The Mental Pressures of Re-entering the Real World

It’s been well over a year and a half since the world went into lockdown and the average day for everyone completely changed. We lost the ability to see our friends and families face-to-face and the ability to do countless day-to-day activities. But as we slowly adjusted to our isolation bubbles, we adapted and quickly learned how to traverse life through the internet without human contact. However, as we now enter into the latter part of 2021, the world around us is finally returning to some sense of normalcy. Businesses and restaurants are welcoming customers, Zoom meetings are becoming in-person ones, and students are returning to their classrooms. Yet, no matter how “normal” life may seem, it is impossible to pretend that this pandemic hasn’t radically altered the world we live in.

It is that truth that has led to the most understated, long-standing effect of the pandemic: the mental toll that it has placed on everyone, namely in the form of “re-entry anxiety.” There has been a significant increase in the reports of anxiety and depression symptoms, with over 40% of people in the US reporting some form of mental health issue. Luana Marques, a clinical psychologist from Harvard Medical School, states that these rates are not “going to go back to baseline anytime soon.” She bases these claims on the past, where significantly stressful events have left affected communities with higher anxiety levels than those unaffected. While these anxiety levels stem from the pandemic itself, the situation will not be benefited by the stresses of leaving our isolated bubbles. Our social interaction skills are not as sharp as they once were, and simple social interactions that were once easy may prove more difficult than we expect. As Elissa Epel, a professor from the University of California, San Francisco, states, “We’re re-entering a different world, with new rules, and we are coming from different pandemic experiences.” The expectations in this new society are completely different from those in our past, and these changes will present new social challenges the average person will have never encountered before. Whether that be having difficulties reading emotions through a mask or having to ask someone to take a step back mid-conversation or anything in between, there’s a multitude of social issues that stem from the steps society is taking to return to a normal world. However, none are more polarizing or stressing as the issue of vaccination. While the scientific community has constantly stressed the importance and benefits of getting vaccinated to the general public, the voices of those who are against it are loud and dangerous. If we expect life to return to normal, it is crucial we can ensure that pandemics like this one are less likely to occur and increase the population’s protection against COVID-19, both of which are possible through vaccination efforts. The stress of a non-vaccinated society, prone to relapse, in combination with the social stresses of re-entering the world, creates an unnecessarily large mental burden on those trying to heal society. The pandemic has undoubtedly left its mark in the minds of people around the world, and we should not expect that mark to fade anytime soon. Given that these concerns are here to stay, the question then arises: what solutions can we implement to ease this ever-increasing anxiety? Experts agree that for those experiencing these worries, gradual re-entry is the most effective and safe method. By taking one step at a time, it is possible to evaluate one’s comfort level at each stage and comfortably navigate the world at that stage. As we move into a new world filled with novel stressors everywhere we go, we join a battle of mental fortitude that calls for everyone to act in society’s favor; it’s a call that everyone must answer together if we hope to return to a “normal” and safer world.

References

1. ​https://www.nature.com/articles/d41586-021-00175-z

2. https://www.ucsf.edu/news/2021/05/420581/feeling-re-entry-anxiety-expert-advice-navigating-covid-19-reopenings

3. https://www.ucsf.edu/news/2021/05/420581/feeling-re-entry-anxiety-expert-advice-navigating-covid-19-reopenings

The Mental Health Pandemic: COVID-19 and the Rise of Telehealth

To some extent, all of us have experienced negative mental health effects from the COVID-19 pandemic, whether that is a clinical diagnosis, the implications of less social interaction and isolation, or job loss. Students and employees all over the world have had to adapt to the new pandemic-world; such radical changes to typical life are bound to have adverse consequences on an individual’s mental health. For instance, the number of adults in the United States that have reported symptoms of anxiety or depressive disorders has increased from 11% to 41.1% [1]. In addition to the worsening of chronic conditions, a survey from June 2020 found that 13% of adults have reported new/increased substance use, 11% have suicidal ideation, and difficulty with eating/sleeping have also increased [1]. Several populations in particular face unique challenges in response to COVID-related lifestyle changes, such as low-income or working parents with school-age children enduring the consequences of school closures and lack of childcare services. Older adults are also exposed to increased mental health issues, namely elevated anxiety and depression levels due to their high vulnerability to severe complications from coronavirus and less social support in place for appropriate safety measures.

Loneliness, even prior to the pandemic, has been associated with reduced lifespan and a greater risk of mental and physical illness. A poll from March 2020 also found that the widespread social isolation from those who followed shelter-in-place orders resulted in more negative mental health effects in comparison to those who did not shelter-in-place [1]. One group particularly impacted by this are young adults (ages 18-24), who have reported symptoms of anxiety and/or depressive disorders at a higher frequency than any other adult age group [1]. Given university closures, loss of income, and reduced access to mental health services, young adults are more likely to experience substance abuse, suicidal thoughts, or exacerbated existing mental illness rates. Children also face unique mental health challenges from the pandemic, such as increased child abuse that is less likely to be intervened upon by educators and community figures, as well as the stress of disrupted routines and decreased social interaction [1]. As such, it is important to acknowledge the disparate ways in which different populations have been and continue to be affected by the pandemic and the critical pre-existing issues in mental health that have been emphasized by such a rapid, global lifestyle change.

Not only has the COVID-19 pandemic amplified mental health issues in all populations, but it has also exposed underlying inequities in psychiatric disorders, health care as an industry, and society as a whole. In particular, communities of color have experienced disproportionate mental health effects during the pandemic, with 48% of non-Hispanic Black adults and 46% of Latino/Hispanic adults reporting anxiety and/or depressive symptoms, compared to the 41% of non-Hispanic white adults [1]. These mental health implications are also paired with higher rates of COVID cases and deaths in Black and Hispanic communities. Within such circumstances, it is important to interpret these rates in the context of systematic oppression against these groups. All of the previously mentioned mental health effects are intensified in these communities while simultaneously having less access to mental health resources and increased financial burden. Furthermore, the important distinction between “essential” and “nonessential” workers has placed a heavy burden on workers in the industries that we deem most critical. Those working in the industries of food and health garner greater risks of contracting the virus and additional stressors, resulting in higher rates of anxiety, depression, substance abuse, and suicidal thoughts [1]. Specifically, frontline health care workers have reported adverse mental health issues and burnout, with physicians experiencing an elevated risk of suicide from the added stresses of working in the pandemic and being exposed to patients with the coronavirus [1]. Finally, with regard to the high rates of job loss coupled with the potential inability to work remotely, low income individuals have also reported significant negative mental health effects. Therefore, in addressing the impacts of mental health in the COVID-19 pandemic, we must consider the disproportionate burden that vulnerable populations endure due to higher exposure/stress and the systematic oppression that intensifies pre-existing disparities. Public health responses and intervention efforts associated with mental health conditions should prioritize racial/ethnic minorities, essential workers, young adults, and unpaid adult caregivers; further policies must address the health inequities that contribute to the impacts that have simply been magnified through the pandemic [3].

As a result of amplified mental health issues in the general population, telehealth counseling appointments have become essential to provide psychological services in the virtual world. This change presents the question: how effective is virtual therapy? Pre-existing limitations to mental health care access, primarily due to a shortage in mental health professionals, have only escalated in the pandemic, so delivering health care remotely has allowed providers to reach more people. Studies have shown that telehealth is just as effective as face-to-face therapy, but with higher retention rates [4]. However, with novel methods of care come additional barriers. In navigating this new form of therapy, providers must ensure that patients have access to comfortable, private, quiet spaces with stable internet access, which may present issues for low-income communities who already face issues receiving treatment. Moreover, clinicians must now master the technology as part of their responsibilities and compensate for the difficulty in picking up nonverbal cues virtually. Even as more people get vaccinated and states begin opening up, telehealth will likely remain to reach more patients and in navigating the psychological impacts that will endure even after the physical pandemic is over.

References

[1] Nirmita Panchal, Rabah Kamal, and Feb 2021. “The Implications of COVID-19 for Mental Health and Substance Use.” KFF, 10 Feb. 2021, www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/.

[2] Abbott, Alison. “COVID's Mental-Health Toll: How Scientists Are Tracking a Surge in Depression.” Nature News, Nature Publishing Group, 3 Feb. 2021, www.nature.com/articles/d41586-021-00175-z.

[3] Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049–1057. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1

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[4] Abrams, Z. (2020, July). How well is telepsychology working? Monitor on Psychology, 51(5). http://www.apa.org/monitor/2020/07/cover-telepsychology

Can COVID-19 Bring Visibility to Women’s Invisible Chronic Illness?

Awaiting medical test results has become a new social norm for patients and non-patients alike as a result of the COVID-19 pandemic. Perhaps for the first time, the weight of these results and their diagnostic labels have given the broader public a glimpse into the world of those who are used to it-- the world of chronic illness patients. While chronic illnesses don’t carry the weight of fearing contagion, they make up for that weight in needing proof to be recognized. Both are entirely reliant on the results to know the impact on their lives. Many chronic illnesses can be referred to as “invisible illnesses'' because they do not present themselves with identifiable presentations or symptoms, and consequently tend to be overlooked both in and out of a healthcare environment. In a New Yorker Article entitled, “What’s Wrong with Me?” by Meghan O’Rourke, who lives with chronic illness, she reports, “A 2004 Johns Hopkins study found that nearly two-thirds of doctors surveyed felt inadequately trained in the care of the chronically ill” [1]. COVID-19 has garnered an entire population’s attention on what it means to be diagnosed and how beneficial effective care can be. In contrast, COVID-19 can also demonstrate the power of when that is missing. However, Chronic COVID Syndrome may just be the means of bridging the gap between effective care and the lack thereof in chronic illness.

Some of the most common chronic illnesses include Lupus, Crohn’s Disease, Lyme’s Disease, fibromyalgia, Hashimoto's thyroiditis, and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), but the number and range of conditions is unknown because of the inability to fully comprehend chronic illness etiology [2]. Frequent symptoms can be physical and/or psychological such as sleep disorders, fatigue, brain fog, depression, and anxiety. These symptoms can arise either as a direct result of the condition itself or may be induced from the difficulty of having to prove the condition’s existence to be acknowledged [3]. These illnesses are persistent and debilitating, and even still, they tend not to garner adequate assistance and resources. Carol Head, who is the President and CEO of the Solve ME/CFS Initiative, described patients who “have been housebound for months, or even years, at a time—in part because their vague, complex, and frustrating symptoms have been down-played, misdiagnosed, or ignored by medical providers” [2]. According to American Autoimmune Related Diseases Association (AARDA), it takes five years on average to get a sufficient diagnosis [1]. Because these illnesses have such an effect on mental wellbeing, they are also closely tied to the discourse of psychosomatic conditions and diagnosis and tend to get viewed as a manifestation of emotional distress [1]. These illnesses often are then written off or not pursued further, a powerful commentary on how emotional distress is addressed in the current health climate and the overall lack of mental healthcare available, but also leaving patients doubting the validity of their physical symptoms.

Interestingly, chronic illness has a far higher prevalence in women. This raises the question of how much the emotional distress and psychosomatic write-offs are linked to a historical writing off of women’s medical symptoms to conditions like “Hysteria” and placing blame on the woman [4]. Virginia Ladd, founder and director of the AARDA explains: “More than 40 percent of women eventually diagnosed with a serious autoimmune disease have basically been told by a doctor that they're just too concerned with their health or they're a hypochondriac” [5]. Meghan O’Rourke states in her article that 75% of autoimmune patients are women, and said that “As it is, many clinicians assume that the patient, who is often a young woman, is just one of the ‘worried well’”. This atmosphere of disbelief, of blaming the mind, of roots to hysteria and the psychosomatic, place these women in a position of self-doubt and losing their grip on their own patient experience. O’Rourke felt, “It wasn’t just the ‘loss of self’ that sociologists talk about in connection with chronic illness, where everything you know about yourself disappears, and you have to build a different life. It was that I no longer had the sense that I was a distinct person”.

While COVID-19 is becoming the basis for what constitutes efficient testing, diagnosing, and recognition as a whole, Chronic COVID Syndrome has had a response much more similar to these other chronic illnesses and experiences like O’Rourke’s. Chronic COVID Syndrome is the condition where patients continue experiencing COVID-19-related symptoms following their actual infection for weeks, months, or without end [6]. Reports of symptoms include brain fog, fatigue, and difficulties with memory and concentration, all of those that seem to be getting overlooked in chronic illness outside of the COVID domain [7]. With patients experiencing this calling themselves the “Long-haulers”, Chronic COVID Syndrome struggled to get validation and consequently became “the first illness created through patients finding one another on Twitter: it moved from patients, through various media, to formal clinical and policy channels in just a few months” [8]. Professor Paul Garner, an infectious disease specialist who has been experiencing Chronic COVID Syndrome explains, “This stuff is real. People are ill. Doctors need to stop diagnosing this as anxiety. We have messed up before, let's not do it again with long term Covid-19 illness” [9]. There is significant attention from all angles on tracking COVID-19 responses, and therefore Chronic COVID Syndrome serves as an example to bring light to the overlooking of invisible illness. While men seem to be experiencing higher mortality rates. women appear to be affected at a higher rate than men for Chronic COVID-19 Syndrome, analogous to other chronic illnesses. Women appear to be experiencing post-viral fatigue at a rate of 2:1 with men [9]. In addition, a study done at Assistance Publique–Hôpitaux de Paris showed a 4:1 ratio of women to men experiencing Chronic COVID Syndrome symptoms [10].

Not having symptoms and experiences believed is extremely detrimental to the mental and physical well-being of patients with chronic illness. Overlooking the validity of these situations continues to perpetuate the stigmatization of mental illness, a lack of attention to women’s health, and is leaving millions suffering with little hope as to how they can recover their selves. COVID-19 has been devastating and Chronic COVID Syndrome continues to be a topic of great stress at how long-term the effects of the pandemic will last, but the increased attention to these aspects of the medical field can lead to significant medical progress. The “Long-Haulers” of Chronic COVID Syndrome are succeeding in bringing attention to the invisible, and if the momentum can carry over to other chronic illnesses, patients may finally feel like their experiences are visible and are actually being seen.

References

[1] O’Rourke, M., Max, D., & Levy, A. (2013, August 9). What's wrong with me? Retrieved April 03, 2021, from https://www.newyorker.com/magazine/2013/08/26/whats-wrong-with-me

[2] Gold, S. S. (2020, March 5). Millions of women are living with "Invisible ILLNESSES": Here's what that means. Retrieved April 03, 2021, from https://www.health.com/condition/autoimmune-disease/invisible-illness

[3] Living with chronic illness. (n.d.). Retrieved April 03, 2021, from https://my.clevelandclinic.org/health/articles/4062-chronic-illness

[4] Gaslighting in women's health: No it's not just in your head. (n.d.). Retrieved April 03, 2021, from https://www.northwell.edu/katz-institute-for-womens-health/articles/gaslighting-in-womens-health

[5] Overlooked or misdiagnosed conditions in women. (2015, February 11). Retrieved April 04, 2021, from https://womenshealth.obgyn.msu.edu/blog/overlooked-or-misdiagnosed-conditions-women

[6] Collins, F. S. (2021, February 23). NIH launches new initiative to STUDY "Long COVID". Retrieved April 04, 2021, from https://www.nih.gov/about-nih/who-we-are/nih-director/statements/nih-launches-new-initiative-study-long-covid

[7] Mayo Clinic Staff. (2020, November 17). Covid-19 (coronavirus): Long-term effects. Retrieved April 03, 2021, from

https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351

[8] Callard, F., & Perego, E. (2020, October 07). How and why patients made Long Covid. Retrieved April 03, 2021, from https://www.sciencedirect.com/science/article/pii/S0277953620306456?via%3Dihub

[9] Jackson, G., (2021, March 09). Covid long-haulers are often Women. maybe it'll change the system's perspective on our pain. Retrieved April 03, 2021, from https://www.nbcnews.com/think/opinion/covid-long-haulers-are-often-women-maybe-it-ll-change-ncna1259686

[10] Davido, B., Seang, S., Tubiana, R., & De Truchis, P. (2020, July 22). Post–COVID-19 chronic symptoms: A postinfectious entity? Retrieved April 03, 2021, from

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(20)30436-5/fulltext