The Mental Health Crisis: COVID-19 and its Effects

Dr. Fred Lewis, a psychiatrist and PRA’s Vice President of Medical and Scientific Affairs, explains the larger impact of COVID-19 on the mental health crisis.

Key Highlights

Learn how COVID-19 has contributed to the mental health crisis, the positives that have emerged as a result, and what to expect from future generations.

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Dr. Fred Lewis
Dr. Fred Lewis
VP, Scientific Affairs

The COVID-19 pandemic has been a catalyst for people already struggling with mental health conditions, as well as prompt conditions for those who wouldn’t otherwise be struggling under normal circumstances. Additionally, existing barriers to care only made matters worse as the demand for mental health professionals increased. Nearly three out of ten mothers say they needed yet were unable to receive mental health services in the past year. Many people were unable to get these services largely due to cost.

Vaccination uptake in certain areas of the globe is making things feel lighter and hopeful. However, challenges for mental healthcare still remain. These challenges continue to shed light on a growing worldwide mental health crisis.

Since the start of the pandemic, how has the mental health crisis evolved? Has it worsened? Improved?

I think it has evolved and certainly worsened. When you look at reports prior to the pandemic, the average American adult experiencing depression and anxiety was about 10%. During the pandemic, that reached as high as 40%.

Young adults are being hit the worst, in terms of the increase in anxiety, depression, and substance use. The elderly, while impacted like everyone else, have actually suffered less in terms of their mental health.

At ages 18 to 24, there’s a lot of unknown ahead of you—trying to find your way in life, getting through school, getting your life started. You may not have financial resources. You may be suffering from debt. It’s a time of instability. When you add a pandemic on top of that, the stress on young adults is huge.

Average Share of Adults Reporting Symptoms of Anxiety Disorder and/or Depressive Disorder
Figure 1: Average Share of Adults Reporting Symptoms of Anxiety Disorder and/or Depressive Disorder, January-June 2019 vs. January 2021

First responders have also experience major negative impacts to their mental health. A tremendous amount of stress has been placed on first responders due to the demands and expectations from their jobs. This includes ambulance paramedic personnel, firefighters, police, and of course, hospital personnel. The rates of suicide, drug overdoses, and alcohol abuse in this particular group has gone up.

Finally, stress-related disorders, depression, and substance use has most likely reached every family in the country. Those suffering from these conditions prior to the pandemic now have aggravated and exacerbated symptoms. Additionally, individuals who otherwise were feeling fine could be struggling now.

Since first discussing this topic, what research and studies have been conducted regarding mental health during the pandemic? What was found?

More literature is emerging regarding the impact of this pandemic on people. For example, this research done during the pandemic points to concerns around poor mental health and well-being for children and their parents—especially mothers—as many have experienced challenges with school closures and lack of childcare.

Additionally, the pandemic has disproportionately affected the health of minority communities. Non-Hispanic Black adults (48%) and Hispanic or Latino adults (46%) are more likely to report symptoms of anxiety and/or depressive disorder than Non-Hispanic White adults (41%). These sobering facts are, sadly, not surprising—historically, these minority communities have faced challenges accessing mental healthcare or healthcare in general.

We absolutely cannot underestimate the grief that’s a direct result of the millions of lives taken by COVID-19. Three in ten people who know someone close to them who has died of COVID-19 say the pandemic has had a major impact on their mental health.

As the pandemic continues and vaccinations are distributed, we’ll continue to see how the mental health crisis will progress. Personally, the negative effects this pandemic has had on mental health far exceeded my initial expectations.

In areas where vaccinations are readily available, do you think there might be a shift in people’s mentality or mood?

I talk to my colleagues in Europe every week, and I hear things there are not enthusiastic. People are still on lockdown even if they’ve been fully vaccinated. They still can’t leave their homes or travel around the country.

In the US, however, it seems like people believe we've started to turn the corner. Things are opening up. While not perfect, they’re much better than they were. However, we have to be vigilant—as the weather cools in the fall, cooler weather may bring another resurgence, and the mental health cycle would start all over again.

What are the biggest barriers keeping people from receiving treatment?

There’s two parts to this. First, the barriers have always been there. Second, it remains a problem that access to mental health care in the US is well below other developed countries. It’s unfortunate how much of a disparity exists. For example, some benefits may allow a person to see a gastroenterologist, but may not pay for a person to see a psychiatrist and other mental health professionals. There are limits on benefits for mental health care, which is an impediment to people accessing treatment.

What are some solutions the healthcare industry can offer when addressing barriers to mental healthcare?

Telemedicine and telepsychiatry skyrocketed during the pandemic. The industry has accelerated the movement towards this decentralized approach to caring for patients with mental illness and psychiatry and other mental health practice within psychology.

For mental health professionals, this makes a lot of sense. They largely don’t touch patients—they just need to be able to communicate with them to help them make decisions about their care. Being in-person might be helpful for some patients, but it isn’t a necessity. There are many practitioners now who are largely working from their homes, scheduling their appointments remotely, and electronically sending in prescriptions.

Through decentralized means, access has improved and in some ways has become less expensive. There are organizations advertising inexpensive access to psychotherapists and counseling sessions. These come at a very reduced fee because the costs are much lower than someone who would normally need to pay for office overhead, an office secretary, equipment, etc.

Now, patients and healthcare professionals can work from home, using their phones or laptops to conduct their sessions. Due to the lowered costs, accessibility has increased for people who don't have coverage or have full coverage. In the past, that was near impossible because the out-of-pocket fees were much higher.

COVID-19 has been a traumatic event for everyone. How will this affect children and future generations?

The intergenerational impact has to do with children who are aware of what's going on and how they see their parents struggling with the circumstances. They could end up carrying that with them as they grow and develop. Children begin at a very young age mirroring their parent’s mood and anxieties, and respond to their stress levels.

For example, my parents were children during the 1918 pandemic. During that time, the virus mainly attacked the middle-aged, which hollowed out and devastated the most productive portion of the population. This trauma gets carried on in the form of anxiety and stress disorders such as post-traumatic stress disorder, as well as a weakened coping skills. People during that time became different people because of what they lived through and what they saw. Of course, those behaviors that they've adopted can get passed down in how they treat their own children.

But COVID-19, unlike previous viral pandemics, has been a successful virus with ease of transmission, resulting in an immense global impact in mortality and morbidity. We're seeing the emotional impact now especially amongst first responders, healthcare workers, and nurses. This pandemic has taken a huge toll on the healthcare system with a disproportionate impact on third world countries.

Fortunately, with the accelerated development of safe and highly effective vaccines, the burden of disease has been abated, and we appear to be headed to a brighter, COVID-free future.

Learn more about how PRA is changing the clinical research paradigm through Decentralized Clinical Trials

COVID-19 has been a traumatic event for everyone. How will this affect children and future generations?

The intergenerational impact has to do with children who are aware of what's going on and how they see their parents struggling with the circumstances. They could end up carrying that with them as they grow and develop. Children begin at a very young age mirroring their parent’s mood and anxieties, and respond to their stress levels.

For example, my parents were children during the 1918 pandemic. During that time, the virus mainly attacked the middle-aged, which hollowed out and devastated the most productive portion of the population. This trauma gets carried on in the form of anxiety and stress disorders such as post-traumatic stress disorder, as well as a weakened coping skills. People during that time became different people because of what they lived through and what they saw. Of course, those behaviors that they've adopted can get passed down in how they treat their own children.

But COVID-19, unlike previous viral pandemics, has been a successful virus with ease of transmission, resulting in an immense global impact in mortality and morbidity. We're seeing the emotional impact now especially amongst first responders, healthcare workers, and nurses. This pandemic has taken a huge toll on the healthcare system with a disproportionate impact on third world countries.

Fortunately, with the accelerated development of safe and highly effective vaccines, the burden of disease has been abated, and we appear to be headed to a brighter, COVID-free future.

If you or someone you know is struggling, please use the resources below:

Learn more about how PRA is addressing the current mental health crisis

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