (PEERS) Act?(H.R. 2767/S. 2144) , which would allow patients using Medicare to receive peer support services
• Fulfilling the Promise of 988, the National Suicide Prevention Lifeline, which includes:
• Excellence in Mental Health and Addiction Treatment Act?(H.R. 4323/S. 2069) , which would expand the Medicaid certified community behavioral health clinic demonstration program and authorize funding for additional grants to certified community behavioral health clinics.

Behavioral Health Crisis Services Expansion Act?(S. 1902) , which would set standards for behavioral services so they are available to more people, regardless of age or ability to pay.

“If there is any silver lining to the tremendous toll the pandemic has taken in terms of lives lost and widespread illness, it is that there is increased recognition of the importance of mental health and a general awareness that mental health is a significant part of public health,” Borja said.

For Dr. Krass, taking mental health seriously as a society means “funding mental health research, reducing the impact of social determinants of mental health care such as community violence and structural racism, and, of course, broadening access to mental health treatment across the care continuum,” she said.?

“There is a lot of work to be done,” Krass added. “I hope we can leverage this moment to start to make constructive changes.”

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