Fighting to protect the health of the economy and the health of the people are not mutually exclusive endeavors. In fact, they are strongly related. While COVID-19 does present a significant threat to the physical health of at-risk individuals, the shut-down poses a more significant threat to the mental health of all individuals.

As a physician anesthesiologist practicing pain medicine and addiction medicine for the past 25 years. In my pain practice, there has been an increase of over 30% of patients requiring medical attention with respect to anxiety as relates to their pain. And in my addiction practice, I’ve seen at least a 50% increase in overdose and unfortunately, a 30% increase of death related to substance use disorders.

COVID-19: Unemployment, isolation, and mental health

Most political arguments surrounding opening up America are focused on the economic state of the country, and individual households. With unemployment at unprecedented levels, there is much discussion about failing businesses, lost income, and people’s inability to support their families.

The counterarguments focus on the risk of additional exposure and promote continued isolation. But, the risk of isolation on mental health is not being considered as it should. Both unemployment and isolation are well-known to follow a path straight to depression. Combine the two, and a person is now on the expressway to poor mental health. It’s a road that often ends in the very thing we are fighting against with the coronavirus: death.

COVID-19’s effect on mental health

COVID-19, directly and indirectly, affects the mental health of the population. Simply the fear of the unknown, the threat of harm to one’s family, the invisible danger, and more cause stress, anxiety, and even paranoia. Then, add the more tangible stressors of lost loved ones, unemployment, isolation, and domestic violence, and there is no arguing that mental health is greatly affected during this global pandemic.

Stress and anxiety

The Kaiser Family Foundation (KFF) recently conducted a survey that 47% of adults sheltering in place reported negative mental health effects due to worry or stress related to the coronavirus. However, those not sheltering in place reported a significantly lower effect on their mental health at 37%. This study was conducted on March 25-30, and it is reasonable to assume these figures have only increased since then. However, the relation to the coronavirus has likely shifted from the direct fear of the virus to the indirect stressors of unemployment and isolation.

Depression

Stress and anxiety often go hand-in-hand with depression. According to the Anxiety and Depression Association of America (ADAA), nearly 50% of people diagnosed with depression are also diagnosed with an anxiety disorder. As anxiety rises, so does depression, and vice versa.  Anxiety disorders are highly treatable, but the ADAA states only 36.9% of those suffering receive treatment—a statistic that was procured before this pandemic. Now, amid stay-at-home orders and the high demand on our healthcare system, the number of those not receiving treatment is most likely much higher.

Abuse and suicide

Stay-at-home orders are meant to keep us safe. Unfortunately, many people are not safe at home, either from themselves or a member of their household. Substance abuse, domestic abuse, and suicide are sharply on the rise. Local and state-run hotlines have reported sizeable increases in call volume, as highlighted by The Health 202 article in the Washington Post.

The Substance Abuse and Mental Health Services Administration (SAMHSA) confirmed to The Health 202 that texts to federal government mental health hotline increased by more than 1,000% in April. Furthermore, the National Domestic Abuse Hotline call volume increased by 12% at the end of April. A legal information service run by National Network to End Domestic Violence also received three times the number of emails relating to the coronavirus in April than it did in March.

The increase in contacts to distress hotlines is a clear indication of the worsening mental health crisis. Most of these figures were reported in April, and the weight of the global pandemic has only gotten heavier as time in isolation continues. The threat of harm due to substance abuse, domestic violence, and suicide must be considered as much as the viral threat of COVID-19.

Opening up America for the sake of mental health

People who have lost their jobs are among the majority of people whose lives have been disrupted the most. The loss of employment and loss of income, plus all of the stressors related to unemployment quickly add up to a serious mental health issue. The majority of people in the workforce are at very low risk of serious illness due to the coronavirus. Yet, they are at the highest risk of mental health issues. The higher risk of mental health issues also leads to higher risks of substance abuse, domestic abuse, and suicide.

Thus, we must consider the mental health threat to the younger population as much as we consider the physical threat to the elderly population. Ongoing isolation and unemployment poses a larger threat to the majority of the population, and the majority of the population are at very low risk of serious illness due to COVID-19.

Now that we have measures in place to support our healthcare institutions during this pandemic, we must shift our focus to safely opening up America. Opening up America is not just about the economy; it is about preserving and supporting the mental health of our nation. We must take this mental health crisis as serious as the viral threat, or we will see a casualty toll that could have been prevented.

Shining a light on the shadows of COVID-19

Mental health issues due to COVID-19 are being endured in the shadows. We need to shine a light on the pandemic’s ever-increasing threat against the mental health of the people. People have a right to speak up for their mental health as much as physical health, and we must listen with equal attention. We should not sacrifice one to spare the other.

John Dombrowski is an anesthesiologist.

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