Mental health is a growing concern after the stresses and losses of the COVID-19 pandemic. For many, the pandemic feeds stress over health and finances. It can also exacerbate the challenges of managing underlying anxiety.
Also, the social distancing measures needed to slow the spread of the virus separates the most vulnerable people from their support networks. Our natural wiring to seek comfort from other people, especially during times of stress and fear, is short-circuited by the need to distance.
In the general population, evidence from early COVID-19 studies suggests we should expect elevated levels of anxiety, both through fear of contamination, and the stress, grief, and depression that can be triggered by actual exposure to the virus. Even without exposure to the virus or fear of the virus, anxiety can be compounded by high levels of stress driven by unemployment, lack of social contact, and/or the difficulties that come with working from home.
Findings from China
China is a few months ahead of the United States in terms of the coronavirus. In the province of Hubei, a large segment of the population went into an unprecedented lockdown for 11 weeks. People were not allowed to leave their homes except for essentials. Images on the news showed overwhelmed hospitals and healthcare workers wearing full-body protective gear. Understandably, many people were frightened.
As in Hubei, many Americans have experienced a significant period of quarantine and isolation. Although enforcement in the United States is less rigorous, the quarantine was still unexpected and extremely stressful for many people. In addition, the isolation period may extend for a longer amount of time in the United States.
In China, researchers have had the opportunity to assess the mental health effects of the pandemic on the population in a nationwide survey. Study findings indicate that the pandemic triggered a wide variety of psychological problems such as anxiety, depression, and panic disorder.
Expect different reactions in different subgroups
Research found women were much more likely to experience high levels of stress compared to men, and women were more likely to develop PTSD symptoms.
There were differences found across age groups as well. Individuals aged 18 to 30, migrant workers, and those over 60 reported the highest stress levels. Researchers suspected higher stress levels among the 18 to 30 group may have been a result of high levels of media consumption while those over 60 were experiencing heightened stress due to increased vulnerability to the virus. Migrant workers were likely concerned over a variety of reasons including loss of income.
Unemployment and risk of suicide
The global lockdown measures are causing widespread unemployment. In April, in the United States alone, more than 20 million private-sector jobs were lost and the numbers continue to rise.
Previous research has indicated unemployment can raise suicide rates by 20% to 30%. According to the World Health Organization (WHO), each completed suicide is accompanied by more than 20 suicide attempts.
Given the current global crisis, mental health workers can expect an increase in the number of people in distress and a spike in the number of people expressing a need for services. As a society, we need to increase awareness of mental health issues and develop a better understanding of the link between unemployment and suicide.
How social distancing impacts stress recovery
When we connect to and bond with other people, oxytocin is released in the body. Oxytocin is a hormone associated with touching, love, cuddling, and boding. Oxytocin is also known to be associated with a range of health benefits including aiding in the physiological recovery of psychological stress. For example, oxytocin plays a role in lowering heightened blood pressure, reducing cortisol levels, and encouraging growth and healing.
Many mental health experts have voiced concern over the potential mental health effects of social distancing and isolation during the COVID-19 pandemic. We know isolation is a major risk factor for depression and anxiety. In one study researchers investigating the effects of isolation in mice found lowered oxytocin levels correlated with an increase in depressive and anxious behavior. Once the mice were injected with oxytocin, anxiety and depressive behaviors were reduced.
In humans, researchers have found that while experiencing psychosocial stress, on average, oxytocin levels increase by 51%. While this oxytocin release does not reduce the stress response in the short-term, after a period of time had passed, higher oxytocin levels were associated with faster physiological recovery times from the stress response.
These findings are important in assessing the mental health fallout of COVID-19. One of the dangers of chronic stress is the ongoing reactivity of the nervous system. For some people, it is very difficult to calm themselves when they are experiencing worry or stress. Not only does the mind continue to replay continuous worst-case scenarios, the body is also responding with high cortisol levels. This is concerning as chronic stress can have serious consequences for long-term physical and mental health.
Oxytocin is known to be connected to the sensory system, and studies show that the release of oxytocin is linked to touch. This is likely why many people may automatically be inclined to reach out and pat someone on the hand or hug them in an attempt to provide comfort when they are distressed. In the current environment, this is challenging. Exactly the kind of supportive behavior that would stimulate the release of oxytocin at the time we need it most is severely limited for many people.
Psychological Support during COVID-19
During this period, when hugging and touching is problematic, we can apply other tools that can aid in coping and even stimulate the release of oxytocin in our bodies and the bodies of our loved ones.
Evidence suggests that purely psychological support can trigger the release of oxytocin. This means connecting to others.
For individuals struggling to cope with anxiety, depression, and stress, reaching out to a mental health professional helps. Therapy can not only help you learn good coping strategies to reduce anxiety and depression, but it can also help you reduce conflict in your relationships.
If you are struggling, connecting to others who can support you even if you can’t engage in face-to-face contact is still helpful. Try talking on the phone or using online meeting platforms such as Zoom, Facetime, or Skype. In addition, Telehealth and online therapy offer an opportunity to connect to professionals who can help you reduce your stress levels and recover from the mental health effects of the pandemic.
Choose your support network carefully to select supportive contacts. Reaching out to people who are not supportive or who tend to increase your anxiety will be counterproductive. Reach out to family or friends that can help you reduce your anxiety or set an online appointment with a therapist.
The emotional difficulties triggered by COVID-19 – lockdown, social isolation, and uncertainty – are substantial. Connecting and receiving support may make a greater difference in how you feel than you expect.
- Wind, T. R., Rijkeboer, M., Andersson, G., & Riper, H. (2020). The COVID-19 pandemic: The ‘black swan for mental health care and a turning point for e-health. Internet Interventions.
- Qiu, J., Shen, B., Zhao, M., Wang, Z., Xie, B., & Xu, Y. (2020). A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. General psychiatry, 33(2).
- April 2020 ADP National Employment Report. https://adpemploymentreport.com/2020/April/NER/NER-April-2020.aspx
- Kawohl, W., & Nordt, C. (2020). COVID-19, unemployment, and suicide. The Lancet Psychiatry, 7(5), 389-390.
- WHO Suicide prevention. https://www.who.int/health-topics/suicide#tab=tab_1
- Olff, M., Frijling, J. L., Kubzansky, L. D., Bradley, B., Ellenbogen, M. A., Cardoso, C., … & Van Zuiden, M. (2013). The role of oxytocin in social bonding, stress regulation and mental health: an update on the moderating effects of context and interindividual differences. Psychoneuroendocrinology, 38(9), 1883-1894.
- Han, R. T., Kim, Y. B., Park, E. H., Kim, J. Y., Ryu, C., Kim, H. Y., … & Back, S. K. (2018). Long-term isolation elicits depression and anxiety-related behaviors by reducing oxytocin-induced GAB. Aergic transmission in central amygdala. Frontiers in molecular neuroscience, 11, 246.
- Engert, V., Koester, A. M., Riepenhausen, A., & Singer, T. (2016). Boosting recovery rather than buffering reactivity: higher stress-induced oxytocin secretion is associated with increased cortisol reactivity and faster vagal recovery after acute psychosocial stress. Psychoneuroendocrinology, 74, 111-120.
- Charmandari, E., Tsigos, C., & Chrousos, G. (2005). Endocrinology of the stress response. Annu. Rev. Physiol., 67, 259-284.
- Uvnäs-Moberg, K., Handlin, L., & Petersson, M. (2015). Self-soothing behaviors with particular reference to oxytocin release induced by non-noxious sensory stimulation. Frontiers in psychology, 5, 1529.
- Uvnas-Moberg, K., & Petersson, M. (2005). Oxytocin, a mediator of anti-stress, well-being, social interaction, growth and healing. Z Psychosom Med Psychother, 51(1), 57-80.
© Copyright 2020 GoodTherapy.org. All rights reserved. Permission to publish granted by Fabiana Franco, PhD
The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.