COVID’s mental-health toll: how scientists are tracking a surge in depression

Major events that have shaken societies, such as the 9/11 terrorist attack in New York, have left some people with psychological distress for years, says Marques. A study1 of more than 36,000 New York residents and rescue workers revealed that more than 14 years after the attack, 14% still had post-traumatic stress disorder and 15% experienced depression — much higher rates than in comparable populations (5% and 8%, respectively).

Fear and isolation

The distress in the pandemic probably stems from people’s limited social interactions, tensions among families in lockdown together and fear of illness, says psychiatrist Marcella Rietschel at the Central Institute for Mental Health in Mannheim, Germany.

Studies and surveys conducted so far in the pandemic consistently show that young people, rather than older people, are most vulnerable to increased psychological distress, perhaps because their need for social interactions are stronger. Data also suggest that young women are more vulnerable than young men, and people with young children, or a previously diagnosed psychiatric disorder, are at particularly high risk for mental-health problems. “The things that we know predispose people to mental health problems and conditions have been increased as a whole,” says Victor Ugo, a campaign officer who specializes in mental-health policy at United for Global Mental Health, a mental-health advocacy group in London.

Scientists running large, detailed international studies say that they might eventually be able to show how particular COVID-control measures — such as lockdowns or restrictions on social interaction — reduce or exacerbate mental-health stress, and whether some populations, such as minority ethnic groups, are disproportionately affected by certain policies. That could help to inform the response in this pandemic and future ones, say researchers.

“We have a real opportunity, a natural experiment, in how policies in different countries impact people’s mental health,” says epidemiologist Kathleen Merikangas at the US National Institutes of Mental Health in Bethesda, Maryland.

MONITORING MENTAL HEALTH

Tackling the psychological impact of the COVID pandemic in a developing country such as India has been particularly tough, says Mythili Hazarika, a clinical psychologist at Guwahati Medical College in Assam, India. Public resources are scarce and awareness of mental-health problems is low, she says.

When the COVID crisis struck, Hazarika launched a telephone counselling service with six emergency helplines lent to her by Assam police. In an preliminary study of 239 callers last April, she and colleagues found that 46% had anxiety, 22% some form of depression and 5% suicidal thoughts. This was enough to convince the government to act, and, after months of wrangling with officials, Hazarika and her colleagues launched a state-wide remote mental-health service called Monon in June.

They developed guidelines for tele-counselling during a disaster and trained 400 volunteer counsellors. Anyone who tested positive for COVID-19 in Assam received a call from the service. This proactive approach is crucial, says Hazarika, because stigma and lack of awareness mean that few people would think of calling a helpline. “In rural areas, mental illness means you have to go to an asylum and nobody can cure you,” she says.

Easing restrictions means in-person counselling is possible again. But by December the service had called more than 43,000 people and collected preliminary data about mental well-being from roughly half. They found that 9% had anxiety symptoms, 4% had some form of depression, and more than 12% of people were suffering stress related to COVID-19.