May is Mental Health Awareness Month, a time to raise awareness, educate the public, and push back on the stigma against mental health conditions and care. Many different factors can play a role in a person’s mental health; beyond genetics and brain chemistry, the circumstances and environment in which one exists can play a significant role in the development of a mental health disorder.
Over the last few years, the entire world has been affected in various ways by the COVID-19 pandemic. Though the World Health Organization (WHO) recently declared it was no longer a global health emergency¹, COVID-19 continues to afflict people worldwide and the pandemic continues to cast a long shadow. People worldwide spent months isolating in their homes, fearful of how COVID-19 could affect them and their loved ones. Many in service jobs still had to go to work during the worst of the virus.
It is only natural that such a fraught, stressful time would result in mental health struggles for many. Although some studies suggest the pandemic had a rather minimal effect on mental health², many others concluded its impact was indeed significant. As we recognize Mental Health Awareness Month, what do we know about how the COVID-19 pandemic affected mental health?
Did the Pandemic Increase Anxiety and Depression?
Many reviews have suggested there was a significant increase in the prevalence of anxiety and depression as a result of the COVID-19 pandemic. WHO, for example, reported in 2022 that there was a 25% spike in global anxiety and depression.³
The stress and isolation of the pandemic took a mental toll on people worldwide. A January 2022 study in The Lancet Regional Health – Americas claimed that depressive symptoms rose from 2020 to 2021.⁴ Among the study’s participants, reported depressive symptoms jumped from 27.8% in 2020 to 32.8% in 2021, despite fewer participants reporting at least four COVID-19 stressors in 2021 compared to 2020.
Whose Mental Health Was Particularly Affected by Pandemic?
Anxiety and depressive disorders increased worldwide amid the COVID-19 pandemic a study in The Lancet found that as many as 53.2 million cases of major depressive disorder and 76.2 million cases of anxiety disorders can be attributed to the pandemic.⁵ Due to unique sets of risks and circumstances, different groups of people worldwide were particularly vulnerable to mental health struggles, including:
According to studies on the pandemic’s impact on mental health, women were often more likely to experience depressive symptoms. Among the participants of the aforementioned The Lancet Regional Health — Americas study, for example, women were 1.6 times more likely to report elevated depressive symptoms.⁴ Of the 76.2 million reported increases in anxiety disorders, 51.8 million (68%) were among women.⁵ This was consistent with major depressive disorder as well, as 35.5 million of the 53.2 million new cases (66.7%) were among women.
Children and Adolescents
Children were forced into sudden and stressful circumstances in 2020, and it caused pronounced effects on their mental health. One particularly striking study, published in The Lancet Psychiatry in March 2023, found evidence of an increase in pediatric emergency department visits for attempted suicide during the pandemic.⁶ The investigators also found evidence of an increase in self-harm among teenagers.
Isolation led to an increase in struggles with mental health. The 2022 Adolescent Behaviors and Experiences Survey from the US Centers for Disease Control and Prevention (CDC) found a generation frequently struggling with mental health.⁷ According to the CDC, 37% of teens reported that their mental health was not good either most or all of the time during the COVID-19 pandemic, and 44% said that at some point in the last 12 months they felt sad or hopeless every day for at least two weeks in a row to the extent that they stopped doing some of their usual activities.
When this survey was broken down into demographics, girls were found to experience these struggles more frequently than boys, with 49% saying their mental health was not good compared to 24% of boys. In addition, high schoolers who identified as gay, lesbian, or bisexual reported more mental health struggles than those who identified as heterosexual.
Parents have also noticed and shared concern for the mental health of their children. In a recent Pew Research Center survey, 40% of US parents of children under 18 said they were extremely or very concerned about their children’s struggles with anxiety and depression, with an additional 36% saying they were somewhat concerned.⁸
Young adults were also hit particularly hard by the pandemic. Those under 60 experienced anxiety and major depressive disorder at a higher rate than those over 60, particularly those aged 20 to 40.⁵ This could in part be due to working jobs that were either more likely to result in loss of employment or that required them to continue working in crowded public spaces.
In a Pew Research Center analysis on psychological distress between March 2020 and September 2022, 41% of US adults reported high levels of psychological distress, with younger adults making up a much larger portion.⁹ In this analysis, 58% of US adults aged 18 to 29 had experienced high levels of distress in at least one of the four surveys used for the analysis, compared to just 27% of those aged 65 years or older.
People With Disabilities
Another group found to have particularly elevated levels of psychological distress were people with disabilities or health conditions that kept them from full participation in work or school; 66% compared to 34% among those without a disability.⁹ Many with disabilities found themselves in a particularly stressful environment during this time, often at an increased risk of complications from COVID-19.
People With Lower Income
With employment becoming more precarious at the beginning of the pandemic and the stress of potential medical expenses in the event of COVID-19 looming, lower-income individuals experienced significant distress. Among those with lower income, 53% experienced psychological distress compared to 38% for middle income and 30% for high income individuals.⁹
COVID-19 and Substance Use
People with substance use disorders were greatly affected by the pandemic, particularly in rural areas. During a 12-month period ending in April 2021, the United States had over 100,000 overdose deaths.¹º Those who used drugs often reported worse mental health and economic conditions, and struggled to find confidence that they could maintain economic stability. Isolation, not just from loved ones but also from harm reduction programs, was likely a factor that increased anxiety and depression. This, in turn, increased the likelihood of drug use.
How Does Getting COVID-19 Affect Mental Health?
Some studies suggest that there can be a change in a person’s mental health after a case of COVID-19. A 2022 study in The BMJ examined a group that was diagnosed with COVID-19 between March 2020 and January 2021 and survived to estimate the risk for mental health disorders in the aftermath.¹¹ The researchers found they were at increased risk for incident anxiety disorders, depressive disorders, stress disorders, opioid use disorders, and use of antidepressants and benzodiazepines.
We are still not far enough along to determine precisely how long-term brain chemistry alterations from COVID-19 could affect patients, and researchers continue to learn more about how the disease affects a person over time and the ways in which it can cause symptoms. A recent study from the National Institutes of Health (NIH) identified that many common symptoms of long COVID, including mental ones, are a result of nervous system dysfunction.¹² These symptoms included fatigue and “brain fog,” a form of cognitive impairment that can lead to great frustration in patients.
The hope from studies such as these is that as we learn more about the way COVID-19 affects patients neurologically; that way, health care professionals will be able to better understand how to treat their patients.
This article originally appeared on Clinical Advisor
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8. Minkin R, Horowitz JM. Parenting in America today: a survey report (2023). Pew Research Center. https://www.pewresearch.org/social-trends/2023/01/24/parenting-in-america-today/. Published January 24, 2023. Accessed May 9, 2023.
9. Pasquini G, Keeter S. At least four-in-ten U.S. adults have faced high levels of psychological distress during COVID-19 pandemic. Pew Research Center. https://www.pewresearch.org/short-reads/2022/12/12/at-least-four-in-ten-u-s-adults-have-faced-high-levels-of-psychological-distress-during-covid-19-pandemic/. Published December 12, 2022. Accessed May 9, 2023.
10. The impact of COVID-19 on drug use –and how it contributes to overdose risk. New York University. https://www.nyu.edu/about/news-publications/news/2022/april/covid-19-drug-use.html. Updated April 25, 2022. Accessed May 10, 2023.
11. Xie Y, Xu E, Al-Aly Z. Risks of mental health outcomes in people with COVID-19: cohort study. BMJ. Published February 16, 2022. doi:10.1136/bmj-2021-068993
12. NIH study identifies features of Long COVID neurological symptoms. National Institutes of Health. https://www.nih.gov/news-events/news-releases/nih-study-identifies-features-long-covid-neurological-symptoms. Published May 5, 2023. Accessed May 12, 2023.