COVID-19’s Negative Mental Health Impact Goes Well Beyond Standard At-Risk Populations

Abstract

Since the 1960s, many studies have been conducted on the psychological impact following local, short-term disasters, starting with Lindemann’s (Rogers, 1963) focus on the 1942 Boston Coconut Grove nightclub fire. Researchers found that although most disaster survivors are resilient and recover without psychological treatment, a percentage is more vulnerable to develop long-term trauma (Cohen & Abukhalaf, 2021). However, up until COVID-19, very little research has been conducted on the psychological impact of long-lasting and far-reaching pandemics.

Present studies of COVID-19 show that populations at greater risk of post-disaster mental health disorders are being impacted the most (Naser et al., 2020). In addition, other typically resilient populations are being negatively affected as well. People of all ages and backgrounds are struggling with emotional issues. Until now, COVID-19 emphasis has primarily been on physical wellbeing (Varghese et al., 2021; Naser et al., 2021a). An equal emphasis must be placed on psychological needs to help prepare for the calamities to come, including worsening climatic events and additional pandemics. This discussion raises the issues that must be addressed by providers and policymakers to prevent growing mental health disruption, particularly with at-risk populations.

1. Introduction and Literature Review

As chief of psychiatry at Boston General Hospital, Lindemann (Rogers, 1963) found that many Coconut Grove fire survivors were showing symptoms of stress, anxiety, and depression. Kai Erikson’s 1978 seminal book Everything in its Path detailed the devastating psychosocial impact of a collapsed dam that poured 132 million gallons of muddy water on Buffalo Creek, West Virginia. The 4,000 homeless residents were traumatized by being crowded into trailers with little regard for prior social networks or neighborhoods. Researchers wanted to understand individual reactions to traumatic experiences. Penick, Powell, and Sieck (1976) found that three-fourths of tornado survivors faced increased psychological distress five months later. Martin (1962) recommended necessary psychological first-aid measures: maintaining victims in family groups, encouraging discussions on personal situations, and performing positive activities.

Research recognizes that most disaster victims are resilient and able to recover (Abukhalaf & von Meding, 2021b). Still, more vulnerable individuals are at greater risk of mental health impairment: They have “additional needs before, during, and after an incident in functional areas, including but not limited to maintaining independence, communication, transportation, supervision, and medical care” (FEMA, 2011; Abukhalaf & von Meding, 2020). Several populations are recognized as potentially vulnerable, including individuals with physical and mental disabilities, elderly persons, females/pregnant women, children/youth, and economically disadvantaged minorities (FEMA, 2011; Abukhalaf & von Meding, 2021a). Recent research also includes first responders at high risk from their involvement during and after a calamity (Schmidt and Cohen, 2020).

Studies are also determining the multiplying effect of cumulative catastrophes, as in Louisiana, Texas, and California. Following Hurricane Katrina, veterans with preexisting mental illness had a 6.8 times greater risk for additional psychological problems compared to those without a preexisting mental illness (Sullivan et al., 2013). The first disaster may lower the sense of safety for future events, especially for at-risk individuals. SAMSAH reported that trauma from an initial catastrophe could enhance trauma and feelings of vulnerability as well as impair resilience in subsequent events (Schmidt and Cohen, 2020).

2. Discussion

Scientists are continually gaining medical insights to understand and respond to COVID-19 (Naser et al., 2021b). Similarly, mental health professionals can gain considerable knowledge from research on the current psychological crisis. Most of this information is new since few studies have been conducted on the mental health impact of the Spanish flu and later epidemics (Eghigian, 2020). Mamelund (2003) was one of few researchers focusing on the 1918 influenza, noting how survivors complained of trouble sleeping, depression, mental distraction, and coping at work.

Present studies show how the far-reaching and long-term pandemic has a much more significant impact than earlier short-lived local disasters. The research also demonstrates how climatic changes are enhancing these negative effects. Given that future events are only expected to be more common, intense, and extensive, scientists are already stressing the world needs to prepare now for greater calamities to come (Plump, 2021; Chmutina et al., 2020; Miller, 2021; Makary, 2021).

2.1 Impact on Vulnerable Populations

Understanding the multi-faceted nature of vulnerability and exposure is necessary for determining, developing, and employing effective disaster risk management strategies.

I. Children/youth: Due to the ever-changing pandemic, school-aged children have dealt with ongoing unpredictability and constrained social life. They have experienced their parents/caregivers increased stress and sometimes more significant domestic and substance abuse. Over 25% of high school students reported inferior emotional and cognitive health; over 20% of parents with children 5 to 12 said their families experienced lesser emotional health (Panchal et al., 2021).

II. Individuals with physical and mental disabilities. Physically disabled individuals are significantly impacted by social isolation, which can exacerbate loneliness and medical problems, and susceptibility to COVID-19 (O'Sullivan and Bourgin, 2010). Discrimination may keep these individuals from receiving necessary care (Priestley and Hemingway, 2006), which adds to greater anxiety and stress. People with preexisting psychological disorders are even more at risk of increased stress, anxiety, and depression at times of tension and social isolation. Chronic mental health disorders such as schizophrenia, bipolar, and PTSD need ongoing treatment to maintain status, but the mentally disabled have a more difficult time acquiring vital medical supplies, especially when in short supply (Campbell et al., 2009). The current decline of clinics and practitioners has aggravated this situation.

III. Elderly and frail. Residents of assisted living and nursing homes are the most vulnerable and least resilient, with the greatest risk of dying. Yet many have received the worst care during COVID-19. Social isolation and fear of illness and death have increased emotional pain.

IV. Females. A World Bank (2021) report shows how gender inequalities and negative disaster impact go hand in hand due to male/female societal expectations. According to Hamel and Salganicoff (2020), more women than men (49% vs. 40%) said their lives were disrupted “a lot” by the pandemic. Madgavkar et al. (2020) reported that women’s jobs and livelihoods have been more vulnerable to the pandemic. Although females were 46% of the workforce before COVID-19, 54% lost their jobs. Women also face greater emotional issues at home, from concern about their family’s wellbeing to increased domestic violence.

V. Poor and disenfranchised. According to a Human Rights Watch (Root and Simet, 2021) analysis, COVID-19’s s economic fallout has had a devastating and unbalanced effect on the rights of low-income individuals. Over 45% of food-insecure households are in the bottom income quartile or making less than $35,000 a year. Black and Latino adults living in food-insufficient households are over two times that of their white counterparts. This only adds to the already overwhelming mental health stressors experienced by this population.

2.2 Additional Vulnerable Populations during COVID-19

Other populations have also been significantly impacted by COVID-19 and are at risk of greater mental health concerns.

I. Healthcare Workers. Unlike earlier disasters, COVID-19 has had a profound negative effect on this population, especially those combating the virus. From June to September 2020, Mental Health America (2021) hosted a survey on healthcare workers’ experiences during COVID-19. The 1,119 responders said they faced stress (93%), anxiety (86%), frustration (77%), exhaustion and burnout (76%), and being overwhelmed (75%). In a Centers for Disease Control (CDC) study (2021) of over 26,000 public health workers from March 29 to April 16, 2021, 53% reported having at least one of the following: depression (32%), anxiety (30%), PTSD (37%), or suicidal ideation (8%).

II. Cross-Generational. Typically, non-elderly (non-vulnerable) adults are very resilient in times of high stress. Not so during COVID-19. Adults caring for small children or elderly parents have experienced the worst mental health issues during the coronavirus (T.H. Chan Harvard School of Public Health, 2021). Job loss, bereavement, eviction concerns, family trauma/violence, isolation, and fear of illness, among other worries, can result in depression, anxiety, and PTSD.

III. Covid-19 ICU Patients. A study (Tzeng, 2020) found that SARS was associated with the increased risk of psychological disorders and suicide up to 12 years later. The authors stress: “This is also a reminder for the clinicians that psychiatric morbidity is an important issue in the patients with severe coronavirus infections, such as COVID-19.”

3. Conclusion and Recommendations

Javed et al. (2020) stressed that throughout the pandemic, the emphasis nationwide has been on the physical effects, with the mental impact—especially for the long-term—much less reported or studied. These authors state “There has been very little concern expressed over the effects on one's mental health and on strategies to prevent stigmatization.” Their comments need to be reiterated for this discussion: A pandemic is much more than a medical phenomenon. It is a nationwide psychosocial impact affecting all individuals that can lead to disruption, anxiety, stress, and stigma.

Consider the present two-year-long, nationwide mental health situation, which includes 42 million people who experienced COVID-19 (counting long-haulers), bereavement of 680,000 deaths, and emotional impact of people of all ages and backgrounds (some more vulnerable than others). Add to this the simultaneous worsening climatic events, a cumulative effect for many people. However, COVID-19 impacts psychological wellbeing; the result rests on an already weak system--one out of five experiencing a mental health disorder before the pandemic. To help people recover mentally from the coronavirus and become more resilient for the challenges to come, the country needs to invest significantly more in fighting the short- and long-term effects. The commitment to mental health must be equal to that for medical care. A coordinated countrywide public health plan for long-term mental health support is vital.

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