COVID and the Emerging Mental Health Crisis

August 19, 2020

The most recent Morbidity and Mortality Weekly Report (MMWR), the weekly publication of the CDC, paints a concerning picture of the burgeoning mental health crisis in the United States resulting from the COVID-19 pandemic. Prior surveys by the CDC had already shown increasing symptoms of anxiety and depressive disorders from April to June of 2020, when compared to the same period in 2019, but this most recent survey shows further acceleration of the problem.

In the last week of June, 5412 adults age 18 and over completed a web-based survey conducted by the CDC to assess mental health, substance use, and suicidal ideation. The results showed nearly half of those surveyed, 40.9%, had at least one adverse mental or behavioral health condition. When looking at the breakdown, 30.9% reported symptoms of anxiety or depression, 26.3% reported symptoms of a trauma and stressor related disorder (TSRD) related to the pandemic, 13.3% reported starting or increasing substance use to cope with increased stress related to the pandemic, and 10.7% reported having seriously considered suicide in the 30 days prior to the survey.

When compared to the second quarter of 2019, the prevalence of anxiety disorder in adults was three times higher, and the prevalence of depressive disorder was nearly four times higher. Most concerning was the number of patients in this survey who reported seriously considering suicide just in the prior 30 days – double that reported by patients in a 2018 CDC survey that asked about the prior 12 months. The suicidal ideation rates for young adult respondents age 18-24 was 25.5%, Hispanic respondents (18.6%), African American respondents (15.1%), self-reported unpaid caregivers for adults (30.7%), and essential workers (21.7%) were especially high.

At the same time, a recent NPR report reveals that drug overdoses are spiking, up about 18% since the start of the pandemic. The Overdose Detection Mapping Applications Program (ODMAP) at the University of Baltimore tracks information submitted by over 1200 agencies across the country and can give a real-time snapshot of overdoses in the US as well as where they are occurring. They identified increases in both non-fatal and fatal overdoses when comparing the weeks leading up to the coronavirus quarantine measures to the weeks after. And once again, in this data we see disproportionately high rates in Black and Hispanic communities.

At the end of last year, before the COVID pandemic was fully realized here in the US, I had written about the increase in so-called ‘deaths of despair’ over the past couple of years, initially reported in rural middle-aged whites, but subsequently noted in Black and Brown communities as well. Now, in the context of a worldwide pandemic, we see the impact of decades of neglect in health care and across the social determinants of health on minority communities, which are not only bearing the brunt of COVID-19 disease, but now shown to be overrepresented in these secondary consequences of the pandemic, with increased mental health disorders, suicidality, and drug overdoses. Admiral Brent Giroir, assistant secretary for the US Department of Health and Human Services, summarized it succinctly when he was quoted in the NPR story: “The manifestations of our historic disparities are really just in everyone’s face right now”.

One silver lining may be the rapid and massive expansion of telemedicine services, including behavioral health services, that we have seen as a result of the quarantines and stay at home orders. This may increase and expand access to mental health resources in a way that wouldn’t have been possible just a few short months ago. We can only hope that another benefit in the long term will be to bolster and rebuild our public health infrastructure, while addressing many of these ethnic and racial disparities that have been laid bare during the pandemic, in health care and across other areas of our society.

The Medical Society will continue its work here in the Granite State to work to expand access to mental health services, which was already limited before this worsening crisis brought on by COVID, as well as improving and expanding access to substance use disorder treatment, and through legislative efforts as well as working with like-minded partners across the state, we will bring particular focus to those communities that have historically had the most limited access to these resources and clearly have the most urgent need.

In health,

John Klunk, MD
NHMS President

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