Psychiatric Impact of COVID-19 May Show Up Long After First Wave of Infections, Expert Says

Responding to the ongoing disaster that is the COVID-19 pandemic will be “a marathon, not a sprint,” said Joshua Morganstein, M.D., chair of the APA Committee on Psychiatric Dimensions of Disasters, at the APA Spring Highlights Meeting this past weekend. He is a Captain in the U.S. Public Health Service as well as an associate professor and assistant chair of the Department of Psychiatry at the Uniformed Services University of the Health Sciences.

As with other disasters, the psychiatric morbidities associated with the pandemic are likely to show up well after the first wave of this public health disaster has subsided. “The psychiatric and behavioral impacts of disasters are experienced by more people over a greater geography, across a much longer period of time than all other medical effects combined,” Morganstein said. “If history is any predictor, we should expect a significant tail of mental health needs that extend for a considerable period of time after this event.”

He advised physicians to have a “battle buddy”—a trusted friend or companion who is sharing the experience of responding to this challenge and who can be a reminder of hope and the need to care for oneself. “It’s important to gently remind ourselves that self-care is a critical issue for our patients, our colleagues, and for ourselves,” he said. “Sleep, regular meals, staying hydrated, and exercise improve decision-making and can strengthen our immune system. These are benefits we can all use right now.”

Morganstein said the physical and psychological responses to the public health crisis mirror the responses to other disasters: sleep difficulties; decreased sense of safety; somatic symptoms; irritability; abuse of alcohol, tobacco, and prescription medications; and interpersonal conflict.

The unique nature of a pandemic may also engender fear of shortages and scarcity and of long-term isolation and quarantine, he pointed out. Misinformation can spread rapidly, leading to scapegoating and an altered perception of risk. “It is the perception of risk, not the actual risk, that will determine how people behave—whether people stay at home and whether they are willing to accept treatment or a vaccine” for the virus.

Morganstein echoed other speakers at the meeting in advising judicious attention to the media. “The media are an important source of health information that can shape perception and subsequent behavior,” he said. “But the media also transmit fear and stress. We can remind each other to take a media break.”

For families home together for extended periods, there can be a temptation to leave the television on all day, but continual exposure to reports about COVID-19 can be very distressing to children, he said.

Morganstein concluded his remarks by emphasizing the importance of leadership in reminding people that the future can be brighter and that the crisis will in time subside. “Leaders can promote healing and recovery within their communities by openly acknowledging and addressing issues of grief and loss and helping people look to the future,” he said.

“There must be an honest reckoning with this [suffering]—with kindness, generosity, and human connection. We need to remind people that eventually this will end and that the vast majority of people, including those who encounter difficulties along the way, will ultimately be OK. As we address the critical problems of today, we can look to the horizon and seek out opportunities to use these difficult lessons for the future.”

He received a number of questions from virtual meeting attendees. Among them:

Q. Will responses to COVID-19 result in symptoms that meet criteria for PTSD?

A. Some people will be exposed to things that [may lead to] their meeting the criteria for PTSD. We need to be particularly concerned about our frontline health care workers.

Q. How can health care professionals be encouraged to self-care when they may feel guilt or shame about seeking out their own mental health treatment?

A. It can be challenging for us to seek care because there is a sense of duty and care for others that is the silent ethos of our profession. Creating a culture within an organization where help seeking is encouraged is important. Leaders can set the tone for people in their organization, and peers can also be a very important form of support. ■