COVID-19 is not solely an infectious disease. It’s also the primary cause of rising levels of anxiety and depression.
And for those already suffering from mental health issues, the coronavirus pandemic has brought additional burdens.
“We see a lot more reports of anxiety and depression and just generalized stress,” says Telva Olivares M.D., director of the Medicine in Psychiatry Service at the University of Rochester Medical Center.
Many Americans have felt the pandemic’s effects upon their lives and psyches. According to a Kaiser Family Foundation report, 36.5 percent of adult Americans were suffering symptoms of anxiety or depression in June. By contrast, 11 percent of adults surveyed from January to June last year reported those symptoms. In New York, nearly 31 percent of adults reported symptoms of anxiety or depression.
The pandemic has been associated with anxiety, fear of contracting the disease, depression and insomnia. Social isolation, chronic stress and anxiety exacerbate these feelings. A June study published in the Quarterly Journal of Medicine predicts that the COVID-19 crisis may increase suicide rates during and after the pandemic, and those elevated rates are likely to be present for a long time, peaking after the pandemic abates.
Those already diagnosed with other mental health issues appear to be more vulnerable to these disorders. Anxiety disorders result in symptoms such as repeated episodes of anxiousness, fear or terror; abnormal sweating; and trouble sleeping. Concentrating on tasks can be difficult.
Depression is characterized by a collection of symptoms that includes persistent sadness, a loss of interest or pleasure in normal pursuits, trouble concentrating, and a lack of energy. In some cases, the disorder can generate thoughts of death or suicide. An estimated 15 percent of those diagnosed with severe major depression eventually die by their own hands.
Many factors at play
Several factors can heighten mental health patients’ vulnerability to the pandemic’s psychological ramifications. Most of the 110 clients receiving counseling at St. Joseph’s Neighborhood Center already lack adequate incomes, have suffered physical, sexual and emotional trauma, or carry other personal burdens.
“We see a decent amount of anxiety and depression just as a baseline to many people’s lives,” says Michael Boucher, co-director of counseling and community work at St. Joseph’s.
Patients rendered more vulnerable than normal to infectious diseases by diabetes, heart disease or other medical problems have been particularly worried about the pandemic.
“I think that’s been the biggest stress—fear that they will get the disease, and they have no control of it,” Olivares says.
All but essential employees were forced to stay home while the pandemic raged through the area. Essential workers in positions that involve a lot of personal contact have had to choose between worrying about their health or their finances.
“Do I work? If I don’t, I’m not going to get paid. If I’m not paid, that’s a whole cascade (of problems),” Boucher says.
In addition, patients have had to deal with the social isolation forced upon them by the pandemic and the measures taken to fight it. For months, they were unable to spend time with friends or relatives, or visit the places where they once socialized. Though the Finger Lakes region now has opened up, local therapists say the people they care for are mourning the lives they led pre-coronavirus.
“We’ve been dealing with a lot of patients working through grief and loss,” says Laura Jowly, outpatient manager for behavioral health at Rochester Regional Health’s Clifton Springs Hospital & Clinic.
Pandemic-driven isolation also has deeply affected patients or clients who suffer from drug or alcohol abuse or dependency in addition to their psychological issues. Unable to meet with their sponsors or the support groups upon which they rely—such as Narcotics or Alcoholics Anonymous—they’ve struggled to stay away from the substances to which they once turned at difficult times. Robert Biernbaum D.O., chief medical officer at Trillium Health, has watched some of his mental health patients lose those struggles.
“During a time of significant stress, people will go back to what they know, what works for them,” Biernbaum says. “We’ve had an increase in relapse during the pandemic.”
Delivering care differently
Treatment providers’ responses to the pandemic cut most patients off from another source of face-to-face contact.
“For a short time at the beginning, in the middle of March, outpatient clinics came to almost a grinding halt, in terms of face-to-face (therapy),” says Joe Majauskas, director of behavioral health for Clifton Springs and for RRH’s Newark-Wayne Community Hospital.
Instead, local institutions began conducting most or all outpatient therapeutic sessions remotely.
“We were able to move pretty quickly to telephone visits, but then to virtual visits through our Zoom platform,” Olivares explains.
Some therapists do meet with outpatients in person when necessary, but take precautions to avoid transmitting or contracting the virus. URMC’s mental health patients don masks for face-to-face sessions, and the professionals who treat them wear masks and either face shields or goggles. At one time, therapists at the Clifton Springs Hospital “met” with patients on site, but electronically.
“People could come in here, but they wouldn’t sit in the same room with a provider,” Majauskas says.
Instead, the provider would sit in another room at the hospital, and conduct the therapeutic session digitally over its telehealth system.
Inpatient mental health care also has changed. URMC tests incoming mental health patients for the coronavirus before they arrive at inpatient units. Those who test positive are placed in a special unit to reduce the risk of virus transmission. All the inpatient floors take measures to reduce the risk of spreading the coronavirus.
The shift to remote counseling has come with costs. All patients haven’t been able figure out how to participate in online sessions.
“Some folks who are a little older in age, we’re finding that they have more difficulty with technologies,” Majauskas explains.
Others do not have access to the smartphones or computers required to obtain therapy over the internet, and telephone sessions don’t always suffice.
“You lose, in the telephone visits, that ability to see how somebody’s behaving or acting,” Olivares says.
Even patients who have the equipment and knowledge needed to obtain therapy online might not be able to do so due to privacy concerns.
“If they’re living with too many people, some of the stuff they need to talk about they can’t, because someone is right there,” Boucher explains.
A patient who’s suffering domestic abuse could be in danger if discovered talking to a therapist.
Finally, remote treatment just doesn’t work as well for certain patients as meeting with their therapists in person.
“They really did miss that, and I do think that did contribute in some cases to them not doing well, and needing to come in to be hospitalized,” says Sue DiGiovanni M.D., associate chair of clinical service in URMC’s Department of Psychiatry.
A silver lining
While remote mental health treatment has created hurdles to care, it also has presented advantages. Distance hasn’t prevented Boucher from therapeutically bonding with his clients.
“Telehealth has presented a surprising ability for me to connect and, I think, for the person I’m speaking with to feel connected to me,” Boucher says.
Patients also value being able to talk to their therapists from the comfort of their own homes.
“We have patients who have significant social anxiety, and they actually appreciate the social distancing,” Biernbaum says.
Social distancing and other safety measures have helped reduce new coronavirus infections in the Finger Lakes region, driving them down from a high of 49.45 per 100,000 population on April 9 to 3.85 on July 15.
As the pandemic recedes, mental health treatment providers are taking steps to safely see more patients in person again. At the same time, they plan to continue offering telehealth visits.
“We can also deliver health care virtually, and we can do it really well,” Biernbaum says.
That doesn’t mean the people who have spent more than five months helping patients or clients get through the pandemic will forget the experience anytime soon.
“We’ve had patients who’ve passed from this, and seen patients struggle with their own issues during the pandemic,” Biernbaum says. “We bring these things home.”
Mike Costanza is a Rochester Beacon contributing writer.