As the COVID-19 outbreak continues its hold on the country, mental health issues are on the rise. From panic attacks to loneliness and depression, Americans are feeling the pressure and stress surrounding the coronavirus pandemic.
Take Jennifer Hitchcock, of Berkeley County, W. Va. A headache for her marks the excruciating end of a panic attack. Before that point, she endures much more.
“Mine present in not the classical way,” she said in a recent interview. “It feels like someone’s sitting on your chest. It’s an intense pressure. I have to tell myself to breathe.”
While the world converses on the serious symptoms of the deadly coronavirus, medical professionals and counselors are imploring the public to not ignore the serious and often physical symptoms of mental health during the pandemic.
“Mental health and physical health are very closely connected,” said Dr. Stephanie Rushton, a behavioral health physician with UPMC Williamsport, Pa. “We are sort of in a crises situation, and most crisis situations don’t last for weeks and weeks and weeks. It is equally as important to address mental health as physical health.”
For Hitchcock, those weeks and weeks of working at home and teaching her kids at home, coupled with statewide stay-at-home orders, have meant heightened levels of anxiety and restrictions on her usual coping mechanisms.
Hitchcock is a special education teacher for a district in Loudoun County, Virginia. She has four children, some of whom are also special education students. In mid-March, when her district shut down, she abruptly had to shift to teaching distance learning with her students, while helping her own children learn at home.
“Half the kids in my classes aren’t doing work or completing the assessments or coming to Google classes,” Hitchcock said. “I can’t make sure they’re comprehending what we’re learning.”
In the last two months, her 18-year-old daughter was exposed to the virus and she quarantined for two weeks, though she never showed any signs of infection. Hitchcock’s husband, Jerry, also went through a period of job insecurity, which added to her anxiety.
She said that her usual coping mechanism is to have someone watch her children while she gets out of the house for a while, but she wasn’t able to do that due to social distancing and stay-at-home orders.
“Everything was being taken away, and all of my control was removed to be able to handle certain situations,” she said. “I find water soothing, so when the panic attacks start, I’m supposed to run warm water over my hands to refocus my brain off of what’s causing the attack. The point is to try to focus on what I can control.”
She started therapy sessions through telehealth, and as is the case for so many, it can be very difficult.
“It’s still really new,” she said. “I have to force myself to go.”
Dr. Rushton, meanwhile, said her practice transitioned quickly to telemedicine and video therapy sessions as soon as the pandemic hit.
“We’ve been doing telephone and video conferencing with our patients to help them be able to kind of process through what they’re experiencing,” she said.
Many of the new patients she’s taken on have a mental health history or were doing well until the pandemic. The levels of uncertainty that came with it caused challenges to resurface for some of them.
“The anxiety is there for safety and health,” Rushton said. “We tend to function the best when we have routine, consistency and predictability. The fact that there’s so much of the situation that we can’t control, people are struggling coping with that.”
Dr. Dean Aslinia echoed that sentiment, based on new research from the University of Phoenix.
“Overall, the research is showing that there seems to be a huge concern when it comes to loss of control for many Americans,” Aslinia said.
He explained that being confined for more than a month, with no end in sight, is an adjustment many people are finding difficult to accept.
A survey from the University of Phoenix asked more than 1,000 people to think about how the COVID-19 pandemic has affected them, and the research revealed that 4 in 10 Americans are lonelier now than before as a result of the coronavirus pandemic.
Findings also show that 44 percent of those surveyed say their loneliness has increased, and 19 percent of those surveyed say if social distancing goes on too long, it will affect their long-term mental health.
Aslinia is a psychotherapist and the graduate counseling program chair at the University of Phoenix, Ariz. He explained what is happening to people as they isolate and have had their routines upended because of the pandemic.
“What it found was that 41 percent of people are reporting to be a lot more anxious than they have ever found themselves … as a result of this pandemic,” Aslinia said in a recent phone interview. “Thirty-three percent specifically mentioned anxiety surrounding their inability to pay their bills.”
He added that 26 percent of those polled are worried about reduced salary and jobs, and 22 percent are concerned about losing their jobs completely.
“So those are all the financial aspects,” Aslinia said. “Which, all of them, based on this anxiety, is leading to higher rates of mental health concerns … there’s depression going on for some; there’s feelings of loneliness and isolation.”
Loneliness and stress
While many are worried about finances, even those with steady income are experiencing challenges to their mental health due to being confined to their homes. He said people are reporting loneliness and anxiety regardless of it people are around them.
“There are some that are reporting isolation, which means they are obviously physically separated from others that they can’t engage with, and that’s creating one layer of issues, mental health-wise,” he said. “And the other tier is feelings of loneliness, but not related to isolation.”
What that means, he said, is while some are interacting and engaging with people via phone and video chat, “they’re emotionally feeling drained and lonely because they’re not connecting with people where their emotional needs are met. Meaning, they’re talking about all the surface-level things that they need to do to get by every day … but they’re really not going any deeper than that.”
“They feel there are people around them,” he concluded, but “they just can’t connect with anybody.”
His advice to combat that loneliness is to focus on the quality of conversations people have, rather than quantity of interactions.
He equated the move to hitting the “like” button on social media posts.
“You’re fully engaged, but you’re not taking any emotional satisfaction from it because nobody understands where you are mentally or emotionally, or vice versa,” he explained.
He said checking in with friends and family to ask how they are really doing is the first step into going deeper into those relationships, which will help curb the loneliness.
The stress surrounding the loss of control and the uncertainty created by the pandemic can be overwhelming for even those who have never experienced mental health issues such as depression and anxiety.
“Obviously, all these different issues are creating stress,” Aslinia said. “And so, what’s happening, when we understand stress from a psychological perspective, stress is immediate. There’s usually an identified trigger with it.”
He said a common trigger right now could be news sources reporting the death toll of the virus, and the fact that an end to the pandemic has not been defined.
“So it shoots up anxiety, which is our body’s reaction to fighting off a potential threat,” he said. “And usually with that, the body responds in three different ways from that anxiety — it either goes into fight mode to fight it, flight mode to run away from it, or to just simply freeze and do nothing about it.”
He said when a person’s reaction to that anxiety is to freeze and do nothing, they are likely to spiral into a depression. That’s what he believes is happening to a lot of people right now, he said.
Some symptoms of depression are changes in appetite or sleep — either eating or sleeping too much or too little. Constant fatigue, physically or cognitively, would be another sign of depression as well.
“Mental fog, or lack of concentration, or memory recall, those are some more signs,” he noted. “If there is a loss of pleasure in doing things that they used to find pleasurable, that’s usually another significant symptom or signal. And then, last but not least, if there is excessive emotional output … crying all the time, or if they’re irritable a lot of times.”
Aslinia recommended that anyone experiencing the aforementioned symptoms seek professional help from a psychiatrist, therapist or counselor, before adding that depression doesn’t go away by itself — even if the stressor involved goes away.
He said the main difference between an anxiety-inducing stress incident and actual depression is that during the stress incident, the anxiety “is immediate but it will subside once a resolution has been reached.” With depression, the feeling of hopelessness lingers even after the incident has been resolved.
When it comes to the amount of patients that have needed services throughout the pandemic, he said there has been an uptick almost entirely across the board.
“I definitely know there’s an increase both for us, as well as for the mental (health) agencies that we partner with,” Aslinia said of the call volume since the pandemic began. “Especially now, a lot of mental health professionals have gone to telehealth, providing telecounseling options, so that in itself would be an indicator that there’s a demand for it.”
On a brighter note, he said that the pandemic could be a step in the right direction toward reducing the stigma surrounding mental health care.
“The silver lining that can come out as a result of this pandemic is people’s awareness of the need for emotional regulation and mental health wellness,” Aslinia said. “And what we say in the counseling world is, ‘People don’t come to counseling because they see the light. They come to counseling because they feel the heat’ of the fire, essentially, and that’s usually when people reach out for help. So this type of pandemic is actually creating that threshold.”
He said with the forced isolation under the same roof as your spouse and family, things can get heated, but because of that, some people are now reaching out for the counseling and help they may have needed for a long time.
“It’s presenting an opportunity for us to deal with many of the factors that daily life’s rigor otherwise doesn’t allow us to take the time away to do,” Aslinia explained. “Dealing with anxieties, how to cope with some of these anxieties, how to better communicate, how to help our children face their anxieties — all of those are topics that are being much better addressed than they ever have been before.”
He said there is never any reason to be embarrassed or ashamed to ask for help.
“We’re moving in a direction that mental health is becoming just as important as any other medical health issue,” Aslinia said. “And so, just as you wouldn’t feel ashamed or guilty for telling somebody you take medication for cholesterol, you shouldn’t be worried … when you say ‘I’m taking an antidepressant or antianxiety medication.’ We all, on some level, struggle with emotional regulation.”
He added that 1 out of 4 Americans struggle with mental health issues, and in order to achieve better mental health, Aslinia offered a few pieces of advice.
“First and foremost, I would say limit or regulate your information intake,” he said. “If you’re experiencing high levels of anxiety by the constant pouring of 24-7 news cycles, then to limit that intake.”
He said setting aside designated times of the day to consume news by reading a local newspaper or watching local news would be a better option than having the TV on all day, “to constantly trigger your anxieties.”
Getting eight hours of sleep per night also factors into better mental health, he added. An exercise routine is also key, even if it’s just walking around the neighborhood.
“What’s important with that is releasing the endorphins, which are the brain’s ‘feel good’ hormones,” he said.
He said that adding mindfulness techniques such as deep breathing, yoga or meditation will help “to be able to calm down the anxieties and the chronic worries in the brain.”
He then added that eating healthy also factors into an overall wellness plan.
Effects on children
Adults are not the only ones dealing with mental health struggles. Many children are experiencing feelings and emotions triggered by the isolation and pandemic, and they may not even understand what is happening to them.
Lisa Farr is a child therapist working from home doing telehealth and phone counseling services in Greenville, Mich. She said conducting counseling via phone or video chat is “a lot harder to get people to engage.” She added that especially with children, getting and keeping their attention remotely is a real challenge right now.
She said the children she works with are struggling with not being able to go out and do things because of the stay-home orders.
“Having to be around their siblings all the time has been difficult,” Farr added.
She noted that the idea of quality family time sounds good, but the reality of it is a different story.
“In reality, they go to school for that social interaction, they go to school to get away from that abusive relationship at home, so it’s very trying for them too,” she said. “I feel like some of the kiddos I’ve been working with have been struggling with not being around other people. And, you know, Mom and Dad dump everything on them. More responsibilities at home, plus schoolwork on top of that.”
She noted some things parents can do to help their kids through such an uncertain time.
“Just validating their feelings and letting them know that a lot is unknown at this time, but it’s still just a temporary thing,” Farr said. “We will go back, somewhat, to where we were before. But not to expect a change right away. I think kids need to be heard, and I don’t think a lot of parents take the time to talk to them.”
Farr noted that kids pick up on all the negativity surrounding the pandemic in the news and through conversations they hear between adults. Because of that, they need an alternative to all the negativity to balance out their mental health.
“I definitely think increasing quality family time, playing games with kids, getting them outside enjoying nature, things that we’ve taken for granted before, would be great for kids to experience,” Farr said.