Mental health is one of the biggest pandemic issues we’ll face in 2021

With progress in efforts for Covid-19 vaccines and predictions for when the population will receive them, there seems to be a light at the end of the long, harrowing pandemic tunnel.

As the physical risks are better managed with vaccines, however, what will likely still remain is the indelible impact of the pandemic weighing on the collective psyche.

“The physical aspects of the pandemic are really visible,” said Lisa Carlson, the immediate past president of the American Public Health Association and an executive administrator at the Emory University School of Medicine in Atlanta. “We have supply shortages and economic stress, fear of illness, all of our disrupted routines, but there’s a real grief in all of that.”

“We don’t have a vaccine for our mental health like we do for our physical health,” Carlson added. “So, it will take longer to come out of those challenges.”

Based on the mental struggles endured by so many this year, these are the issues mental health professionals anticipate coming to the fore in 2021.

Burnout and sedentism

Life was stressful before the pandemic, but new challenges have contributed an additional toll. Virtual homeschooling, staying safe, financial hardships, teleworking, keeping up with new information and coping with sickness and death can make life feel like a never-ending game of Whac-a-Mole.

Isolation, which can lead to loneliness, has hit people of all ages. Many children and adolescents have been missing out on opportunities important for social development.

How you manage the stress is crucial to finding respite from the pandemic, Carlson said, and it comes back to the basics. Being safely outdoors and around trees, which Carlson thinks of “as part of the public health team,” can improve your overall health. When you can, take time to wind down and disconnect from the news.

Focusing “on the basics to get sleep, to eat healthy meals, to move throughout the day, to spend time with pets and loved ones” are going to be critically important, she added. “Taking care of ourselves and each other should be everybody’s focus as we go into 2021.”

When the pandemic sabotages sleep

Since more time at home has meant more snoozing for some, the strange “pandemic dreams” people chattered about this year have greater opportunities to pop up, said Dr. Raj Dasgupta, a pulmonary and sleep doctor and an assistant professor of clinical medicine at Keck School of Medicine at the University of Southern California.

Stress, trauma and new challenges are other factors that have led to sleep disturbances and disorders. People on the frontlines of health care, those who witnessed death and individuals who were stuck on cruise ships may experience post-traumatic stress that can lead to insomnia and nightmares. “There are things that you see that are just etched in your mind,” Dasgupta said.

Lack of separation between work and home can mean irregular sleeping patterns. The pandemic “really threw a curveball in our circadian rhythm,” he added.

Also, “many people have been gaining weight,” Dasgupta said. “Weight has always been a risk factor when we talk about things like obstructive sleep apnea.” Sleep apnea has been linked with a higher risk for developing depression and anxiety.

Since sleep quality is linked to mental health, getting enough sunlight for a normal circadian rhythm, developing a sleep routine and practicing relaxation techniques will be crucial in 2021.

Some disorders thrive in isolation

Without support and accountability, some people’s recovery from eating disorders and substance use disorders has hit a wall.

The “collective trauma” people are experiencing “contributes to increased anxiety, depression and other mental health factors commonly associated with eating disorders,” said Chelsea Kronengold, the communications manager of the National Eating Disorders Association, via email.

Challenges have included concern about a lack of structure, more time in a triggering environment and difficulty finding privacy for telehealth sessions and other virtual support. Some people with eating disorders have experienced increased symptoms as well, such as restricting or binging of food, or relapses.

For those who aren’t ready to recover or are still active in their disorders, isolation has been an opportunity to sustain disordered behaviors — a chance for which some may be grateful, while others are distraught.

“Not only do eating disorders thrive in isolation,” Kronengold said, “there is also added anxiety and guilt about the possibility of running out of food and/or having too much food available at all times.”

Drug relapses on opioids have spiked during the pandemic, and rates of substance use disorders could climb as the pandemic continues.

‘We aren’t experiencing these risks equally’

For many, work is another source of mental challenge.

People who can’t shelter and work at home, can’t avoid public transportation or are unable to stock up on food may be taking an additional hit to their mental stability. Some of the fundamentals needed to support mental health are coupled with employment, Carlson said — so job loss can also mean losing your health insurance, child care or paid sick leave.

“We were at risk before the pandemic,” Carlson said. “Communities of color are suffering even more, and there’s a lot we don’t know because there’s a real lack of reporting of race statistics to help us really, truly understand the impact.”

Native American people’s access to mental health services on reservations has further diminished, and things may not improve by the end of 2021, Jacque Gray said via email. Gray is the associate director of the Center for Rural Health at the University of North Dakota, where she is also a research associate professor.

“I know of one tribe where they have had multiple suicides between the ages of 20-40,” Gray added, “leaving children to be raised by grandparents with no supports for counseling for the kids or help for the grandparents.”

Some studies have “found a large increase in depression particularly among Asians,” said Dr. Tina Cheng, the chair of the University of Cincinnati’s department of pediatrics and director of the Cincinnati Children’s Research Foundation. Asian Americans and Chinese Americans have reported experiencing negative mental health symptoms due to pandemic-related racism.

Pandemic-specific impacts on one’s livelihood and well-being are “expected to amplify the already declining mental health in US society,” said Jasmine Mena, an assistant professor of psychology at Bucknell University in Lewisburg, Pennsylvania.

Frontline workers are another group for whom the pandemic is inescapable. Limited personal protective equipment, long workdays, sickness and deaths of patients and colleagues, exposure to Covid-19 and separation from home have worn down many health care professionals. “Even outside of the pandemic, you’re talking about a vulnerable population of people,” said CNN Chief Medical Correspondent Dr. Sanjay Gupta on CNN’s television show “New Day.”

“To come out of the challenges of mental health, we’re gonna need to work together to do that,” Carlson said.

Many people who were gripped by anxiety and depression before the pandemic have experienced their levels of uncertainty, fear and anguish double or worse. Excessive handwashing and fears of contamination can be hallmarks of obsessive-compulsive disorder — now and in the future, some people with OCD may feel comforted by the public’s acceptance of safety behaviors, but also struggle to not become increasingly obsessive.

For some people in the LGBTQ+ community, the pandemic has meant having to shelter in place with people who aren’t accepting of their gender or sexual orientation. Such objection is sometimes expressed through violence, which could continue as the pandemic does. Rates of suicidal ideation are highest among youth in 2020, but especially among young LGBTQ+ people.

“The simple fact is inequity kills,” Carlson said. “We see those unequal things impacting health directly in the pandemic and really shining a light on problems that we knew were there but are much harder to ignore now.”

No longer infected, but still sick

Long haulers are the people who haven’t fully recovered from Covid-19 weeks or even months after they last showed symptoms. In addition to the respiratory and neurological impacts some people experience long after they’re no longer infected with coronavirus, mental effects have lasted as well.

While concerns for psychological distress during the pandemic have mostly focused on anxiety and quarantine measures, one study said, “a second wave of psychological morbidity due to viral illness may be imminent.”

“People expect you to be sick for a certain amount of time and then you get better,” Carlson said. “These long haulers who have gone months of being sick are well beyond their own expectations or others’ expectations of them.

“There’s a real mental health challenge in that,” she added. “It’s really going to cause struggle for them and for their loved ones, and for how they feel that other people feel about them.”

Silver linings of the pandemic

The mental burden of the pandemic has facilitated more honesty and empathy around mental health, which is key to dismantling the stigma that deters some individuals from seeking help.

Another positive is that more people have been either reaching out for help or serving others — whether it’s donating to an important cause, grocery shopping for neighbors or cheering on those who serve the public. Being kind has its own benefits for mental health.

Some people have found solace in telehealth services, a growing trend in receiving care that can be easier and more accessible. And many are picking up hobbies and endeavors — including meditation, gardening, adopting pets and baking bread — that could help make you feel better at times.

“There are definitely things here that are going to exacerbate each other,” Carlson said. “I really hope that above all, this is really the moment when we break down barriers to talking about mental health, because I think the most important thing we can do — as professionals and in our families and in our communities — is to talk about it.

“Every time we talk about public health, we should talk about mental health. And every time we talk about Covid-19, we should talk about mental health.”