Mental Health During the Pandemic

by Jonathan Temte, MD/PhD

It’s happened to me three times so far. I get a text message from the US Census Bureau requesting, “Please answer survey on COVID19 crisis.” Although my mind initially said, “scam,” I connected using the hot link to find that there is an ongoing assessment of the American population. Among the questions related to employment, changes in income, health care utilization, and food security, I immediately recognized four from the PHQ-2 and GAD-2; these are validated screening instruments for depression and anxiety, respectively, in primary care.

Upon tracking down the Census results, I found that almost 30% of responding adults reported feeling anxious or nervous and 23% reported not being able to stop or control worrying more than half the days or nearly every day in the preceding week. Moreover, 19% reported feeling down and 21% reported having little interest or pleasure in doing things more than half the days or nearly every day during the previous week. Anxiety and depression are following in COVID-19’s wake.

A recent research letter compares the rates of serious psychological distress in early April 2020, using data from a reliable survey platform representing the US adult population, and in 2018, using data from the National Health Interview Survey (NHIS) and yields similar results. Between 2018 and 2020, the estimated prevalence of serious psychological distress increased by 3.5 fold, from 3.9% to 13.6%. The groups with the highest current rates are young adults (age 18—29 years: 24%), those with household incomes of <$35,000 per year (19%) and Hispanic adults (18%). The lowest levels were for individuals aged ≥55 years (7%) and with household incomes ≥$75,000/year (8%). In addition, one in seven respondents reported that they always or often feel lonely, increasing from one in nine in 2018.

Keeping in mind that these assessments are cross-sectional, what do they tell us? The US Census survey implies that there are significant levels of anxiety and depression in adults at this time. McGinty et al suggest that there has been a significant increase in serious psychological distress between 2018 and April 2020, and this distress precedes the recent traumas of racism. Whereas we do not know the specific causes of this psychological distress, I think we all recognize the long tendrils of COVID-19, the imposed social isolation, and the associated economic hits on a great swath of American households. Loneliness, fears of contagion, loss of income and livelihood, and uncertainty of the future are widespread and ongoing. As we reopen our clinics and reconnect with our patients—face-to-face or virtually—keep in mind the psychosocial impacts of an infectious disease. Ask about, screen for, and respond to mental health issues.

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Jonathan L. Temte, MD/PhD, is Associate Dean for Public Health and Community Engagement at the University of Wisconsin School of Medicine and Public Health and professor of Family Medicine.  He served on the U.S. Advisory Committee on Immunization Practices and is a member of the CDC’s Board of Scientific Counselors.

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