Pandemic Mental Health: Entering the ‘Fourth Wave’?

Earlier this year, experts warned of an increase in suicides, overdose deaths, and mental health problems as a result of COVID-19 and its economic and social stressors. In this update, we take a look at how opinions have evolved with a vaccine now on the horizon.

If nine family members are left behind to mourn each of the more than 320,000 COVID-19 deaths in the nation, nearly 3 million Americans are coping with the loss on an unprecedented scale of mass grief.

But unlike past disasters where communities could come together to heal, this one has kept them six feet apart.

“If you think of that grief as pain, that’s not necessarily mental illness … it’s just pain, emotional pain, that needs to be validated, normalized, and voiced out loud,” said Jessica Gold, MD, of the University of Washington. in St. Louis. “Until we actually do that, I think we are stuck in healing.”

Now that the distribution of the COVID-19 vaccine is underway, doctors are focusing on the toll the pandemic has taken on the nation’s collective mental health. With more than 10 million people unemployed and an estimated 11.7% of Americans living in poverty, people are suffering not only death, but the loss of work, school and life as they knew it before. from the pandemic, Gold said.

If there are no dedicated prevention resources now, the mental health consequences of COVID-19 could become the “fourth wave” of the pandemic, said Luana Marques, PhD, PRIDE director of community psychiatry.

“We’ve had 9 months of chronic stress, where your body is at some fight or flight level,” Marques said. MedPage today. “Often what is seen clinically is that when that stressor goes away, people … have the ability to understand how much it has affected them.”

Before the pandemic, 15-19% of adults had symptoms of anxiety or depression. By June, that number had risen to 31%, and nearly 11% reported they were seriously considering suicide, according to data from the CDC survey.

For healthcare workers who experienced high rates of burnout and mental health distress prior to the pandemic, the amount of loss they have witnessed working on the front lines is having an especially emotional impact, said Anish Agarwal, MD, MPH, of the University of Pennsylvania Perelman. Medicine School.

“In March, there were pots and pans pounding at 7pm across the country,” Agarwal said. MedPage today. “That phase is over and now there is a lot of fatigue and frustration, and it is important that we all realize that this is what is happening and invest in ways to support each other in and out of the hospital.”

The vast majority of psychiatrists have switched to telehealth services during the pandemic following flexible federal guidelines that allowed reimbursement for virtual services and online prescribing of controlled substances.

However, preliminary data suggests that this was not enough to avoid the mental health repercussions of the pandemic. Almost all states have anecdotally reported an increase in overdose deaths, and coroners and medical examiners report an increase in suicides. In Maryland, an analysis found that suicides among African Americans had doubled during the time of the pandemic.

Certain populations disproportionately bear the burden of COVID-19 deaths and grief. Black and Latino individuals, along with Native Americans, have been disproportionately killed by COVID-19.

However, many patients of color do not have access to providers who look like them, said Ayana Jordan, MD, PhD, of Yale University School of Medicine. Black, Latino, and Native American psychiatrists comprise approximately 10% of the psychiatric workforce compared to 33% of the US population.

“People belonging to racial and ethnic minorities are twice, or sometimes tripled, because we are also dealing with the trauma of indirectly witnessing racism through the height of highly publicized police brutality,” Jordan said. MedPage today. “All of these things together are affecting people from marginalized backgrounds.”

In general, the mental health system was strained before the pandemic. In a 2017 report from the National Council for Behavioral Health, the demand for mental health services was projected to exceed the system by 6,090 to 15,600 psychiatrists by 2025.

“[Therapists] they’re taking more hours, trying to find time to add them to the program, “Gold said.” That was already happening, and then add what will be the eventual end of the acute hemorrhage of the pandemic. “

In the CDC survey, 13% reported using substances to cope with the stressors of the pandemic. Alcohol consumption, specifically, increased 14% in 2020 compared to the previous year in a RAND survey.

To increase access to substance use disorders, the Substance Abuse and Mental Health Services Administration also relaxed regulations on prescribing drug-assisted treatment to include telemedicine providers.

Although that prevented treatment interruption for many, a recent analysis of Medicare Advantage and commercially insured patients published in JAMA found that fewer patients with opioid use disorder started treatment during the pandemic and fewer patients overall received urinalysis, which is critical to preventing many patients from relapsing.

However, there has been an increase in the number of new mental health conditions and diagnoses of substance use disorders during the pandemic, said Nora Volkow, MD, director of the National Institute on Drug Abuse at NIH. In December, the CDC issued an advisory for medical professionals to be on the lookout for drug overdoses, which have soared to the highest number ever recorded in a 12-month period.

For patients in remission, social isolation, economic insecurity and anxiety about acquiring COVID-19 have also contributed to an increased risk of relapse, Volkow said.

Additionally, patients with mental illness and substance use are at increased risk of COVID-19 infection, increasing the vulnerability of this population, he added.

“We’ve also seen that some of the support systems there to help them are no longer present, which again puts them at a much higher risk if they get infected, and that could explain why we’re seeing much worse results as well,” Volkow said. MedPage today. “COVID has affected them from two directions.”

Volkow recommended dedicating resources to public health campaigns and increasing reimbursements for psychiatric services to handle the next increase in mental health needs.

In addition to the resources needed for vaccine distribution, “we also need the resources to provide mental health support,” Volkow said. “Without him, once the COVID-19 pandemic is brought under control, we will be in serious trouble.”

Jordan highlighted the importance of deploying community-based mental health services in the worst affected areas and providing free subscriptions to online talk therapy services to prevent suicide and overdose rates from continuing to rise.

He also urged greater federal support for programs that link health professionals, in particular, mental health services.

“Any administration would be naive if it didn’t have a plan for the doctors during this time,” Jordan said. “We are experiencing the pandemic of our century, we need help and there has to be a concerted effort to proactively help healers.”

If you or someone you know is considering suicide, call the National Suicide Prevention Line at 1-800-273-8255.