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CDC Report Reveals “Considerably Elevated” Mental Health Toll from COVID-19 Stresses

  • 1Consulting Editor, JAMA Health Forum and JAMA

More than 2 in 5 US residents report struggling with mental or behavioral health issues associated with the coronavirus disease 2019 (COVID-19) pandemic, including anxiety, depression, increased substance use, and suicidal thoughts, according to new findings from the Centers for Disease Control and Prevention.

“Markedly elevated prevalences of reported adverse mental and behavioral health conditions associated with the COVID-19 pandemic highlight the broad impact of the pandemic and the need to prevent and treat these conditions,” the report noted.

The report, published in the August 14 issue of the Morbidity and Mortality Weekly Report, also notes that certain groups are disproportionately affected by COVID-19–related stresses, including younger adults, Black and Hispanic individuals, essential workers, unpaid caregivers for adults, and those receiving treatment for preexisting psychiatric conditions.

Two earlier studies by CDC researchers had found a substantial increase in anxiety disorder and depressive disorder symptoms in the United States during April through June compared with the same time frame in 2019. To further assess mental health, substance use, and suicidal ideation during the coronavirus pandemic, researchers from the CDC and institutions in Boston, Massachusetts, and Melbourne, Australia, conducted representative panel surveys among US adults during late June.

Of 9896 eligible US adults 18 years or older invited to participate in the research, 5412 (approximately 55%) completed the web-based surveys during June 24 to 30. Overall, nearly 41% reported experiencing at least 1 adverse mental or behavioral health condition.

Nearly 31% reported symptoms of an anxiety or depressive disorder, 26% reported a trauma- or stressor-related disorder associated with the pandemic, and 13% said they had started or increased substance use “to cope with stress or emotions related to COVID-19.” Nearly 11% of respondents said they had seriously considered suicide in the preceding 30 days, more than twice the rate reported in a 2018 survey.

These symptoms and behaviors disproportionately affect certain groups. More than half of respondents agesd18 to 24 years (74.9%) or 25 to 44 years (51.9%) reported having at least 1 mental or behavioral health symptom, as did the majority of respondents who were Hispanic (52.1%), held less than a high school diploma (66.2%), were essential workers (54.0%) or unpaid caregivers for adults (66.6%), or were already receiving treatment for previously diagnosed anxiety (72.7%), depression (68.8%), or posttraumatic stress disorder (88.0%) at the time of the survey.

Certain groups also show a disproportionately high risk for suicide ideation. Those who had seriously considered suicide in the past 30 days included respondents aged 18 to 24 years (25.5%), Hispanic (18.6%) and Black (15.1%) respondents, individuals with less than a high school diploma (30.0%), essential workers (21.7%), and unpaid caregivers for adults (30.7%).

These same groups were also disproportionately more likely to start or increase substance use to cope with pandemic-related stress or emotions, including respondents aged 18 to 24 years (24.7%), Hispanic (21.9%) and Black respondents (18.4%), essential workers (24.7%), and unpaid caregivers for adults (32.9%).

The authors’ analysis of responses of 1497 individuals who had completed the survey, along with related surveys during April 2 to 8 and May 5 to 12, revealed a particularly high burden of distress among unpaid caregivers for adults. Compared with others, they were significantly more likely in June than in May to start or increase substance use and to report seriously considering suicide.

The report noted that many unpaid caregivers of adults are currently providing “critical aid to persons at increased risk for severe illness from COVID-19” and that approximately 39% of these caregivers (compared with 27% of other survey respondents) shared a household with children. “Caregiver workload, especially in multigenerational caregivers, should be considered for future assessment of mental health, given the findings of this report and hardships potentially faced by caregivers,” the authors added.

To address mental health disparities and prepare support systems to lessen adverse mental health consequences as the pandemic evolves, the researchers urge provision of social support, comprehensive treatment options, and harm reduction services to address substance use related to COVID-19 stresses. They also note that expanded use of telehealth to deliver treatment for mental health conditions might help reduce COVID-19–related mental health consequences.

Community-level efforts to promote health services and communicate culturally and linguistically tailored messages about practices to improve emotional well-being also “should prioritize young adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers,” they said.

According to the Commonwealth Fund’s 2020 Commonwealth International Health Survey of more than 8000 adults from March 30 to May 25, 2020, US adults were shouldering a heavier mental health burden from COVID-19–related stresses, such as social isolation and greater economic challenges, compared with their counterparts in other high-income countries.

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    1 Comment for this article
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    COVID-19: Psychiatric Consequences Including From Encephalopathy.
    Gary Ordog, MD, DABEM, DABMT | County of Los Angeles, Department of Health Services, (retired)
    There is no mention of encephalopathic changes caused by COVID-19 affecting cognition, including the emotional state. Anxiety and depression could be direct results of the virus, not just a secondary cause. Brain imaging studies have shown COVID-19 changes including encephalitis and vascular injuries. A high percentage of patients have anosmia, with evidence of injury to the olfactory bulb, an extension of the brain. The virus affecting this part of the brain may be also affecting parts of the brain involved in emotion, including anxiety and depression. Further studies are required to see how much is primary from encephalopathy, or secondary from pandemic stressors. Thank you and stay safe.
    CONFLICT OF INTEREST: None Reported
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