Pandemics & outbreaks: the mental health side

Fear of infection and of possibly contaminated surfaces was one of the most common pandemic worries researchers measured.

Some caution is healthy and protective. It becomes heavy when it takes over your day or keeps growing even when the risk is low.

Fears about the economic effects of a pandemic formed their own cluster of stress in research.

SAMHSA lists time off work, lost income and job security, and trouble getting groceries and basics among the most common worries during an outbreak.

Compulsive checking and reassurance-seeking about pandemic threats was another pattern researchers found.

Checking can calm worry for a moment, but often makes it come back stronger. SAMHSA suggests staying up to date while limiting news, since around-the-clock coverage tends to raise anxiety.

Researchers also measured fear of outsiders who might spread infection. This kind of fear can turn into unfair blame of whole groups.

The section “Stigma, blame & fear of others” in this guide looks at how that harms people and what helps.

Some people had nightmares and intrusive thoughts about the pandemic. These traumatic stress reactions were another cluster in research.

SAMHSA advises reaching out to a clinical provider if reactions like these last 2 to 4 weeks or more.

Worrying about people who could get very sick is natural. It shows how much you care.

SAMHSA also names worry about caring for children or others who depend on you as a common outbreak stress.

Infectious illness spreads in ways no one can fully control. Getting sick, or passing it on, is not a moral failing.

If guilt stays heavy, especially after a loss, the “Survivor’s guilt” guide in this app may help.

SAMHSA lists anger about being exposed through other people’s negligence among typical reactions.

Anger is a normal signal that something felt unfair. Naming it, moving your body, or talking it through can help it pass without harming relationships.

Media coverage can make the danger feel closer than it is. SAMHSA suggests looking to credible sources and avoiding news 24/7.

A WHO review found misinformation in up to 28.8% of social media posts about COVID-19.

WHO names loneliness and isolation as key reasons mental health worsened during COVID-19. Isolation limited people’s ability to work, lean on loved ones and take part in community life.

A major review of quarantine research found boredom and frustration were common stressors, along with longer time apart.

SAMHSA lists boredom and frustration about not being able to work or do daily activities among typical reactions.

The National Child Traumatic Stress Network notes that outbreaks can disrupt routines and important life events for families.

Missing these moments is a real loss. It’s okay to grieve them, even if others had it harder.

One year into the COVID-19 pandemic, 2 in 3 U.S. adults said they were sleeping more or less than they wanted.

Being absent during a loved one’s final moments was one of the hardest parts of pandemic loss for many families.

If you couldn’t be there, it was not because you didn’t love them. Writing a letter, recording a message, or sharing memories can help say what was left unsaid.

A review of research on funerals found the benefit of rituals depends on whether people can shape them and say goodbye in a way that feels meaningful to them.

That means it’s never too late. Some families hold a memorial, plant a tree, or mark an anniversary once it feels right.

From March 2020 to April 2021, an estimated 1.1 million children worldwide lost a parent or custodial grandparent, and over 1.5 million lost a primary or secondary caregiver.

The researchers call this a “hidden pandemic” and say psychosocial and economic support can help families care for these children.

In one Dutch study, grief levels a year or more after a COVID-19 loss were similar to grief after other natural deaths. Sudden, unnatural losses tended to bring heavier early grief.

Early research found many healthcare workers struggled with mood and sleep during the outbreak, and called for ways to protect their mental health.

In 2021, U.S. essential workers were more than twice as likely as other workers to have received mental health care since the pandemic began (34% vs 12%).

Their work kept communities running, often with more exposure and less choice. Their stress deserves recognition too.

Nearly half of U.S. parents (48%) said their stress had increased since before the pandemic. Among parents whose children were still learning from home, it was 62%.

WHO says young people were especially affected and at higher risk of self-harm.

In 2021, 37% of U.S. high school students said their mental health was poor most of the time or always during the pandemic.

WHO says women were more severely affected than men.

A review of 134 groups of people followed over time found small worsening of anxiety, depression and general mental health among women in particular.

WHO says people with physical health conditions were more likely to develop symptoms of mental health conditions.

A review of 65 studies also found the early rise in symptoms was most pronounced among people with physical health conditions.

WHO reports that mental health services were among the most disrupted of all essential health services during much of the pandemic.

WHO also notes people with existing mental health conditions, especially severe ones, were more likely to become very ill if infected.

A review of 18 studies found reported domestic violence rose after stay-at-home and lockdown orders.

WHO lists the illness and death of loved ones, and grief after bereavement, among the main causes of worse mental health during COVID-19.

The section “Grief when goodbyes couldn’t happen” in this guide covers this more.

WHO notes COVID-19 led to discrimination against people of certain ethnic backgrounds.

In a 2020 survey, 31% of Asian American adults said they had faced slurs or jokes about their race since the outbreak, and 26% said they had feared being threatened or attacked.

SAMHSA notes that people who were isolated because of illness may feel sad or angry when others still fear catching it from them, even after they are no longer contagious.

SAMHSA says learning and sharing accurate information about the real risk often calms these fears and helps people reconnect.

WHO says stigma can reach anyone seen as having been in contact with the virus.

People who care for the sick deserve support, not suspicion.

A 2023 review of 134 groups followed before and during the pandemic found most changes in anxiety, depression and general mental health were close to zero. Depression worsened only slightly.

Averages can hide people who struggled a lot. But they also show how much resilience people have.

In the review of 65 studies, increases in depression and mood symptoms tended to be larger and were still raised in May–July 2020.

Women, young people and people with health conditions were more likely to feel lasting effects.

WHO found that by the end of 2021, mental health services had improved somewhat, but many people still couldn’t get care. Many turned to online support.

In early 2021, 47% of U.S. adults said they had delayed or canceled health care.

The CDC describes Long COVID as a wide range of symptoms that can last months or years after infection. These can include fatigue, “brain fog”, sleep problems, depression or anxiety.

Symptoms can come and go, and often get worse after physical or mental effort.

Among U.S. high school students in 2021, those who felt close to people at school were far less likely to report poor mental health (28% vs 45%) or persistent sadness (35% vs 53%).

• Ask how they are really doing, and listen without rushing to fix
• Offer something specific, like a call each Sunday or dropping off food
• Remember hard dates, like the anniversary of a loss
• Share helplines gently if they seem overwhelmed

WHO’s guidance during COVID-19 encouraged people to support neighbours and others in their community.

Research on quarantine also found that seeing it as protecting others, rather than only as a rule, could make it easier to bear.