I’ve been talking and writing recently about the indirect health effects of the COVID-19 pandemic.
Over the past two years, COVID-19 has had a profound impact in terms of acute physical illness, death and even the lasting effects attributable to so-called “Long COVID.” It has also affected access to care, social factors influencing health, chronic disease management and mental health. Today, I’d like to focus on the indirect effects of the pandemic on mental health and well-being.
Mental health disorders are among the leading adverse health conditions of human beings. Affective disorders, including anxiety and depression, are by far the most common. By some estimates, in the United States the lifetime prevalence of anxiety is 5% to 10% and the lifetime prevalence of depression is up to 20%.
There are many factors influencing the risk for anxiety and depression, including genetic (familial) predisposition, the experience of adverse childhood events and other social factors, and situational factors, including social isolation, loss and grief. The pandemic has magnified many of these risks.
Substance use disorders have also been affected by COVID-19 in the U.S. For instance, alcohol sales and consumption have increased since the start of the pandemic. Meanwhile, a national survey of U.S. adults reveals that excessive drinking (such as binge drinking) has increased by 21% during the pandemic. This is particularly concerning since it has been shown that a sustained increase in alcohol consumption for one year can result in a 19% to 35% additional risk of death from alcohol-related causes.
Also, the opioid use epidemic, which long predates COVID-19, has been growing more severe. The impact of these “twin” epidemics has been unprecedented in terms of lives affected by opioid misuse and lives lost from opioid overdose.
In 2021, according to national data, the rate of total overdose deaths exceeded 100,000 Americans, the majority of which were attributed to opioids, especially synthetic opioids such as fentanyl. Various pandemic-related factors affected this spike in overdose deaths, including closure of substance-use treatment clinics; focus of emergency departments on COVID-19 patients; social distancing and shelter-in-place orders affecting mental health; a decline in bystander overdose rescues; and economic challenges.
Mental well-being is the result of many variables. Social connectedness and building a network of social support (e.g. family, church, school, place of employment, civic organization) is critical, especially because there is a known direct connection between social isolation and problems with mental health and substance misuse. Meanwhile, other social factors, including economic and food security, age-appropriate developmental stimulation (school and extracurricular activities for kids) and access to mental health and substance rehabilitation services, are all important.
The long climb out of the pandemic will require not just measures aimed at the virus itself, but also a communitywide approach to build resilience and ensure that no one is left behind during the recovery. A focus on resources for social outreach and engagement and access to behavioral health care will be a critical part to this recovery.
Dr. Matthew A. Clark, a board-certified physician in internal medicine and pediatrics, works for the Indian Health Service.