“I was doing fine at the beginning, but now I am overwhelmed by stress.” “I worry about money and my kids. I can’t sleep. It never ends.” 

These are just some of the quotes we have heard on a daily basis since the COVID-19 pandemic arrived and altered our lives.

While the world has experienced horrific events — natural and human-made disasters, and pandemics such as the bubonic plague and the 1918-20 influenza pandemic (Spanish flu) — the COVID-19 pandemic poses extraordinary challenges to our mental health and well-being.

Most natural and human-made disasters are singular and localized events that have long-lasting effects on those people and communities directly impacted. Most survivors recover, but those with intense exposure, low socio-economic status and/or loss of home and community are at greater risk.

Common issues include: drug and alcohol dependence, depression and post-traumatic stress disorder (PTSD). Importantly, human-perpetrated violence is more likely to cause mental health issues (particularly PTSD). While understudied, prolonged or complicated grief related to loss of life and loss of resources is also common. Another unfortunate finding is the apparent increase in the rates of interpersonal violence, child maltreatment and suicide post-disaster.

HOW ARE PANDEMICS DIFFERENT FROM OTHER DISASTERS?

Pandemics differ from other disasters in that they generally affect a larger number of people, threat to life is prolonged, and illness and mortality come in waves, not all at once. There is an erosive effect due to the constant and prolonged exposure to stress.

Although there have been recent pandemics such as Ebola and the “swine flu,” not since the Spanish flu has the United States experienced such widespread and virulent contagion. About 28% of the U.S. population was infected with the Spanish flu, with 0.81% dying. Unfortunately, there is little information regarding its mental health impact, except for some relevant data from Norway, where there was a 7.2-fold increase in first-time asylum admissions over a 6-year period post-pandemic. Symptoms described included sleep disturbances, depression, mental distraction, dizziness and difficulties coping at work. Furthermore, there were upsurges in cases of neurologic illness among a group of patients in recovery.

HOW IS COVID-19 DIFFERENT FROM PREVIOUS PANDEMICS?

While the Spanish flu offers a glimpse of a pandemic’s impact, today’s world is quite different:
• In 1918, most people lived on farms or in small towns, and industry was in its early stages.
• Little was imported from overseas. 
• Death from infectious disease was common, and epidemics were frequent. 
• People did not expect physicians to cure them; we had no antibiotics, diagnostic testing or ventilators.
• We didn’t have public health science which informs stay-at-home orders or disinfection protocols.
• People died surrounded by loved ones, further spreading the flu. 
Our current medical knowledge will greatly limit the number of deaths, while possibly making us more vulnerable to mental illness. The enormous stress of caring for the ill, social isolation, and financial decline only add to our burden and risk for psychiatric sequelae.

WHAT YOU CAN DO TODAY

Luckily, we know a great deal more about how to cope with this inordinate stress and there is ample access to resources. We know that teamwork and maintaining social connections are powerful stress inoculators. There are tools we can use to calm ourselves and limit our stress response, and we know much more about the importance of sleep and how to improve it.

Although the risks to our mental health are high, with stress management skills and early identification and intervention for depression and other stress-related disorders, we can limit the number and severity of mental health morbidities.

Steven Berkowitz, MD
Professor, Department of Psychiatry
Director, START Center
University of Colorado Anschutz Medical Campus

Mind the Brain Podcast #1

REFERENCES

1. Shear MK, McLaughlin KA, Ghesquiere A, Gruber MJ, Sampson NA, Kessler RC. Complicated grief associated with hurricane Katrina. Depress Anxiety. 2011;28(8):648–657. doi:10.1002/da.

2. Rezaeian M. The association between natural disasters and violence: A systematic review of the literature and a call for more epidemiological studies. J Res Med Sci. 2013;18(12):1103–1107.20865

3. Noymer A, Garenne M. The 1918 influenza epidemic's effects on sex differentials in mortality in the United States. Popul Dev Rev. 2000;26(3):565–581. doi:10.1111/j.1728-4457.2000.00565. 

4. Mamelund SE. The Impact of Influenza on Mental Health in Norway, 1872-1929. Workshop. May 2010. Carlsberg Academy, Copenhagen, Denmark.https://pdfs.semanticscholar.org/7276/25455394eab84386133b95cc97909017213f.pdf. Accessed April 18, 2020.

5. Mamelund SE. Effects of the Spanish Influenza Pandemic of 1918-19 on Later Life Mortality of Norwegian Cohorts Born About 1900. Working Paper October  2003. https://www.researchgate.net/publication/5097223_Effects_of_the_Spanish_Influenza_Pandemic_of_1918-19_on_Later_Life_Mortality_of_Norwegian_Cohorts_Born_About_1900. Accessed April 19, 2020. 

6. Henry J, Smeyne RJ, Jang H, et al. Parkinsonism and Neurological Manifestations of Influenza Throughout the 20th and 21st Centuries. Parkinsonism & Related Disorders. 2010;16:566-571.

Mind the Brain CME Information: 
CME Survey for the April 28, 2020 Edition

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