General Information on Impact of Pandemics

The COVID-19 pandemic is a traumatic event for everyone. All of us are experiencing chronic stress and trauma in response to the pandemic, with biological and psychological impacts. Quarantine, social distancing, and financial strain also have significant effects on humans. People feel less safe when we lack social and physical contact with others; on a physiological level, the isolation required by quarantine is experienced as a threat. The impacts of this chronic stress, and chronic activation of our fight-or-flight systems, will last for years. Most of our understanding of the impacts of the pandemic are extrapolated from findings related to natural disasters (or after the 9/11 terrorist attacks), as the literature specific to pandemics is more limited.

Based on what we know from natural disasters, terrorist attacks, and the SARS pandemic, we expect the following:

  • Posttraumatic stress disorder will be the most common new-onset mental health condition

  • Depression will be the second-most common new-onset mental health condition

  • Suicide attempts will increase significantly

  • Use/abuse of alcohol/substances will increase substantially

  • Impacts on mental health and functioning are long-lasting, up to years after the traumatizing incident

  • Reactions in children are likely to be influenced by parents’ threat reactions and their communication of this reaction to their children (Remmerswaal & Muris, 2011).

Following the SARS pandemic, 44% of those infected developed posttraumatic stress disorder. Even after recovery from SARS, posttraumatic stress disorder persisted years later in 82% of those. Risk factors for posttraumatic stress disorder during the SARS pandemic included:

  • High mortality risk

  • Low social support

  • Close friends/relatives who were infected with SARS, or who died from SARS

Although there is little data available on COVID-19 impacts, recent studies in adults living in China have found:

  • 55% reported the pandemic had a moderate or severe psychological impact

  • 35% generalized anxiety disorder

  • 20% depression

  • 14% new onset insomnia; 13% worsening insomnia symptoms

  • 7% incidence of PTSD in the hardest-hit areas; more common in women

Many adults in the United States are experiencing extreme financial strain and stress due to the pandemic. Mental health impacts from the Great Recession of 2009 persisted into 2013, well into the economic recovery. Financial strain experienced during the Great Recession of 2009 was is associated with an increase in:

  • Panic attacks

  • Excessive worry

  • Depression

  • Problematic substance use

  • Suicide, especially among men

Financial strain may have an especially significant impact on the mental health of individuals who are already at a lower socioeconomic status. During the Great Recession, those with the lowest socioeconomic status saw the greatest increases in negative affect, and the greatest declines in positive affect and life satisfaction, as well as in psychological well-being.

 

Substance Use Disorders During Pandemics/Disasters

During pandemics, those who abuse alcohol and/or other drugs, as well as those in recovery, are particularly vulnerable. Across the United States, the COVID-19 pandemic has caused dramatic increases in psychiatric emergencies, overdoses, and relapse. Preliminary studies have shown that the stay at home orders have led to more alcohol and drug use to cope with stress of COVID-19. Alcohol and marijuana sales have increased exponentially. A recent U-M study that tracked behaviors for one week in mid-March found that more than 1 in 4 adults (28 percent) said they used alcohol or drugs to help cope with the stress of the coronavirus pandemic (Ward, 2019).

Not only are people using more substances during the COVID-19 pandemic, people with SUDs are at a higher risk of COVID-19 infection and complications. Alcohol has the ability to decrease immune function, which can increase susceptibility to illness (Sakar, 2015). According to Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), COVID-19 is especially dangerous for individuals who smoke tobacco or marijuana or who vape, or with opioid use disorders, due to the way COVID-19 attacks lung and pulmonary function (Volkow, 2020).

Impacts of Social Distancing, Quarantine

As social creatures, humans are particularly vulnerable to the effects of social isolation and loneliness. Social connectedness is thought to scaffold our sense of self. Social isolation is perceived as unsafe by most people, which can increase unconscious hypervigilance for additional threats in the environment which may in turn heighten anxiety and stress.

Outside of times of pandemic, social isolation and loneliness are associated with increased risk for mental health disorders. Loneliness is a significant predictor of the development of depression and is associated with suicide. In experimental studies, social isolation and loneliness caused depression, perceived stress, fear of negative evaluation, anxiety, anger, reduced optimism, and lower self-esteem.

Quarantine longer than 10 days is associated with greater impacts to mental health and well-being. Moreover, populations which are already isolated prior to a pandemic (elderly, undocumented immigrants, homeless individuals, those with mental illness) are at increased risk for negative impacts of quarantine.

Specific stressors during quarantine include:

  • Duration (longer than 10 days = more impacts)

  • Fear of infection of self or others

  • Disruption of normal routine

  • Reduced physical contact with others

  • Inadequate household supplies/personal protection supplies

  • Inadequate information from public authorities

  • Lack of transparency from public authorities

Specific stressors after quarantine include:

  • loss of income/financial loss

  • predictor of high distress among those with lower incomes (including PTSD, depression)

  • Stigma (especially among healthcare workers)

  • Further disenfranchisement of minority/already disadvantaged populations.

The most commonly identified impacts of quarantine include:

  • Symptoms of posttraumatic stress

  • Confusion, anger, grief, numbness, fear, insomnia

  • Longer-term avoidance of crowded public places

  • Increased handwashing vigilance

Specific risk factors which may increase negative impacts of quarantine may include:

  • Less educational attainment/lower socioeconomic status

  • Female

  • Presence of child(ren) in the household

  • History of mental health illness

  • Employment in health care

  • Bereavement, injury to self/family member, life threat

  • Separation from family

Specific factors which may reduce negative impacts of quarantine may include:

  • Mentally healthy before the pandemic

  • Strong social support before, during, and after the pandemic

Health care workers are at especially high risk of the following quarantine-related impacts:

  • alcohol abuse/dependency

  • exhaustion (physical and emotional)

  • difficulties with concentration

  • reluctance to go back to work, absenteeism

Children

Children are doubly vulnerable because they are impacted not only by their own social isolation, but also by how their parents are affected.

One study found that following the H1N1 pandemic, mean posttraumatic stress scores were 4 times higher in children who were quarantined, compared to children who were not quarantined. In the same study, 25% of parents met diagnostic criteria for a trauma related disorder, compared to 7% in parents who did not experience a quarantine.

Close and open communication with children is important for identifying and mitigating traumatic stress.