Mental Health in a Time of Pandemic

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The ongoing Covid-19 outbreak is in many ways unprecedented, in both the scale of this challenge, the scale of public health response, and the historical context in which all this is unfolding. Covid-19 is the first global pandemic of the social media age, the first of the “alternative facts” era, and is occurring at a moment when politics and society seem to be in a state of accelerated flux.

Yet for all that is new about Covid-19, the disease still behaves like any number of prior epidemics. It is, for example, similar to the 2003 severe acute respiratory syndrome (SARS) outbreak, an event which created a number of lessons for our present moment. SARS was, in many ways, the best-case scenario for responding to a global infectious threat. The spread of SARS was contained fairly quickly by public health efforts, chiefly through the widespread use of quarantine. But even this relative success still had consequences for health. In 2004, I worked with colleagues on a study of SARS control and the psychological effects of quarantine in Toronto, Canada. We found among quarantined persons a high prevalence of psychological distress, including symptoms of depression and posttraumatic stress disorder (PTSD). A key takeaway: Even if we can halt the physical spread of a disease through the expeditious use of quarantine and social distancing, we will still have to contend with its mental health effects in the long-term.

This is a message that is frequently forgotten. The mental health effects of Covid-19 can shape health for many years, long past the events that precipitated them. We have been focusing, correctly, on saving lives and mitigating the short-term consequences of Covid-19, but the long-term consequences may be equally, if not more, important. While it can be difficult to take the long view when the events of the moment are so compelling, it is necessary, if we are to ensure the steps we take now are in the best interest of public health once this pandemic passes and our task moves from one of response to one of recovery.

To envision how this long-term future may unfold, it helps to look to the past, and not just to past epidemics. Protests, riots, mass uprisings, and natural disasters can also teach us much about how large-scale, disruptive events can shape mental health. What do we know about the consequences of such events?

In a study published earlier this year, I worked with colleagues to investigate the mental health effects of protests, riots, and revolutions. Our work looked at the immediate effects of these events, as well as their long-term consequences. We found that the prevalence of depression and PTSD among populations after collective actions like protests and riots is comparable to levels experienced after natural disasters and terrorist attacks. This was the case for populations directly and indirectly affected by such events, suggesting a “spillover effect,” as anxiety over a disruptive event ripples through communities. We see similar effects after natural disasters, where mental health consequences can include depression, PTSD, and substance use disorders.

Then there are the economic effects of such events. In the case of Covid-19, we have already seen traces of these effects in the falling stock market, but the fortunes of Wall Street do not reflect what may be the true cost of this pandemic. With so many eyes focused on the stock market, it is possible to miss that the economic brunt of Covid-19 will likely be borne by low-wage, hourly workers, who can ill-afford the time away from work that containing the disease may necessitate. This will have consequences for health. Income is closely linked to health—physical and mental. There is, for example, a 10 to 15 year difference in life expectancy between Americans at the very bottom of the economic ladder and those at the very top, and income inequality has been linked with depression risk. Covid-19 could deepen this inequality over the long-term, even as, in the short-term, it undermines the peace of mind necessary for robust mental health, and compounds the challenges of people already prone to mental health struggles.

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