MENTAL HEALTH EFFECTS OF A PANDEMIC

Mental health, as conceptualized by the World Health Organization, is a state of well-being in which the individual realizes their own abilities, can cope with the normal stress of life, can work productively, and is able to make a contribution to their community (PAHO/WHO, n.d.).

Pandemics disrupt the mental health of individuals and society on many different levels, one of them being widespread panic and increasing anxiety in people subjected to the real or perceived threats of the infectious agent. The mental health effects of a pandemic can impact health for many years, well past the precipitating event. These effects can compound the many challenges facing people who are already prone to mental health problems (Galea, 2020).

During a pandemic, it is common for people to feel stressed, anxious, worried, and fearful. Fear of the unknown or fear of uncertainty may be the most debilitating of the psychological effects of a pandemic. As a pandemic begins to spread, people may experience:

  • Fear of contagion and death of self or loved ones
  • Fear of contracting illness while caring for sick loved ones
  • Fear of infecting a loved one
  • Guilt regarding being the source of illness for a loved one
  • Inability to intervene to prevent illness or death of loved ones
  • Witnessing the illness or death of family members
  • Bereavement and grief from loss of loved ones
  • Psychological trauma due to quarantine and social distancing
  • Difficulty maintaining self-care activities
  • Domestic pressures caused by school closures, disruptions in daycare, or family illness
  • Sense of ineffectiveness and powerlessness
  • Loss of faith in health institutions, employers, or government leaders
  • Belief that medical resources are not fairly distributed
  • Restrictions on civil liberties that are perceived to be inequitable
  • Frustration with lack of information and available resources
  • Loss/disruption of job, financial hardship

As the pandemic decelerates, additional stressors begin to arise, which may include:

  • Multiple losses
  • Personal and population-wide bereavement
  • Fear of recurrent waves of the pandemic returning
  • Recuperation from illness
  • Long-term medical complications
  • Continued scarcity of basic necessities
  • Massive economic disruptions
  • Delays in reopening schools, daycare centers
  • Ongoing stress on healthcare infrastructure
  • Dealing with dependent family members who have lost their caretaker
  • Changes in social support due to death and illness
    (Shultz, n.d.)
MENTAL HEALTH DURING THE COVID-19 PANDEMIC

In a study conducted during the COVID-19 pandemic, nearly half of Americans surveyed reported recent symptoms of an anxiety or depressive disorder, and 10% of respondents felt their mental health needs were not being met. Rates of anxiety, depression, and substance use disorder also increased since the beginning of the pandemic. People who have mental illnesses or disorders and then developed COVID-19 were more likely to die than those who didn’t have mental illnesses or disorders.

Data suggested that people are more likely to develop mental illnesses or disorders in the months following infection, including symptoms of posttraumatic stress disorder (PTSD). People with long COVID may also experience many symptoms related to brain function and mental health (NIH, 2022).

Psychological Stressors among Healthcare Professionals

Because of their prominent role in responding to a pandemic, healthcare professionals are at high risk for mental health effects. Studies following the MERS and SARS epidemics found high rates of depression and PTSD among physicians and frontline healthcare professionals. More recent research describes similar increased levels of mental stressors during the COVID-19 pandemic. These included:

  • Fear
  • Anxiety
  • Depression

Stress levels were higher among those working in a clinical capacity, particularly frontline healthcare professionals in infectious disease, respiratory, and emergency departments. Lower stress scores among intensive care and anesthesiology specialists may be explained by their higher level of training in treating COVID-19 patients. Similarly, those who were confident of infection control strategies and training showed lower stress levels (Hassan et al., 2022).

Additional stressors among healthcare workers on the frontline (i.e., those who provide direct care and services to the sick or injured) may include:

  • Stigmatization and ostracization due to caring for infected patients and their remains
  • Shaming oneself about voicing one’s own fears and concerns
  • Fear of passing the infectious agent on to family and friends and the need to isolate oneself from them
  • Tension between public health priorities and the wishes of patients and their families regarding quarantine
  • Strain of strict bio-security measures:
    • Physical strain of having to constantly use protective equipment (e.g. dehydration, heat, exhaustion)
    • Physical isolation, which makes it difficult to use touch to provide comfort to a sick or distressed patient or to give/receive comfort after working hours
    • Need to be constantly aware and vigilant regarding infection control procedures
    • Strict procedures that prevent spontaneity and autonomy
  • Psychological effects when the system fails to provide adequate personal protective equipment (PPE):
    • Fear of increased risk of infection
    • Extreme stress around disregarding usual practices for caring for oneself in order to remain uninfected and to continue to provide safe patient care
  • Higher demands both professionally and personally:
    • Long hours
    • Increased patient numbers
    • Working in unfamiliar areas
    • Keeping up to date with best practices and developing information
    • Possible separation from and concern about family members
    • Inner conflict about competing needs and demands (e.g., “I want to take care of my patients; it’s my calling and I am expected to; but I know I am taking great risks by doing so.”)
  • Witnessing human suffering and dealing with life-and-death decisions
  • Reduced capacity to use social support due to intense work schedules and stigma within the community toward frontline workers and the need for social distancing
  • Insufficient ability to carry out adequate self-care because of work demands and time constraints
  • Lack of information about long-term exposure to infected individuals related to insufficient scientific knowledge about the infectious agent
  • Burnout and compassion fatigue
    (IASC, 2020)