International Journal of Academic Medicine

EXPERT COMMENTARY
Year
: 2020  |  Volume : 6  |  Issue : 4  |  Page : 328--331

The mental health burden of social distancing during the coronavirus disease 2019 pandemic


Samia Mazumder, Ijeoma Nnodim Opara 
 Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA

Correspondence Address:
Dr. Samia Mazumder
Wayne State University School of Medicine, 540 E Canfield St., Detroit, MI 48201
USA

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has had far-reaching economic and mental health impacts on a global scale. Symptoms of anxiety, depression, and overall distress may have been exacerbated by the mental health tolls of the pandemic. It is also important to consider the impact of gender, socioeconomic status and whether one is a frontline worker involved in the treatment of critically ill patients. In order to fully recover from the pandemic, we must be able to identify and treat any mental health disorders that may emerge from the effects of social distancing. Improving access to mental health screening and treatment opportunities through platforms that utilize telehealth may be a part of the solution. In addition, providing institutional support for health-care workers, promoting a safe work environment, and encouraging a robust conversation about mental health will aid in mitigating the negative impacts of social distancing during the COVID-19 pandemic. The following core competencies are addressed in this article: Interpersonal and communication skills, Practice-based learning, Systems-based practice



How to cite this article:
Mazumder S, Opara IN. The mental health burden of social distancing during the coronavirus disease 2019 pandemic.Int J Acad Med 2020;6:328-331


How to cite this URL:
Mazumder S, Opara IN. The mental health burden of social distancing during the coronavirus disease 2019 pandemic. Int J Acad Med [serial online] 2020 [cited 2021 Mar 2 ];6:328-331
Available from: https://www.ijam-web.org/text.asp?2020/6/4/328/304603


Full Text



Since early 2020, the terms “social distancing,” “quarantine,” and “isolation” have become new additions to the everyday vocabulary of our global society. Media outlets have popularized slogans like “Stay Home, Save Lives” throughout the United States to make a concerted effort to battle the coronavirus disease 2019 (COVID-19) pandemic. Amidst curbing the viral pandemic, we must also be weary of another looming pandemic concerning our mental health.

Although “quarantine” and “isolation” may seem new to our society, these concepts have been utilized in prior pandemics, such as the severe acute respiratory syndrome and Middle East respiratory syndrome pandemics of 2003 and 2012, respectively.[1] During these outbreaks, multiple studies have shown an increase in mental health disorders, such as depression, anxiety, and posttraumatic stress disorder in the population.[2],[3] A rise in mental health disorders could lay the foundation for increased suicidality or substance use disorders, especially for populations who are psychologically vulnerable.[4] The widespread economic damage from the COVID-19 pandemic has left a trail of unemployment and financial turmoil within all societies. The combination of economic instability and rising mental health disorders brews the perfect storm for a mental health crisis.

There is an increased awareness of the role of gender on the mental health impact of the COVID-19 pandemic. A study by Lai et al. demonstrated a significant discrepancy between men and women who were frontline workers during the pandemic. When screened for depression (patient health questionnaire-9) and anxiety (generalized anxiety disorder-7), women were found to have higher scores across the board.[5] New mothers are also at a higher risk of postpartum depression during the pandemic. Postpartum depression is the result of a dynamic interplay between biological, psychological, and social risk factors, all of which can be amplified during the COVID-19 pandemic. Physical distancing and isolation remove the social support that is vital to preventing or mitigating postpartum depression and managing stress during this critical period. Stay-at-home and shelter-in-place interventions also increase the risk of women and girls to experience sexual- and gender-based violence.[6] Disasters exacerbate preexisting gender inequities and power hierarchies, especially as economic stressors increase tension within households. Isolation separates victims from helpful resources and removes opportunities to distance themselves from their abusers.

Moreover, the majority of individuals who live below the poverty line in the United States of America are women, particularly single mothers, women of color and elderly women who live alone.[7] These women are especially vulnerable to economic fragility and the resulting health consequences. In addition to everyday home and childcare responsibilities, women comprise approximately 60% of the population who provide unpaid care for children with special needs or adult friends and family members.[8] These additional responsibilities may become a burden that is amplified by the pandemic. By acknowledging the unique stressors that men and women may endure separately, we will be able to form a holistic understanding of the mental health burden of the pandemic as well as develop customized interventions that consider the gendered realities of populations.

The discourse on the mental health impact of COVID19 is incomplete without addressing the experience of frontline workers, especially those in the health-care field, who are experiencing an increased strain on their mental health as they continue to battle the pandemic. This may be due to the emotional and physical exhaustion when caring for critically ill patients, experiencing shortages in key resources (personal protective equipment, ventilators, etc.,) and concerns regarding workplace exposure or infecting loved ones.[9] A study by Lai et al. assessed mental health outcomes from clinicians in China who were directly involved in COVID-19 patient care. Over 1800 health-care workers were surveyed and 50.4% of respondents reported symptoms of depression while 71.5% stated that they were experiencing distress. Anxiety and insomnia were also frequently reported among respondents.[6] Increased levels of stress may also stem from following strict biosecurity measures and contending with intrinsic and extrinsic stigma associated with mental health within the health-care community. Ultimately, this may hinder our ability to acknowledge or recognize our personal needs during these unprecedented times, a reality further compounded by social distancing and isolation from social support networks such as family and colleagues.

A review by Brooks et al. suggested that the psychological impact of isolation and quarantine is expected to be “wide-ranging,” “substantial,” and “long lasting.”[10] It is imperative that we, as a global society, prepare ourselves to fight the undoubtedly fast-approaching mental health crisis with the same solidarity that we exhibited during the COVID-19 pandemic. One of the first steps to mitigate the mental health consequences of the pandemic is to change the parlance of “social distancing” to “physical distancing” where we can remain socially connected while maintaining physical distance.[11] Fortunately, we live in an era of technology that facilitates connection through the telephone, social media, video calls and rapid access to global news outlets. During this time, it is increasingly important to emphasize and strengthen our social bonds. Although access to news may help us stay connected, it is critical to ensure that the we avoid excessive exposure to media and verify that the news we are receiving is accurate. Misconceptions and fearmongering may heighten fear and paranoia regarding the virus, which is ultimately detrimental to mental health. Therefore, government, media, and public health officials must prioritize providing accurate information and avoid vague or contradictory statements.

Telehealth offers a unique opportunity for clinicians to screen for wellness and provide mental health care while maintaining physical distance. Although telehealth, particularly telepsychiatry, was utilized over the last several decades, it has become an invaluable asset to clinicians during the pandemic. Telepsychiatry enables patients to access health-care effectively and efficiently while maintaining outcomes that are equivalent to in-person care.[12] As the demand for mental health services increases, telehealth is considered to be an excellent, cost-effective platform for clinicians and patients to collaborate and connect. It can also be leveraged to combat gender-based violence as healthcare providers can perform screening and referral to services as indicated.

However, it is important to be cognizant that not everyone has equal access to information and communication technologies at an affordable cost and quality. Although the International Telecommunication Union reported in 2018 that more than half of the world's population (3.9 billion) is now online, this also means that the other half of the population is still offline. This is primarily in low- and middle-income countries where, on average, only 45% of the population is using the internet. It is also likely that rural areas are more affected than urban or suburban areas.[13] In the United States of America, roughly 3 in 10 adults with household incomes below $30,000/year (29%) do not own a smartphone. More than 4 in 10 adults do not have home broadband services (44%) or a traditional computer (46%). In comparison, each of these technologies is ubiquitous among adults in households earning $100,000 or more per year with higher-income Americans having home broadband services (64%).[14] In addition, it has been shown that racial minority groups have suboptimal access to broadband services compared to Caucasian households.[15] These findings indicate that telehealth may not be universally accessible and therefore may contribute to an already existing plethora of health-care disparities. Thus, it is necessary that health-care organizations collaborate with government, the private sector, and nonprofit groups to increase access to information and communication technology through subsidized broadband services. Furthermore, equal network distribution to low-income areas including underserved areas and Native American reservations should be emphasized. The Federal Communications Commission “Connected Care” initiative and the new COVID-19 Telehealth Program (as a result of the Coronavirus Aid, Relief, and Economic Security Act) to improve broadband connectivity for connected health services is an example of such a collaboration.[16]

Institutional support for health-care workers is critical to provide safe work environments that are free of stigma, coercion, and fear of negative consequences. Destigmatizing the conversation about mental health, wellness, and self-care should be made routine. Improved access to psychotherapy and counseling services should be emphasized. Multi-faceted self-care strategies enable institutions to support a sense of control and contribution without reinforcing unrealistic expectations of the responsibility for the lives of others. Healthy self-care strategies include self-monitoring and pacing; regular check-ins with colleagues, family, and friends; working in partnerships or teams; regular peer consultation and supervision; frequent breaks for bodily care and refreshments. It is crucial to focus on what is within our control and accept what is not within our control. Negative coping strategies, such as substance use, negative views on personal contributions, and depreciating the value of self-care should be avoided.

Finally, we must begin an honest and robust conversation about mental health on global, national, and local levels. Policies, protocols, processes, practices, and procedures must be co-developed with key stakeholders to invest in a comprehensive, compassionate, and culturally competent mental healthcare system. Additionally, providing safe spaces to individuals who are struggling with mental health concerns is critical to ensuring appropriate treatment in a timely manner. It is important to re-emphasize universal screening methods, while paying particular attention to populations who may be psychologically vulnerable (victims of intimate partner violence and human trafficking, veterans, elderly) to prevent the negative outcomes of mental health disorders.

The mental health implications of social distancing during the COVID-19 pandemic will ripple throughout the global society in the foreseeable future. Finding strength in solidarity and social connectedness will be one of the greatest weapons we can wield when navigating the mental health challenges associated with the COVID-19 pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Ethical conduct of research

Ethical approval is not required at our institution to publish an expert commentary.

References

1Mak IW, Chu CM, Pan PC, Yiu MG, Ho SC, Chan VL. Risk factors for chronic post-traumatic stress disorder (PTSD) in SARS survivors. Gen Hosp Psychiatry 2010;32:590-8.
2Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ 2003;168:1245-51.
3Bai Y, Lin CC, Lin CY, Chen JY, Chue CM, Chou P. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr Serv 2004;55:1055-7.
4Olié E, Jollant F, Deverdun J, de Champfleur NM, Cyprien F, Le Bars E, et al. The experience of social exclusion in women with a history of suicidal acts: A neuroimaging study. Sci Rep 2017;7:89.
5Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3:e203976.
6John N, Casey SE, Carino G, McGovern T. Lessons never learned: Crisis and gender-based violence. Dev World Bioeth 2020;20:10.
7The Population of Poverty USA.” Poverty USA. Available from: http://www.povertyusa.org/facts. [Last accessed on 2020 Apr 15].
8Caregiver Statistics: Demographics. Caregiver Statistics: Demographics Family Caregiver Alliance; Available from: http://www.caregiver.org/caregiver-statistics-demographics. [Last accessed on 2020 Apr 15].
9Ayanian J. Mental health needs of health care workers providing frontline COVID-19 care. JAMA Netw Open 2020; Published online April 1, 2020.
10Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020;395:912-20.
11Courtet P, Olié E, Debien C, Vaiva, G. Keep socially (but not physically) connected and carry on: Preventing suicide in the age of COVID-19. J Clin Psychiatry 2020;81:20com13370.
12Hilty DM, Rabinowitz T, McCarron RM, Katzelnick DJ, Chang T, Bauer AM, et al. An update on telepsychiatry and how it can leverage collaborative, stepped, and integrated services to primary care. Psychosomatics 2018;59:227-50.
13Measuring the Information Society Report. Measuring the Information Society Report; 2018. Available from: http://www.itu.int/pub/D-IND-ICTOI.[Last accessed on 2020 Apr 15].
14Anderson M, Kumar M. Digital Divide Persists Even as Lower-Income Americans Make Gains in Tech Adoption. Pew Research Center, Pew Research Center; 7 May, 2019. Available from: http://www.pewresearch.org/fact-tank/2019/05/07/digital-divide-persists-even-as-lower-income-americans-make-gains-in-tech-adoption/. [Last accessed on 2020 Apr 15].
15US Census Bureau. The Digital Divide: By Internet, Computer, Race & Hispanic Origin. The United States Census Bureau; 15 January, 2018. Available from: http://www.census.gov/library/visualizations/2017/comm/internet.html. [Last accessed on 2020 Apr 15].
16Federal Communications Commission. Available from: http://docs.fcc.gov/public/attachments/DOC-362365A1.pdf. [Last accessed on 2020 Apr 15].