Mental Health During Coronavirus (COVID-19)
Fear, anxiety, and uncertainty exist with the outbreak of the coronavirus (COVID-19). The global pandemic affects all members of society, and mental health care needs are urgent, not only for COVID-19 patients, but for close contacts, suspected cases, families and friends of affected people, healthcare professionals (HCPs) caring for infected patients, and the general public.1
COVID-19 has been labeled a potentially new fatal virus, which increases fear in infected patients and perpetuates a sense of danger among healthcare workers and the public.1 Symptoms such as fever, hypoxia, and cough can lead to increased distress. Public health responses like contact tracing and quarantine may also increase anxiety about the effects of contagion and stigma on close friends and family.
People living with HIV (PLHIV) may be at increased risk of mental stress. PLHIV may already be suffering from mental health issues like depression, and they may be concerned about their vulnerability to COVID-19, as those with underlying health conditions who are immunocompromised have a higher risk for developing serious illness, especially those with comorbidities and/or poorly managed disease.2,3
Additional stress factors for PLHIV during COVID-19 may include medical care or community services being disrupted, and social isolation, especially when living alone or in settings that restrict visitors.2 This is in addition to common stress responses felt among all people during an infectious disease outbreak like COVID-19, which requires social distancing, quarantining, and isolation.2,4
Common stress responses during an infectious disease outbreak like COVID-192,4:
Feeling anxiety about the ability to effectively care for loved ones; job security and potential loss of income; securing food and other necessary items; and more
Experiencing changes in sleep and eating patterns
Having difficulty sleeping or concentrating
Worsening of chronic or mental health problems
Increasing use of alcohol, tobacco, or other drugs
During the COVID-19 outbreak, DHHS interim guidelines recommend that HCPs take the following steps to assist PLHIV5:
Request that drug-supply quantity restrictions be waived by drug providers (Medicaid, Medicare, commercial health insurers, ADAPs) so PLHIV can obtain a 90-day supply of ARV drugs
Assess patients’ needs for social assistance for things like food, housing, transportation, and childcare, and connect them to appropriate resources, including navigator services if available
Assess patients’ mental health and substance abuse issues, and arrange for additional (preferably virtual) consultations as needed. Call ahead if they have to be seen at a clinic or hospital
Provide telehealth services to connect with PLHIV for routine visits and to triage patients who become ill
ADAP=AIDS Drug Assistance Programs; ARV=antiretroviral; DHHS=Department of Health and Human Services.
Addressing stigma around COVID-19
PLHIV may already be dealing with stigma stemming from fear and misconceptions about HIV, and the social discrimination that can result, such as being refused healthcare services or being isolated from the community.6 PLHIV who internalize HIV stigma may develop feelings of shame, fear of disclosure, and despair.
Similarly, fear and anxiety about the infectious disease COVID-19 outbreak can lead to social stigma and discrimination; social avoidance and rejection; denials of healthcare, education, housing, or employment; and physical violence—all of which impact mental health.7
Groups who may be experiencing stigma with COVID-19 include7:
People of Asian descent
People who have traveled
People who have been released from quarantine
HCPs and first responders
Stopping stigma makes communities stronger and better equipped to recover from stress. Anyone can help stop stigma around disease by knowing the facts and supporting stigmatized groups at home and in the community.6,7
Public health officials and communicators, specifically, can help prevent stigma around COVID-19 by raising awareness without raising fear. This may include7:
Maintaining privacy of people seeking healthcare and people involved in contact investigations
Sharing accurate information about how the virus spreads
Being mindful that images shared do not reinforce stigma stereotypes
Speaking out against negative statements or behaviors against specific groups of people
Engaging with stigmatized groups publicly, face-to-face and via news channels, including social media
Thanking healthcare workers and responders for their valuable service
Mitigating suicide risk during COVID-19
As the pandemic continues to spread, suicide may become a more pressing concern.8 Several factors at hand have been associated with increased suicide risk, including: increased depression, anxiety, and post-traumatic stress; loss of employment and financial stressors; social isolation; substance abuse; domestic violence; and feeling the effects of stigma.
Some individuals in crisis, however, may be hesitant to seek help if they feel services are overwhelmed or in-person visits may put them at risk for getting sick.8 Clear pathways for remote mental health assessment and care need to be developed, as well as training to support staff in the new ways of working, to ensure that easily accessible help is available. Helplines that are stretched beyond capacity may require more support and flexible scheduling to maintain volunteer workforces.
Frontline workers, in particular, may be stressed with increased workloads and new ways of working, and may be adversely affected by exposure to multiple traumatic deaths.8 To mitigate suicide risk, frontline workers should be given adequate breaks, proper protective equipment, and the ability to access additional support from mental health providers as needed.
Strategies for healthcare settings
Despite widespread mental health issues at play with COVID-19, many HCPs working in affected facilities receive little to no training in mental health care.1 It may be helpful to consider strategies used in the 2003 outbreak of severe acute respiratory syndrome (SARS), which are outlined below.
IMPLEMENT MULTIDISCIPLINARY SUPPORT
Multidisciplinary mental health teams that include psychiatrists, psychiatric nurses, clinical psychologists, and other mental health workers, should be available at regional and national levels to offer appropriate support to patients and healthcare workers.1
PROVIDE CLEAR COMMUNICATION
Ongoing communication with accurate, up-to-date information about COVID-19 should be provided to patients and healthcare workers to help alleviate uncertainty and fear.1 This includes providing clear treatment plans and health status updates for patients and their families.
RAMP UP VIRTUAL CARE
Virtual visits using smartphones, tablets, and apps should be implemented safely and securely to make psychological counseling services available to affected patients, families, healthcare workers, and members of the general public.1 Virtual communication between infected patients and families are also encouraged to decrease feelings of isolation.
CONDUCT ROUTINE SCREENING
Patients with suspected or confirmed cases of COVID-19, as well as the HCPs caring for them, should be regularly screened by mental health care professionals for depression, anxiety, and suicidal tendencies, in order to provide appropriate treatment in a timely manner.1
Additional tips for individuals and communities
CDC and SAMSHA offer the following tips to help everyone cope with stress during this unprecedented time2,4:
Know the facts. Understand the risk to yourself and those around you by consulting credible sources of information, such as CDC and WHO; at the same time, avoid 24/7 news consumption, including social media, which can increase anxiety and worry
Connect with others. Reach out to the people you know and trust via phone, text, email, and social media, to share your feelings and concerns and to reduce anxiety, depression, loneliness, and boredom during social distancing and isolation
Try to relax. Take deep breaths, stretch, meditate, or pray, and make time for activities you enjoy; take a break between stressful activities to do something fun
Take care of your body. Eat healthy, make time for exercise, get enough sleep, and avoid alcohol and drugs
Know when to seek help. If you or someone you know is experiencing symptoms of extreme stress, feeling overwhelmed, or unable to keep up with routine activities, call your healthcare provider or one of the hotline numbers listed below
SAMHSA’s Disaster Distress Helpline
Toll-Free: 1-800-985-5990
SAMHSA’s National Helpline
Toll-Free: 1-800-662-HELP
National Suicide Prevention Lifeline
Toll-Free: 1-800-273-TALK
CDC=Centers for Disease Control and Prevention; SAMHSA=Substance Abuse and Mental Health Services Administration; WHO=World Health Organization.
Find additional resources for mental health and COVID-19 online:
FROM SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA)
SAMHSA resources and information, guidance for opioid treatment centers, and additional federal guidance.
FROM HEALTH RESOURCES & SERVICES ADMINISTRATION
Coronavirus Disease 2019 Frequently Asked Questions
Information on CARES Act funding, AIDS Drug Assistance Programs, funding opportunities, and more.
FROM US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
Using HOPWA Program Funds for Infectious Disease Preparedness and Response
Details on how HOPWA funds can be used to prepare for and respond to infectious diseases like COVID-19.
HOPWA=Housing Opportunities for Persons with AIDS.
References:
1. Xiang YT, Yang Y, Li W, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry. Published online February 4, 2020. Accessed April 22, 2020. doi: 10.1016/ S2215-0366(20)30046-8.
2. Coronavirus disease 2019 (COVID-2019): stress and coping. Centers for Disease Control and Prevention website. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html. Published April 16, 2020. Accessed April 22, 2020.
3. Coronavirus disease 2019 (COVID-2019): people who are at higher risk for severe illness. Centers for Disease Control and Prevention website. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html. Published April 15, 2020. Accessed April 22, 2020.
4. Tips for social distancing, quarantine, and isolation during an infectious disease outbreak. Substance Abuse and Mental Health Services Administration (SAMHSA) website. https://www.samhsa.gov/sites/default/files/tips-social-distancing-quarantine-isolation-031620.pdf. Accessed April 22, 2020.
5. Interim guidance for COVID-19 and persons with HIV. AIDSinfo website. https://aidsinfo.nih.gov/guidelines/html/8/covid-19-and-persons-with-hiv--interim-guidance-/554/interim-guidance-for-covid-19-and-persons-with-hiv. Published March 20, 2020. Accessed April 23, 2020.
6. Facts about HIV stigma. Centers for Disease Control and Prevention website. https://www.cdc.gov/hiv/basics/hiv-stigma/index.html. Published September 27, 2019. Accessed April 22, 2020.
7. Coronavirus disease 2019 (COVID-2019): reducing stigma. Centers for Disease Control and Prevention website. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/reducing-stigma.html. Published March 30, 2020. Accessed April 22, 2020.
8. Gunnell D, Appleby L, Arensman E, et al. Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychiatry. Published online April 21, 2020. Accessed April 22, 2020. doi: 10.1016/S2215-0366(20)30171-1.
HVUWCNT190042 June 2020
