A Tsunami?

The psychological fallout from COVID-19 is as yet unclear, but mental health experts are forecasting a tsunami of new disorders. The World Health Organization warned in May 2020 of “a massive increase in mental health conditions in the coming months,” wrought by anxiety and isolation.


According to a Kaiser Family Foundation poll, nearly fifty percent of Americans report that the pandemic harms their mental health. A federal emergency hotline for people in emotional distress registered over a 1,000 percent increase in April compared with the same time last year. In May alone, practically 20,000 people texted that hotline, run by the Substance Abuse and Mental Health Services Administration.


The remote therapy company Talkspace reported a 65 percent jump in clients since mid-February. An anonymous collection of text messages and transcribed therapy sessions by the company revealed coronavirus-related anxiety to be the primary patient concern.


Aside from the virus, mental-health experts are particularly concerned about the increasing economic devastation. Research has established a direct link between financial upheaval, and suicide and substance use. A study of the Great Recession that began in late 2007 showed that there was about a 1.6 percent increase in the suicide rate for every percentage point increase in the unemployment rate.


Using such estimates, Meadows Mental Health Policy Institute, a nonprofit based in Texas developed models suggesting that if unemployment resulting from COVID-19 increases five percentage points to a level similar to the Great Recession, an additional 4,000 people could be expected to die of suicide, and an additional 4,800 from drug overdoses.


According to Meadows, if unemployment rises four times that amount, by 20 percentage points — to levels similar to the Great Depression in the 1930s, suicides could increase by 18,000 and deaths caused by overdoses by more than 22,000.


“We’re now hitting a period of uncertainty where a lot of people ask themselves how long they can keep it up,” said Liselotte Dyrbye, a Mayo Clinic doctor and a leading researcher on burnout. “The teapot can only boil for so long.”


Or a Ripple?

But according to others, this new wave of mental problems is still safely offshore, and it could never even make landfall. There are those in the mental health arena, including psychiatrists and therapists who have had experience working with people when other disasters hit, such as earthquakes and hurricanes. They have noted that the immediate surges in anxiety and helplessness seldom became traumatic or even chronic.


Surveys that take people’s temperatures regarding their emotions amid a crisis are generally inaccurate predictors of lasting distress, nor of severe psychological disorders, like schizophrenia and bipolar disorder. And most people living with these conditions see little overall change over time.


“In most disasters, the vast majority of people do well,” said Dr. Steven Southwick, a psychiatry professor at Yale. He has worked with survivors after numerous cataclysms, including mass shootings. “Very few people understand how resilient they are until faced with extraordinary circumstances. One of our first jobs in these situations is to call attention to just that.”


Looking at this through the pharmacological lens, prescription trends have provided little data to support the contention that there has been an explosion in mental disorders in recent months. In March, at the height of the epidemic in many regions, prescriptions for anti-anxiety drugs such as Xanax and Klonopin were up by 15 percent over February; antidepressants were up by 14 percent, and sleeping pills by 5 percent, according to data provided by OptumRx, the pharmacy benefit arm of UnitedHealth Group.


But by early April, those rates began to decline. And the total prescriptions in April were 8.7 million for anxiety drugs and 27.4 million for antidepressants — which was very close to their usual averages for April, according to data supplied by IQVIA, a healthcare analytics firm.

After the terrorist attacks of September 11, 2001, there was a similar concern among mental health officials. They feared that a new wave of mental disorders would overwhelm the mental health system.


In a 2004 study, researchers studied prescription data for one month before and after the terrorist attack, comparing prescription rates across a broad range of psychiatric drugs. “The acute shock and fear of the events of September 11 were not accompanied by a commensurate increase in the use of psychotropic medications,” they concluded, except for a modest increase in New York City.


What do you think?