According to a study in The Lancet, symptoms of post-traumatic stress, anger and heightened stress may come as side effects of the nationwide quarantine, and they may be long-lasting. Stressors for symptoms of poor mental health include lack of resources (medical and otherwise), extended quarantining, fears surrounding the virus, monetary loss, stigmatization of the illness and boredom. Lack of information and quarantining with no end in sight are also risk factors for declining mental health.
Health workers putting in long, grueling hours are heavily affected.
But COVID-19 is unique in the high degree to which it also affects Americans behind the front lines. A study conducted by the Journal of the American Medical Association (JAMA) Network warns that, while the need for social distancing guidelines in this country is quite apparent, the effects of social isolation and being homebound could contribute to heightened suicide and overdose rates in the United States.
According to the Centers for Disease Control and Prevention, racial minorities, particularly black and Hispanic people, are more likely to live in densely populated areas due to the effects of institutional racism and/or housing segregation.
Because of this, they may have a harder time socially distancing.
Almost a quarter of black and Hispanic workers are in the service industry or employed by businesses deemed essential during the quarantine, meaning they’re at higher risk of coming into contact with the virus.
These factors, combined with the healthcare disadvantages racial minorities face due to decreased access, could in part explain why black and Hispanic Americans are disproportionately affected and killed by COVID-19. The CDC said it is working to address these racial disparities, according to its page, COVID-19 in Racial and Ethnic Minority Groups.
Tanya Shah, vice president of the Commonwealth Fund, said that isolation isn’t just a social issue, but something that affects mental and physical health as well. She started researching social isolation, particularly in adults, about three years ago, and the Fund has been working to raise awareness of this issue in terms of policy, research and screening ever since.
Isolation has a large impact on mortality and morbidity, according to Shah.
“We need to be paying attention to social isolation,” Shah said in an interview with Capital News Service. “Just like we ask if you’re a smoker or how many drinks you have a week, we need to be asking about your social structural context, because it has such a tremendous impact on health or vice versa. How your health changes has a huge impact on how you’re able to connect with others.”
Lack of social connection and a solid support system can contribute not just to mental health conditions like depression and anxiety, but also to cardiovascular risks and decreased cognitive and physical function. These risk factors overlap a lot with those of COVID-19, Shah said.
“Social isolation really means… a structural construct of being alone,” she said. “Not everyone who is socially isolated would say they’re lonely…Loneliness is more that perception of being isolated, but they’re very interrelated.”
This isn’t to say that isolating isn’t essential to flattening the COVID curve. Shah said that elderly, poor and sick people are the most at risk of contracting the virus because they’re more likely to live in intergenerational dwellings or to have to continue working to provide for the family.
The 44% of women over 75 living alone and the 50% of low-income people who report suffering from loneliness are at a higher risk of suffering from social isolation, Shah said.
One in four non-institutionalized older adults report feeling socially isolated. Together, these groups constitute tens of millions of Americans, according to Shah.
When social distancing and the subsequent loss of social support are added into the equation, these individuals are more at risk for serious health issues and 25% more at risk dying prematurely.
Shah said some research indicates that being socially isolated, whether from a group a person was once active in, like a church, or from loss of contact with healthcare providers, can be as or more harmful to health than smoking, obesity or physical inactivity.
Isolation-related illnesses also are not confined to the most at-risk groups.
“To be honest, we have not, in modern scientific history, experienced a pandemic of this proportion with these types of measures of physical distancing and social isolation and sheltering in place,” Shah said.
There are some hints from past pandemics, though.
A couple of studies done on SARS survivors a year after the 2003 outbreak found evidence of still-elevated levels of stress and psychological distress, especially among healthcare workers.
Quarantined Liberians during the Ebola epidemic from 2013 to 2016 said stigma related to the illness led to the exclusion and disenfranchisement of minority groups in the country. Many who were quarantined may have avoided seeking medical help for treatable, non-Ebola-related illnesses out of fear of further stigmatization, according to The Lancet.
Mental health has long been under-resourced in this country, according to Shah, who added that benefits should be expanded to pay for these types of services.
“Mental health services need to play a much bigger role in our response efforts as well as in our rehabilitation in the longer term post this pandemic…The research shows it’s a long-term impact, not just the six weeks or the three months that we have to be socially isolated,” Shah said. “We definitely need to be doing more.”
Abiding by social distancing guidelines doesn’t mean people have to be lonely, experts say. There are some precautions people can take in order to care for themselves in the short term, but larger, more systemic changes must take place to deal with bigger picture issues presented by the pandemic.
Go for walks, FaceTime friends, or talk to neighbors (from a safe distance), experts recommend.
The Washington State Department of Health recommends that individuals struggling with anxiety, depression or other symptoms of poor mental health should avoid watching distressing news coverage of the virus when possible.
Health experts also advise people to structure their days and keep to a routine, especially those who are prone to depression or anxiety. The more life in quarantine reflects normal life, the better, they say.
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