University HealthCare Alliance

September 20, 2020

Stanford Medicine | Sounding the Mental Health Alarm

The psychological distress of living through a pandemic, and how to build resilience

For many Americans, aspects of ordinary life — working in an office, going to school, eating inside a restaurant, hugging a friend — still feel impossibly unsafe. Amid continued uncertainty about when the COVID-19 pandemic will be brought under control, Stanford mental health experts are planning for the psychological fallout of having an entire population under prolonged stress.

“We’ve all been talking about virus surges. What we’ve been preparing for in psychiatry is a surge in mental health problems,” said child and adolescent psychiatrist Victor Carrion, MD, director of the Stanford Early Life Stress and Resilience Program.

Such a surge was well underway as early as March and continues today. In late March, the Kaiser Family Foundation conducted a poll asking American adults whether pandemic-related worries were harming their mental health; 45% said they were. By the end of July, that figure had risen to 53%.

Other indicators, such as more phone calls to hotlines designed for reporting child and domestic abuse, worry experts, too.

The emotional consequences of the pandemic will vary, said Carrion, the John A. Turner, MD, Endowed Professor for Child and Adolescent Psychiatry. Some people are discovering strengths, including the capacity to adapt to the strange circumstances and support their loved ones.

But others are finding their coping skills overwhelmed. This group could experience increases in post-traumatic stress disorder, anxiety and depression, as well as greater rates of substance abuse and domestic violence.

Although the pandemic affects everyone, certain groups are more vulnerable, including the young, older adults, people with pre-existing mental health conditions, individuals adversely affected by racism or gender discrimination, frontline health care workers, and people experiencing economic losses. Stanford psychologists and psychiatrists are using a variety of tactics to help.

What do we know about disasters?

Previous research on the mental health status of those who survive wars, natural disasters and other catastrophes shows that, although they might feel distressed, the majority of people recover without long-term psychological problems. The Stanford experts are seeing this in their day-to-day interactions during the pandemic.

“I’ve been pleasantly surprised by how resourceful people have been,” said Shaili Jain, MD, clinical associate professor of psychiatry and behavioral sciences. “I’ve had conversations with people who I was concerned about, but they are doing well.”

Still, she knows that losses during the pandemic will tip some people from successfully coping into being unable to adapt, with mental health consequences that include PTSD, which is characterized by flashbacks, avoidance of circumstances that resemble the original trauma and emotional numbing.

“I think people have experienced micro-traumas: loss of a way of life, perhaps a job, maybe their perception of how safe and predictable the world is,” she said. “And it happened suddenly. The sudden bit is what I, as a PTSD specialist, associate with a traumatic response.”

Depending on their proximity to a disaster — whether they’re a victim, rescue worker or member of the general population — 5-40% of people will experience PTSD. The number rises to nearly 100% in certain situations, such as among children who witness random acts of extreme violence. Incidences of major depression and substance abuse also increase after a disaster, especially in people who have a history of these conditions.

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