COVID: severe psych, substance use problems

 i mentioned the CDC report of the increased psych and substance use problems currently in my last blog (see http://gmodestmedblogs.blogspot.com/2020/08/covid-transmission-and-distancing.html ), but given how striking the effects of Covid-19 are on the general population, i thought it would be important to review this report in more detail. see https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm or https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6932a1-H.pdf for the CDC report

Details:

--survey done june 24-30, 2020

--5470 respondents: 51% female, 13% 18-24yo/35% 25-44yo/35% 45-64yo/17% >65yo, 63% white/12% black/5% asian/16% hispanic, household income mostly $25-200K, education mostly high school to professional degree, 63% employed with 33% of them essential workers, 89% urban, 20% knew someone with covid-19/8% knew someone dying from covid-19

--prior depression 10%, prior anxiety 10%, prior PTSD 5%

Results:

--41% of US adults reported struggling with mental health or substance abuse:

    --anxiety/depression: 31%

    --started or increased substance use: 13%

    --trauma/stressor-related disorder symptoms: 26% (this was related directly to the pandemic)

    --seriously considered suicide: 11%, highest in those 18-24yo (26%!!!), in minority racial/ethnic groups (about 16%), and those self-identified as essential workers (22%)

--these symptoms were not significantly more common in essential workers than others, when adjusted for gender, employment status, and unpaid adult caregiver status

--by subgroup analysis, at least 50% of the following had at least 1 mental or behavioral health symptom:

    --those 18-24yo (75%!!!)

    --25-44yo (52%)

    --hispanic ethnicity (52%)

    --less than high school diploma (66%)

    --essential workers (54%)

    --unpaid caregivers for adults (67%)

    --those reporting prior treatment for depression (67%)

    --those reporting prior treatment for anxiety (73%)

Commentary:

--these are astoundingly high numbers, reflecting the wide-spread societal impact of Covid-19, including to those having no personal contact with people having Covid-19

--the prevalence of anxiety and depression are 3-fold and 4-fold (respectively) the rates found in the second quarter of 2019

--many of the unpaid caregivers of adults (very high psych risk, as noted above) are likely taking care of people at particularly high risk of more severe Covid-19 cases

--this survey does not include the reported increases in domestic violence or sexual abuse associated with Covid-19

limitations:

--self-reported (and not clinically validated) responses to the questions

--this was web-based survey, likely explaining the skew of the sample (more wealthy, more educated, and more urban), and may not adequately reflect the general population

so, the implications of these results for us are quite profound:

--there are widespread very dangerous social/clinical implications of Covid-19 that extend beyond the virus itself: we as clinicians have often been so involved with Covid testing, talking about social distancing/PPE/mask wearing/hand washing that we may be missing the many peripheral sequelae of Covid on the broader society

--and the reinforcing of the social isolation required for controlling the pandemic is undoubtedly exacerbating the adverse psych effects (ie, all that we are needing to do as a society to contain the pandemic are leading to profound social disruptions in all aspects of life, and these large-scale life changes have profound adverse psychological effects)

--so, what are we to do???

    --we really do need to pay more attention to the psychological state of our non-Covid patients (ie, ask about how they are doing), and help them through this remarkably difficult and disruptive time. including by the use of counseling and meds as appropriate

    --we should probably reinforce the importance of getting out of the house and going for regular walks/getting exercise, though of course in a safe way with appropriate distancing

    --we should encourage our communities to set up venues for people to get out of their home confinements/isolation more, venues that are safe but fulfill some of peoples' social needs. some of these interventions might be doable at home (zoom-type meetings that are geared to the specifics of the patients: eg, for people who attended now-closed senior day programs, perhaps having organized zoom programs that allow for interaction with their former buddies, maybe with culturally-appropriate films/music/even dancing). some may be at community centers with appropriate distancing/safety. These types of activities should be a societal imperative: people need to be taken care of in these very trying times.

    --and, we should hope really really hard for an effective and safe vaccine.....

geoff

 

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