The ongoing COVID-19 pandemic has resulted in quarantine and social isolation measures designed to keep individuals physically distanced from others. Although these initiatives are necessary to prevent the spread of the novel coronavirus, they may be causing widespread mental health effects, including depression and loneliness, among younger and older individuals alike.
Children Need Structure
Children will be challenged primarily by a lack of structure associated with the closing of schools.
Daily structure is important to everyone, but particularly to children in their psychological and emotional development. The consistency of schedules, predictable rules and consequences, and set expectations teach children how to behave, develop self-discipline and impulse control and, importantly, a sense of safety and control. Clinically, there is often an exacerbation of behavioral problems in our pediatric patients when their routine or structure is disturbed.
The extent of this challenge depends on the family’s ability to provide support and structure at home, which further depends on the family’s unique dynamics, resources and stressors.
Clinicians can serve a vital role in helping parents and caregivers form structure for children.
Children learn from watching adults, and since they will often be at home together now, they will observe not only what the adults in the home say, but also how they implement structure, ensure consistency and deal with their own emotions. Teaching parents the importance of daily structure and consistency in their responses to their children’s behaviors is a priority.
Parents are likely experiencing significant stress during this time, so clinicians have a “double mission” of ensuring parents manage their own anxiety and stress while also modeling for their children.
For children with a history of mental illness, the lack of structure and increased stress in the family can exacerbate psychiatric symptoms, such as depression and anxiety. These symptoms may manifest clinically as somatic complaints, difficulty sleeping or eating, or behavioral regression, depending on the developmental stage of the child.
College Students Face Increased Rates of Anxiety
Research over the past decade has shown a steady increase in the prevalence of depression, anxiety and suicidality among college students across the United States.
Some of the most important predictors of mental health and some of the biggest factors that have been targeted in terms of prevention have been trying to foster a sense of belonging and connection for students.
Campus closings and the overall response to the coronavirus have shifted how college students may think about their sense of belonging. In addition to depression and loneliness, college students will also likely face increased rates of anxiety, fueled by the uncertainties surrounding the virus.
For students who are struggling with anxiety, the uncertainty regarding the coronavirus is something we really need to be worried about, since it has the potential to amplify already high rates of anxiety.
Before we can get to solutions, it’s important to think about ways to be positive and to pause and recognize that this is a really, really difficult time.
College leaders also play a role in mitigating mental health effects among students, and initiatives such as a pass-fail system can help achieve this end.
Working-Age Adults Need Fulfillment
With the closing of many businesses and places of employment, a significant proportion of working-age adults have lost their jobs. This can be a blow to individuals’ sense of fundamental purpose in life.
It eats at our sense of competency if we're not at work and makes us worry whether we’ll be able to pay for essentials, such as rent and food. It's a very profound, existential threat. For those deemed essential service workers who are still going to work, there’s added stress regarding whether they will get the virus.
Perhaps the most difficult mental health concern for this demographic is increased anxiety associated with having to suddenly provide additional care for family members, such as school-age children or elderly parents, combined with potential work-related responsibilities.
Social isolation from work colleagues is another potential challenge.
With this virus shutting down the workplace, people have lost not only social interactions with best friends who don't happen to live in their home, but also interactions with the wide variety of supportive, friendly, casual relationships at work and in public that make for a rich social texture.
For clinicians to be able to help this patient population, they must first quell their own anxiety. Further, they can ask themselves questions such as, “How am I looking after myself? How am I protecting myself against the virus while also protecting myself against burnout?”
Older Adults Need Connection
With social isolation measures in place in much of the world, loneliness has become a familiar facet of everyday life. Research has shown that loneliness increases risk for depression and anxiety and heightens feelings of stress — factors that contribute to worsening physical health and poor health behaviors, including substance abuse, poor nutrition and more sedentariness, as well as poor sleep quality.
There’s an important distinction here between loneliness — the feeling of isolation that can set in even when someone has frequent social contact — and what researchers call objective isolation. Right now, we’re experiencing a pandemic of mandated isolation. The fact that many older adults are already isolated by virtue of widowhood, living alone and having mobility or transportation challenges that preclude social activities in the community means they are being forced to give up what little interaction they may have had to begin with.
The pandemic might teach societies an important lesson — isolated older adults face challenges every day, not just during times of crisis.