COVID-19 & Mental Health
This article is part of an ongoing collaboration between the Colorado School of Public Health, the Denver Museum of Nature & Science, and the Institute for Science & Policy. Find all of our previous COVID-19 webinars and recaps here.
For many Americans, the stresses of COVID-19 extend well beyond the virus itself. We may be feeling isolated after months of physical distancing, fearful for our own personal safety, or anxious about household finances and the state of the economy. Frustration, helplessness, depression, exhaustion, anger, grief ─ our emotions can run the gamut, and no two people will ever navigate trauma in quite the same way. Mental health is a difficult subject, one that’s often uncomfortable to broach even with those we’re closest with. But even as the country works to bring the coronavirus under control from an epidemiological perspective, medical caregivers caution that we cannot ignore the long-lasting psychological effects of living through a world-altering pandemic. So what can we do to help ourselves, our families, and our neighbors arrive at healthy outcomes during this period of extreme stress and uncertainty?
Mercedez Lang and Michelle Tijerina, both practitioners and ambassadors for the Healthy Living Team at the Mental Health Center of Denver, joined our series to discuss recent trends and data surrounding mental health, strategies to stay connected with others during times of change, and other educational enrichment opportunities that are available as we navigate the new normal.
This transcript has been edited for length and clarity. Watch the full recording here.
MERCEDEZ LANG: Thank you for joining us today and I hope everyone is well and really centered in a good space. Today, we are going to be talking about COVID-19 and mental health. As the number of the number of cases of COVID-19 increases, so does associated anxiety for the general public. The mental health effects of COVID-19 are as essential to address as the physical health effects.
Now when we think about everything that's being shared, mostly on the news, everywhere you're hearing about the effects physically, about the risk, about loss of work. But we're very rarely hearing about the effect that COVID-19 is having on mental health. So today we're going to talk a little bit more about that.
Before we even get started, I want to state something that I think is so important. And that is: we keep hearing this phrase “we're in this together.” And yes, we are all experiencing this pandemic. And the thing that I'd like you to remember is that each of us is experiencing this in a completely unique and different manner. Why is that? It's many factors. However, the main thing, I believe, is that each of us come from a different background. We've had a different lifestyle. We've had a different experience. Some of us may have had trauma. Some may be struggling with mental illness. Whatever the situation is, it designs it in a way that we each have a unique experience when this pandemic is happening and all the shifts that we are having to encounter. So with that being said, keep in mind, the importance there is for you to have compassion for yourself, as well as others, recognizing that what you're going through might look completely different than what somebody else is going through. This would maybe decrease the judgment that we may give, and just have a little compassion. So with that being said, we are going to get started with our presentation.
First, I'd like to begin with some stats. I did take a lot of these statistics off of the Mental Health of America website, so you can hop on there and you can find all kinds of other information that I thought was extremely helpful. But as we go through some of these statistics, let's break it down a little bit. The first one is that since the beginning of the worry about COVID-19 in mid to late February, there have been at least 88,405 additional positive depression and anxiety screening results over what had been expected. And this the ranging from November of 2019, to January 2020. But that is quite a jump.
There have been 54,093 additional moderate to severe depression, and more than 34,312 additional moderate to severe anxiety screening results from late February through May. The per day number of anxiety screenings completed in May was 370% higher than in January. 370% higher than before coronavirus stress began. Now, per day, the number of depression screens was 394% higher than in January. These impacts on mental health are more pronounced with our youth. And Michelle is actually going to talk a little bit more in depth about the youth, but let's go on with a couple of more statistics that I think are important to know about.
Loneliness and isolation are cited as contributing to mental health problems. So that has quite an impact on society. These percentages have been steady since mid April, despite a dramatic jump in May, more than 211,000 versus 69,000. In April, severity continued to track equal or to a higher extent. Now in May 2020, 21,165 depression screeners reported thinking of suicide or self harm on more than half of the days to nearly every day with 11,894 reporting these thoughts every single day. Now this is alarming if over 11,000, nearly 12,000 individuals are experiencing thoughts of self harm or suicide ideation, in a day. Think about that. They're in their home quarantine, with limited resources to reach out to someone else. That's alarming.
And lastly, we have populations who are also experiencing high anxiety and depression, including LGBT to caregivers, students, veterans, active duty, people with chronic conditions. So, individuals who already have a baseline of other of other struggles that they're working through life with are now experiencing the shift with the pandemic as well.
This isn't just affecting people with anxiety and depression, but other mental conditions too. Among psychosis screeners in May, more than 16,000 were at risk, and the percentage at risk was 73%, also increased wide. This is all from Mental Health America. They have different resources on the website: more statistics more information. But this is just to give you a baseline
Now we're going to bring this home a little bit closer to home and I'm going to turn this over to my peer and colleague, Michelle.
MICHELLE TIJERINA: Thank you so much, Mercedez. And what we're talking about here next are the possible negative effects of COVID-19 on you. I want to be clear, it's not COVID-19 that is causing the negative effects. It's the isolation, it's the decrease in social activity. These are risk factors.
When we look at risk factors, having one risk factor doesn't mean that you will develop a disorder or that you will automatically go to suicidal ideation. It increases the likelihood of that. So the more risk factors that we have or that the young people have, the greater the risk that they will develop a disorder, and will need additional treatment and support. So a decrease in social activity, that's going to include any number of things depending on the uniqueness of the young person. Some young people are in sports. Some young people are not able to engage their friends or possibly hobbies that are outside of the home. And all of these things are protective factors that typically boost mood and self esteem and that's what will help them to steer clear of disorder.
So again, an increase in isolation which can lead to disorders, and some of those include depression, anxiety, eating disorders, and even self harming behaviors. So there's a decrease in support and outlets of care. When you think of the young people that maybe at school they have access to social workers and caring teachers, that is not available to them anymore. You think of the missed milestones, whether that's graduation or birthdays or even regular summer activities that they didn't get to experience this summer and won't be able to get them. And so that by itself is a negative effect on our young.
An increase in social media, we know this, as technology is what our young people go to as an outlet, and it may be because of boredom, but it's the thing that we're most concerned about is that this limited social interaction may be done without supervision. And without supervision - we can go into the online bullying, we can go into other subjects - that is not appropriate for young people.
And then going into the school, the potential to fall back behind academically, that everyone has the resources or the technological advances to really participate in school, as if they would in person. And for some online learning just doesn't work,. It's a need for that personal interaction with their peers and with their teachers.
With all this, there's the four dangerous risk factors and the potential rise of abuse, or domestic violence in the home. Again, without those social workers without those teachers to turn to, there's limited supportive outlets that might be able to intervene.
So, an increase in poverty. We know many people are experiencing a loss of their jobs, a loss of financial stability. And so an increase due to that, and other needed resources, are another respect.
We have some community level signs of struggle, where in one survey, we saw the text messages to distress hotlines where people call in just to get support, or they're feeling like they're in a crisis in that moment - that has increased 1,000%. And so that's not even including the difference between now and February or March, when the pandemic began. We know that more than 1/3 of Americans displayed clinical signs of anxiety, depression, or both since the coronavirus pandemic began. Pre pandemic, we used to see a 1/5 of adults exhibiting these signs, and so we've jumped up to about a third now.
And we're seeing this more in young people, especially young adults. The pandemic stress is significantly higher in them as compared to just 60% of adults 65 and older. Our young people are suffering more, just on a basic level of means. We had a report that food banks here in Denver are seeing a 300% increase, as compared to pre-pandemic. We're seeing a disruption of sleeping and eating patterns, irritability, anger, depressed moods, crying sets, obsessive compulsive behaviors and keeping track on a regular basis of what is happening with the COVID-19 pandemic.
We’ve talked a lot about risk factors. I really want to focus in on our protective factors. These are the things that are going to help our young people to stay healthy. The more protective factors that they have available to them or that they can practice, the easier it is for them to remain well. And so some of those might be personality. Those that have an easy temperament or already have good social and emotional skills, or have learned optimistic coping styles...this is going to help our young people to stay away from negative thinking and low self esteem. Family, even though so many families right now are having such a difficult time, especially with the isolation and maybe being one on top of the other in the home...having family harmony and stability is still possible. Through strong family values, we can show our young people how are the adults are dealing with the pandemic, how adults are dealing with stress.
Our positive school climate - now this is going to be more difficult. It's going to go back to the parents, to the families to help increase that feeling of belonging and connectedness, keeping them on a routine. Making sure that they are connected with what is being taught to them on a regular basis. The number one factor in suicide prevention, because I do run a suicide prevention program for young people, is that the young person has at least one caring adult in their lives that they can turn to, hat can be a supportive figure in critical times, and this is what we're talking about. If this isn't a critical time, I'm not sure what it is.
And also, in thinking about risk factors that we haven't talked about: discrimination and isolation, socioeconomic disadvantages, and lack of access to support services. We know that young people who are from minority ethnicities or backgrounds are even more risk because of that discrimination level and factors, especially in this time of racial disparity and thinking about what's going on in our communities, what's going to be important, what's going to be a protective factor, especially in our young people with various minority backgrounds with strong cultural identity and pride in their cultural identity. And so these are some of the protective factors that we as adults can help our young people understand and learn through this pandemic.
ML: Thank you for that, Michelle. And we're gonna dive a little bit into talking about our elderly population and how COVID-19 might be affecting these individuals. And so first let's look the decrease in social activity leading to isolation, loneliness, symptoms that can lead to mental illness. I know myself, I've worked a lot with this population. We do tea time, we do park games. There's dances, there's dinners, there's all these things that actually bring the seniors together and help increase their self esteem, their self worth, stimulate their mind with interactions, just decrease the loneliness and depression and isolation.
So COVID is really having an impact on our seniors in this particular area. Also, a decrease in resources: so food, transportation, income treatment. Think about this: Uber, the bus, the public transportation, any of this, it's limited now and the fear also of being outside and stepping out of quarantine is real as well.
We also have decreased in physical movement. We have seniors staying in their households not participating, not taking their walks, not participating in groups. We also offer at the Dahlia campus where I work my offices out of, we offer dance groups for seniors, we offer yoga classes, chair yoga. We offer all kinds of movement workouts for seniors. And this is something that’s limited now. Also, missed milestones of family, friends and staff. Think about grandchildren who are graduating from school or weddings or birthdays or even our seniors who are turning 97...big milestones and they're not able to celebrate with their friends and their family and their loved ones.
Also, a possible decrease in cognitive processing due to limited mental stimuli. Now this would affect us all. But with the seniors especially, this stimulation of learning something new, of interacting, of being active is tremendously important and vital to their well being. So we're seeing that as well.
Also, a possibility of abuse and fear of communicating the abuse due to quarantine restrictions. So this could be anything from living with family, living alone, living in a nursing home or assisted facility. What if someone is doing harm to someone that we love someone in this elderly population? What are the odds of them wanting to feel competent and safe stepping out and reaching out to someone, and letting them know, knowing that they will still need to remain in that situation in quarantine, and they're concerned about their safety?
And also, the possibility of the increased health risks. Now seniors are at higher risk, as far as COVID-19. However, think about everything else that could be affected if they're not having their regular visits with a doctor. They're not taking care of their physical well being. If they're experiencing symptoms of depression or anxiety, how that affects the body and the immune system. So they're just more at risk ofother illnesses as well.
So that tells you a little bit about the seniors and of course there's so much more and this is affecting each of us, but with this population, it has a little bit of a tender place in my heart because I've worked so closely with them and I know the need. I know that how this COVID-19 is affecting their overall well being. So let's talk a little bit more about survival mode and uncertainty. Michelle, I'm going to turn this over to you.
MT: Absolutely, thank you, Mercedez. When we're talking about survival mode or the survival model, we are talking about when the brain and body are only focused on the threat of what is going on, and this leads to black and white thinking, where we can’t see the middle, where we're not open to learning. We can feel panicky, afraid about financial concerns, or even child care.
Young adults that are having to work, or need to figure out how to deal with the financial concerns, may not have access to childcare. I know with our young people, some of our young people have not been able to join our group, due to the fact that they have to babysit their younger brothers and sisters. And so this is a situation of instability and uncertainty, and that's what puts us into the survival mode. That fear brings on anxiety, and our window of tolerance gets smaller as we have extended contact with this type of disconnect.
We also need to think about the frontline workers, and single parents. Access to food, access to health benefits...our young people and our adults are no longer experiencing or have access to those benefits, maybe because of loss of employment. That's another concern. And so other forms of resources, other forms of health care are needed. I should say, in terms of are we at risk for getting COVID-19, that can mean obsessive compulsive behaviors. We know that washing our hands, wearing masks...these type of behaviors are a sense of control, but they can also get out of hand and addiction when we're under survival mode. Mercedez will expand on some of these other topics in terms of survival and uncertainty.
ML: Great, thanks Michelle. Yes, we're going to break down a couple of different areas in here. Think about employment. For those of us who are employed and those who aren't, think about this. Employment is causing a platform to make this experience completely different from myself or somebody else. Some are fortunate enough to be working full time, to have stability in their work life, to be on a salary, to have the health benefits, to be able to work from home and have maybe the technology and the resources needed to carry on, and they haven't had as much disruption.
Some are working from home and they have their children at home and they're having to juggle this new platform of virtual reality, and then also care for their little ones at home school, so that's been quite a challenge. And think of those that maybe have lost their employment and now they're being faced with a lack of income, or those who perhaps their employment is still in place, but they're not feeling safe and they're being called to go into work. Some of the employers have been fabulous and they've provided this distancing, masks, everything needed to make you feel as safe as possible. But there are some organizations that are not respecting and honoring this and think of those employees who are having to go to work every day.
In the midst of this, feeling unsafe and then bringing that home to their family, knowing that they would be carrying the symptoms of COVID-19 or something to that nature...employment is something that has definitely caused a diverse reaction and a diverse effect on many. Also with regards to any of these, a lot of them is planning. Think about this: many have had vacations planned or perhaps they're not sure if their kids are going back to school or if children are not going to be in daycare, if they're going to return to working into the field or if they're going to stay remote...so many uncertainties. Are you going to be able to take those classes, or teach those classes? Maybe you had a health issue and you're having to go in for surgery or something to that nature. Attempting to plan your life in the midst of a pandemic has not been easy for anyone, and for some, a little bit more challenging than for others.
And yet we're having to accept this and to carry on. It's almost like a day by day type of situation. Also some other areas in question is stability. How do you feel safe in the midst of a pandemic? How do you feel safe when there's so much uncertainty? And this, of course, affects several other areas that are on this, plus your mental state, your emotional wellbeing.
So this pandemic, it’s not simply the pandemic, but it's the effects of the pandemic that are really increasing mental illness and causing individuals to lose a sense of stability with their emotional and mental wellbeing. Do you have anything to add to that?
MT: Thank you, Mercedez. I think one of the biggest aspects that we don't think about is the relationships in our lives. This is something that we still have control over, but it is definitely if our emotional wellbeing and our mental state are not optimal, than our relationships are going to take more energy. It's going to take more deliberate planning, deliberate routine, perhaps calling a loved one so that our relationships are increased.
Distance doesn't have to mean that our relationships fade. We can make those efforts, but it definitely is another factor in terms of survival mode if we don't have somebody to trust and we don't have somebody to talk to about our feelings and our emotional well being. That's going to be our continued window of tolerance, if you will. There’s so many topics that we can go into in terms of survival, and thinking about the various populations that are experiencing something different from the pandemic.
Mercedez and I work with on a regular basis as part of the Healthy Living team. Mercedez, do you want to go into the eight dimensions of wellness?
ML: I'd love to. Now, the role of prevention. Each of us are working on a way of prevention every single day when we attempt to feed our body better, when we exercise, when we go to annual doctor visits, when we spend time with family, step into nature...we're taking care of our well being in hopes of not becoming ill. So we try to take care of our health.
What sometimes happens is, people forget that there is such an importance in prevention with our mental health as well. So on the Healthy Living team, we have a group of experts that actually go out into Denver and we teach all types of groups. Before, it was face to face. Now we're doing a lot virtually and trying to connect that way. But we work a lot with the eight dimensions of wellness. And what this is, is if we look at the eight dimensions of wellness, these are different areas within our life, that when they are maintained, it enables us to have a better quality of life, a better balance.
We have social interactions and whatnot. We have financial, physical, spiritual, environmental, emotional, intellectual and occupational, which is more like vocational. So with any of these areas, think about this to yourself before we go further: How has COVID-19 influenced or affected any one of these areas in your own life? And if you can track one or more areas that have been hit pretty hard, then you know it's throwing your whole entire well being and balance off.
The prevention helps to decrease stigma associated with mental illness. The more we teach increased mental health awareness, the more we increase awareness, the more we decrease the stigma associated with mental illness. When I was working with Mental Health Center of Denver with the Latino population - this is a population, and me being a Latin woman myself, we keep things within our family structure, and stepping out of the family to talk about depression or anxiety is usually a no no. It's just not something we do. We keep it in. So to actually raise awareness and let individuals know that it is okay to seek help and help is needed, just like it will be for your physical wellness, this is part of the role of prevention. Michelle?
MT: Absolutely, thank you, Mercedez. You know, the goal overall in terms of the role of prevention is to increase and or maintain our well being. That's what each of these dimensions are meant to do. And some of the things that we can do in prevention work is to increase alternative classes. My program was designed to focus on art as an outlet for young people, because our young people often have a hard time putting into words what their mental state is or what their emotional well being is. And so by providing these alternative classes, they can attract individuals to various interests.
There’s a lot of talk of Tik Tok, and the young people being on the Tik Tok and doing their dances. These are all fantastic ways of outlining those feelings and those emotions, that anxiety that is often in there providing knowledge and skills. A lot of people think of therapy as an end, but rather it's another form of prevention. Groups and classes that help us to learn those skills and increase our knowledge of how to deal with stress, because at the end of the day that's what this is: it's stress.
Providing safe spaces and teaching things like mindfulness are such an easy way to increase our wellbeing. Learn the skill of mindfulness, staying in the moment, not worrying about tomorrow, not worrying about even the next hour. This gives our brains needed breaks in order to be healthier. And it sounds very simple, but it's extremely effective. Exercise, nutrition, deliberate routines and how to place them...these are all things that people can learn. Therapists are not the only ones that can teach us and increase our knowledge of how to take care of ourselves. A greater understanding of how we're connected to the world, and how we're connected to nature, is another way that we can increase our mental health awareness and increase prevention.
ML: Thank you, Michelle. Okay, the silver lining. How hard is it to think of the positive, anything good that has come out of this pandemic? I can tell you firsthand from the population that we work with, with myself, with family members, with friends: there is a great level of love that is coming out of this pandemic and we're going to talk to you a little bit about that.
Just a couple of things that come up to mind: we're finding parents or families are home more, giving them time to pause, giving them time to reflect, giving them time to connect with their family members with their children with themselves, with their higher being. We're also seeing a shift as far as people focusing on more of what is important. This has caused such an impact on individuals. All of a sudden people are pausing and saying, well, what is most important to me in life? And thinking about setting goals as to where they want to go.
Michelle, do you have a couple of others that you'd like to add with that?
MT: Absolutely. When we talk about the uncertainty, and not being able to plan, one of the great skills that we are all learning by default whether we want to or not, is an acceptance of our situation. What are the resources that we have at hand, what are the resources in our community amongst our natural networks that are helping us through?
Developing those family values, as we talked about earlier, and being an example to our young people on how to deal with distress, how to deal with the hard times that come in life...ultimately, all of that acceptance of this situation can lead to a focus. We want to be really clear, because it may lead us to our negative risk factors. But it can also, if we're deliberate about it, lead us to a sense of control over our health habits, over our routines and putting those in place.
Even if at the end of the day, all we have control is over our breath, that can help in our mindfulness. That can help in giving our body and brain a break, and learning how to deal with a hard time. And those are going to be skills, that's going to be self knowledge, that is going to help us in our life over the long period, not just during quarantine. And also, I'm noticing – Michelle, I don't know if you've noticed - that people are cooking more and eating at home opposed to eating out, which is normally better for your well being. So that wraps up most of our presentation. But I'd like you to see this slide here because it has www.mhcd.org. If you have any questions, you can call our main line at 303-504-6500. You also can text if you need to just speak with someone. Thank you.
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