Coronavirus disease 2019 (COVID-19) and the policies to contain it have affected individuals all over the world. This has demanded a sudden, immense, and ongoing adjustment in most individuals’ behavior, thinking, and planning, daily routines and interactions, personal lives, and work. Such omnipresent exposure, and the ongoing adjustments and unpredictability, inevitably have an impact on individuals’ psychological constitution and well-being.

Reviewing the scientific literature about the psychological consequences of the COVID-19 pandemic, three major ways can be identified of how SARS-CoV-2 affects our mental health: the pandemic as a traumatic event, the economic consequences of the pandemic, and COVID-19 disease itself.

COVID-19 Pandemic As A Traumatic Event

Causing physical, emotional, and psychological harm, the COVID-19 pandemic can be considered a traumatic event. Major stressors have been inflicted on the population, such as uncertainty, severe shortages of resources for testing and treatment and for protecting responders and health care providers from infection, the imposition of unfamiliar public health measures that infringe on personal freedoms, social isolation, financial threats, and conflicting messages from authorities. Such stressors can doubtlessly contribute to the sensation of a traumatic event and lead to high levels of distress and psychological symptoms, such as depression and anxiety in individuals.

Large-scale traumatic events have previously been shown to impact mental health and lead to enhanced levels of psychological distress, depression, posttraumatic stress disorder (PTSD), anxiety, suicidality, and the manifestation of somatic symptoms in the population affected (Goldmann, et al., 2014). This has been observed, after the events of September 11 (Galea et al., 2002, Silver et al., 2002) and the 2014 Ebola outbreak (Jalloh, et al., 2018).

Measures taken to combat the COVID-19 pandemic can inflict trauma. Collective and individual quarantine measures have been linked with negative psychological consequences, such as psychological distress, PTSD symptoms, confusion, anger, and increased suicidal risk (Barbisch et al., 2015, Brooks et al., 2020). Additionally, exposure to someone diagnosed with SARS-CoV-1 has previously been associated with PTSD and depressive symptoms (Hawryluck, et al., 2004).

In light of this research, it is no surprise that early scientific evidence links COVID-19 with an increase in mental illness, showing elevated anxiety and depression (Cao et al., 2020, Xiao, et al., 2020; Rettie and Daniels, 2020). According to the Center of Disease Control and Prevention (CDC), the prevalence of symptoms of anxiety disorder in the US was approximately three times those reported in the second quarter of 2019 (25.5% versus 8.1%), and the prevalence of depressive disorder was approximately four times that reported in the second quarter of 2019 (24.3% versus 6.5%) (CDC, National Center for Health Statistics). Elevated levels of adverse mental health conditions, substance use, and suicidal ideation were reported by adults. Specifically, young adults, minority racial/ethnic groups, self-reported unpaid care-givers for adults, and essential workers reported increased difficulties (Czeisler et al., 2020).

Social Economic Consequences Of COVID-19 Pandemic

The economic impact of COVID-19 is a global concern, profound, and long-lasting. Mental health is sensitive to economic hardship. This has been well documented in the wake of previous financial recessions, particularly among individuals who are unemployed and are otherwise affected by economic adversity (Ayuso-Mateos et al., 2013, Frasquilho et al., 2015, Tsai et al., 2015, Margerison-Zilko et al., 2016).

The COVID-19 pandemic has caused major job disruptions. Many workers had to reduce their hours or take a pay cut due to the economic fallout from the pandemic. Specifically, younger individuals and people without a university education were more likely to experience drops in their income (Adams-Prassl et al., 2020). Unemployment rates have gone up during lockdowns and even reached record highs (i.e. US, 14.7 %, April 2020) with those holding insecure and casual jobs to be the first to face unemployment. 43% and 31% of employees in the UK and US respectively report having been furloughed in their main job as of April 2020. Unemployment is known to be related with mental and physical health effects, such as somatization, depression, and anxiety, and higher consumption of medication (Linn et al., 1985). Workers who cannot perform their tasks from home were more likely to lose their jobs. Closed schools and child care facilities presented working parents and caregivers with challenges to do their jobs remotely. Caregiver burden, the stress which is perceived by caregivers due to the home care situation, during COVID-19 was linked to higher rates of generalized anxiety and depression (Russell et al., 2020).

Even though unemployment rates fell after the summer, most economies are in a recession or depression. In France alone, the pandemic caused financial hardship for more than 1 million people (Rey-Lefebvre et al., 2020). Those who lost their jobs are facing greater challenges to find employment with the current job market and competition. Business owners and employees in work fear the consequences of further waves for their existence and further employment.

Job disruption is strongly linked to financial struggles which again are strongly linked to psychological problems (Kiely et al., 2015). The prevalence of depression symptoms in the US was found to be more than three times higher during COVID-19 compared with before the COVID-19 pandemic. Individuals with lower social resources, lower economic resources, and greater exposure to stressors (i.e., job loss) reported a greater burden of depression symptoms (Ettman et al., 2020).

COVID-19 Disease - Contagion And Illness

Most individuals infected with COVID-19 do not develop symptoms; treatment options for COVID-19 patients have improved and the fatality rate has dropped. However, the long-term consequences of COVID infection are unclear, and fear of getting infected with the virus is still prevalent. This leads to ongoing caution, and cognitive and behavioral adaptations, such as social distancing and isolation (Nelson et al., 2020). Many will recognize cognitive and behavioral alterations over the past months, such as an increased body awareness, increased regular self-screenings for symptoms, or intensified dreaming (Rettie and Daniels, 2020; Schredl and Bulkeley, 2020; Iorio et al., 2020; MacKay and DeCicco, 2020). Over time, preoccupation can become a stressor and lead to a greater vulnerability to develop psychopathological symptoms. Social isolation is well known to cause psychological harm and can lead to anxiety, loneliness, and depression (Stahn et al., 2019; Leary, 1990).

Furthermore, countless patients are falling ill with COVID-19. Disease courses range from mild to severe trajectories that may require emergency aid and can be fatal. Increasing evidence is showing a manifestation of long-term consequences in patients even after mild courses of disease, with symptoms such as headaches, difficulty with sleeping, concentration and memory problems, and chronic fatigue. For a review on neurological long-term consequences of COVID-19, see this summary.

There can also be a stigma related to infection with COVID-19 which can persist after quarantine. Particularly at risk for social isolation, exclusion, and stigma, and therefore to develop psychological symptoms, are “long-haulers”. Patients with continuous symptoms report experiencing poor understanding by others or even disbelief (Goldberg, 2020). Because the long-term consequences are still not understood, these patients additionally struggle with the fear of not recovering. In a study that investigated symptoms in long-haulers, anxiety was reported by half of the participants and sadness by more than a third (Lambert et al., 2020).

Conclusion

The Covid-19 pandemic has implications for individual and collective health and emotional and social functioning. It is severely stressful and impacts mental health due to its traumatic quality, its economic consequences, and its risks of contagion and illness. Social isolation associated with quarantine can be the catalyst for many mental health consequences, even in people who were previously well.

Some individuals are more vulnerable than others to experience psychological distress and develop psychiatric symptoms. First responders, individuals who suffer from economic consequences, people who contract the disease, those at heightened risk for infection, and people with preexisting psychiatric, or substance use problems are at risk. Screening for mental health problems in treatment centers, offering education, and psychosocial support can be crucial to support individuals in their need with the stress, depression, irritability, insomnia, fear, confusion, anger, frustration, boredom, and stigma.

However, COVID-19 affects everyone and numerous individuals are struggling with the current situation. The initial shock of the first wave of the pandemic has now been replaced with a pandemic fatigue. Emotional distress can help explain why many individuals are tired of and frustrated with the ongoing situation, and why many feel tempted to consider violating orders related to the measures to minimize the spread of COVID-19. Coping strategies and resilience are different for every individual and should not be overlooked but taken into account when evaluating new strategies and regulations to manage the pandemic.

Health care providers, trained psychologists, mental health coaches, and verified health care apps can provide support and suggestions to improve stress management and coping. Relief can be also found in a wide range of online support groups (i.e. social media). Connecting, sharing, and exchanging experiences and strategies to handle challenges can help to improve ways of dealing with the psychological distress of the COVID-19 pandemic.

Katharina Koch is a Clinical Psychologist and earned a PhD in Psychology and Neurosciences.

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