Introduction

The COVID-19 pandemic has exacerbated several known risk factors for mental health issues, unsurprisingly causing a spike in symptoms of depression and anxiety and exacerbating existing mental health conditions. Such risk factors for mental health issues include, but are not limited to, uncertainty and fear of the future, economic instability, social isolation, physical inactivity, and decreased access to basic services like food and healthcare. In a National Health Interview Survey from January-June 2019, 8 percent of adults reported symptoms of anxiety disorder, 6 percent reported symptoms of depressive disorder, and 11 percent reported symptoms of one or both in the last fourteen days. A similar survey that began on April 23, 2020 in attempts to rapidly monitor changes in mental health as a result of COVID-19 shows a dramatic increase in symptoms of anxiety and depression compared to 2019 data; during the week of April 23, 2020—around the time of extremely high COVID-19 death rates in the United States— nearly 31 percent of respondents reported symptoms of anxiety disorder, 23.5 percent reported symptoms of depressive disorder, and 36 percent reported symptoms of one or both in the last 7 days. Since the height of the pandemic in late April and early May 2020, the reported frequency of mental health symptoms has wavered, dipping to relative low points in early June, but increasing again during the week of July 9, likely following another spike in COVID-19 cases in the United States.

Certain populations are more vulnerable than others to both the clinical symptoms of the COVID-19 pandemic as well as the negative mental health outcomes, and the decreased access to mental health services following business and university campus closures is only exacerbating the problem.

Vulnerable Populations

College students
In attempts to limit the transmission of coronavirus, many college campuses closed their doors and sent students home in the middle of the spring 2020 semester, affecting at least 14 million students according to one estimate.[i] As a result of campus closures, many college students have faced unprecedented circumstances that have negatively affected their mental health and wellbeing. Based on survey data from the Healthy Minds Network for Research on Adolescent and Young Adult Mental Health and the American College Health Association, two-thirds of college students report the pandemic has caused them increased financial stress, and nearly 36 percent have been required to move to a new living situation. Compared to the Fall 2019 semester, students report increased depressive symptoms in the period from March-May 2020.[ii] Additionally, there was a significant increase in the number of students reporting that mental health symptoms impaired their academic performance.[iii] Despite the increased prevalence of depression and other mental health symptoms, 60 percent of college students reported that the COVID-19 pandemic made it harder to access mental health care—driven by campus closures, which limited on-campus mental health services.[iv]

College campuses are prime breeding grounds for the spread of COVID-19 thanks to the close social contact in dorms, classrooms, dining halls, and athletic training facilities. One study conducted by Cornell University sociology professors estimates that by the time the average Cornell student runs through their class schedule once, they have potentially shared a classroom with up to 530 other students. With no on-campus intervention, this same study estimates that the number of people infected could double every 2.2 days.[v]  Such conditions made it difficult for schools to decide whether or not to open campuses in the fall, with some making decisions late in the summer months, causing further uncertainty and anxiety for students about the conditions of their upcoming semester.

Elderly
Another particularly vulnerable population to increased mental health symptoms as a result of COVID-19 social distancing guidelines is the elderly. Older adults are more likely than other groups to experience severe symptoms of COVID-19, making the need to social distance more important, but unfortunately limiting familial and caregiver interactions. Furthermore, according to the Kaiser Family Foundation, older adults are already at risk of poor mental health, even without the added stress of a global pandemic, due to common feelings of loneliness and grief.[vi]

Similar to college campuses, nursing homes and long-term care facilities are prime breeding grounds for COVID-19 transmission because of the shared residential spaces, as well as bathrooms, and dining halls.[vii] In addition to the challenges of caring for particularly vulnerable individuals with underlying health conditions, staff members in nursing homes often work in multiple residences, further increasing the risk of infection across facilities.[viii] Long-term care facilities should prioritize access for mental health providers when considering infection control measures, considering telehealth alternatives if in-person services are deemed unsafe.[ix]

An Opportunity to Reimagine Mental Health

On a brighter note, many researchers view the COVID-19 pandemic as a way to highlight failures of existing healthcare delivery systems, and encourage the use of more sustainable and equitable mental health practices.[x] Proposed options often focus on rethinking conventional therapy through the use of telehealth and home-based treatment, and addressing health disparities, particularly for those who have been disproportionately affected by the pandemic. Vikram Patel, psychiatrist, Professor of Global Health at Harvard Medical School, and leader of the Mental Health Innovation Network, suggests three initiatives for transforming mental health care around the world in response to COVID-19, which would transform the mental health workforce, global mental health peer networks, and common core mental health metrics.[xi] From an economic perspective, investing in mental health will produce long-run benefits in the form of healthier societies and happier, more productive individuals.

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[i] https://www.cnbc.com/2020/03/26/how-coronavirus-changed-college-for-over-14-million-students.html

[ii] https://www.insidehighered.com/news/2020/07/13/survey-finds-higher-prevalence-depression-among-students-and-difficulties-accessing

[iii] https://www.insidehighered.com/news/2020/07/13/survey-finds-higher-prevalence-depression-among-students-and-difficulties-accessing

[iv] https://www.insidehighered.com/news/2020/07/13/survey-finds-higher-prevalence-depression-among-students-and-difficulties-accessing

[v] https://www.marketwatch.com/story/how-covid-19-could-spread-on-college-campuses-will-students-be-safe-2020-06-29

[vi] https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/

[vii] https://ctmirror.org/2020/04/22/nursing-homes-prove-ideal-breeding-ground-for-the-coronavirus-pandemic/

[viii] https://ctmirror.org/2020/04/22/nursing-homes-prove-ideal-breeding-ground-for-the-coronavirus-pandemic/

[ix] https://www.mcknights.com/marketplace/tips-to-ensure-your-residents-mental-health-needs-are-met-during-the-covid-19-pandemic/

[x] https://www.thelancet.com/action/showPdf?pii=S2215-0366%2820%2930307-2

[xi] https://www.health.harvard.edu/blog/global-mental-health-in-the-time-of-covid-19-2020061620194

[ix] https://www.health.harvard.edu/blog/global-mental-health-in-the-time-of-covid-19-2020061620194