Research Continues to Reveal the Ongoing Impact of COVID-19 on Mental Health and Other Health Complications

By Yvette C Terrie, BS Pharm, RPh, consultant pharmacist

It’s over one year later and COVID-19 is still part of all of our lives. Great strides have been made in learning more about the transmission, prevention and treatment of COVID-19. Moreover, many individuals are trying their best to get back into daily routines and establish some degree of normalcy while still practicing preventative measures. The approval and distribution of vaccinations have offered the world a glimmer of hope, but there are still no real answers as to when life will return to what we all once knew. The ongoing pandemic has affected everyone in varying degrees and the challenges during this pandemic including social isolation and lockdowns early during the pandemic impacted individuals across the globe and this new way of life still takes a mental toll on individuals from all walks of life. In a 2020 report released from Express Scripts entitled, “America’s State of Mind Report”, the number of prescriptions filled per week for antidepressant, anti-anxiety and anti-insomnia medications augmented 21% between February 16 and March 15, peaking the week ending March 15, when COVID-19 was declared a pandemic.¹ The report also revealed that the highest surge was in prescriptions for anti-anxiety medications, which escalated 34.1% from mid-February to mid-March, including a week-over-week increase of approximately 18% during the week ending March 15 and the number of prescriptions filled for antidepressants and sleep disorders increased 18.6% and 14.8%, respectively, from February 16 to March 15.¹

In conversations with various health care providers in several settings during the pandemic, many have experienced and continue to experience high levels of stress and anxiety at times. They have also witnessed heightened levels of stress and anxiety in many of their patients. Numerous HCPs also believe that this novel virus will never be fully eradicated and will probably circulate like the influenza virus. Several also think that measures such as the availability of approved vaccines, wearing masks and continuing to practice infection control measures are still the best defenses against this relentless virus especially until FDA approved therapies become a reality. Through ongoing research, health experts are continually learning more about this novel virus every day. Researchers are also understanding more about the physical and psychological impacts associated with the COVID-19 pandemic. Examples of these findings can be found below in summaries of some recent publications that explored the impact of the pandemic on mental health.

• In a recently published  retrospective cohort study and time-to-event analysis in The Lancet Psychiatry journal, Taquet et al analyzed clinical data from more than 236,000 COVID-19 survivors focused on 14 neurological and mental health disorders. ² The study revealed that at least 33% of COVID-19 survivors ages 10 and over experienced some degree of neuropsychiatric conditions like anxiety, depression, and even brain hemorrhage in the 6 month time frame after contracting the novel virus. The researchers also indicated that an estimated 13% of patients received these diagnoses for the first time.  Researchers discovered that the most common neuropsychiatric illnesses in recovered COVID-19 patients were on the milder side—17.4% experienced an anxiety disorder, and 13.7 % a mood disorder, substance abuse disorders in 7% and insomnia in 5%. ² By contrast, 2.1 % experienced ischemic stroke, and 0.7% experienced dementia.  Among patients  who had to be admitted to an intensive care unit, 7% experienced ischemic stroke and 1.7 % experienced dementia. They also revealed that when compared to patients with influenza , COVID-19 patients were 44% more likely to experience mental or neurological illness in the 6 months of having the infection. ²
• Another study published in The Lancet Psychiatry revealed that rates of maternal depression and anxiety have risen during the COVID-19 pandemic compared with prior estimates.³ Results revealed more women had clinically significant depression (35.21%) and anxiety symptoms (31.39%) at the COVID-19 impact survey timepoint compared with all previous timepoints of data collection. They also reported larger increases in depression and anxiety symptoms among women with income disruptions, difficulty managing homeschooling and work responsibilities and those with trouble getting childcare.³
• In a study published in the journal, Psychological Medicine , researchers attempted to explore meta-analytic global levels of depression and anxiety during the COVID-19 pandemic and how the implementation of mitigation strategies (i.e. social distancing, public transportation closures, stay-at-home orders, etc.) impacted such disorders.⁴ They revealed that in total, 226, 638 individuals were evaluated within the 60 included studies. Global prevalence of both depression and anxiety during the COVID-19 pandemic was 24.0% and 21.3%, respectively.⁴ There were variations in the incidence of both anxiety and depression reported across regions and countries. Asia (17.6% and 17.9%), and China (16.2% and 15.5%) especially, had the lowest prevalence of both disorders. With regard to the impact of mitigation strategies on mental health, only public transportation closures heightened the incidence of anxiety, especially in Europe. ⁴
• A publication in the journal Psychiatry Research revealed that the COVID-19 pandemic severely impacted the mental health of young people, with heightened levels of clinical depression being identified in this study.⁵ Researchers from the University of Surrey surveyed 259 young individuals pre- pandemic (autumn 2019) and in the midst of initial lockdown measures (May/June 2020) on their levels of depression, anxiety, wellbeing, alcohol use and sleep quality. Researchers discovered evidence of a considerable impact on the mental health of these young adults due to the pandemic, with a substantial increase in depression symptoms and a decrease in overall wellbeing during lockdown compared to the previous autumn.⁵ Levels of clinical depression in those surveyed were found to have more than doubled, escalating from 14.9% cent in autumn 2019 to 34.7 % in May/June 2020.⁵ The authors noted that findings from this study emphasize the significant impact of the COVID-19 pandemic on young people's mental health. ⁵
• A publication in the Journal of Advanced Nursing examining the degree of burnout among nurses and the related factors during the pandemic revealed that  overall prevalence of emotional exhaustion was 34.1% , depersonalization was 12.6% and lack of personal accomplishment was 15.2%.⁶ The key risk factors that augmented nurses' burnout were the following: younger age, decreased social support, low family and colleagues readiness to cope with COVID‐19 outbreak, amplified perceived threat of COVID-19, longer working time in quarantine areas, working in a high‐risk environment, working in hospitals with inadequate and insufficient material and human resources, increased workload and lower level of specialized training regarding COVID‐19.⁶

The findings of the aforementioned studies clearly illustrate the psychological, emotional, physical and social impacts that COVID-19 has had on individuals across the globe. Mental health issues including anxiety disorders and depression have surged among many individuals including health care providers and young people. It is important that awareness about mental health is expanded and that those affected are not afraid to seek the help that they need. Health care providers can be instrumental in recognizing and helping patients suffering with mental health issues via keeping the lines of communication open and providing patients with encouragement and support. They can also direct them to reputable patient resources to get the care that they need to improve their overall health and quality of life.

References:

1. America’s State of Mind Report. Express Scripts website. Published April 16, 2020. Access April 9, 2021. https://www.express-scripts.com/corporate/americas-state-of-mind-report
2. Taquet M, Geddes J, Husain M. Luciano S, Harrison P. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. The Lancet Psychiatry. Published: April 06, 2021. DOI:https://doi.org/10.1016/S2215-0366(21)00084-5.
3. Racine N, Hetherington E, McArthur BA, McDonald S, Edwards S, Tough S, Madigan S. Maternal depressive and anxiety symptoms before and during the COVID-19 pandemic in Canada: a longitudinal analysis. Lancet Psychiatry. 2021 Mar 24:S2215-0366(21)00074-2. doi: 10.1016/S2215-0366(21)00074-2. Epub ahead of print. PMID: 33773109.
4. Castaldelli-Maia JM, Marziali ME, Lu Z, Martins SS. Investigating the effect of national government physical distancing measures on depression and anxiety during the COVID-19 pandemic through meta-analysis and meta-regression. Psychol Med. 2021 Mar 2:1-13. doi: 10.1017/S0033291721000933. Epub ahead of print. PMID: 33648613; PMCID: PMC7985907.
5. Simon Evans, Erkan Alkan, Jazmin K. Bhangoo, Harriet Tenenbaum, Terry Ng-Knight. Effects of the COVID-19 lockdown on mental health, wellbeing, sleep, and alcohol use in a UK student sample. Psychiatry Research, 2021; 298: 113819 DOI: 10.1016/j.psychres.2021.113819.
6. Galanis P, Vraka I, Fragkou D, Bilali A, Kaitelidou D. Nurses' burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis. J Adv Nurs. 2021 Mar 25. doi: 10.1111/jan.14839. Epub ahead of print. PMID: 33764561.