While the world struggles to manage the initial waves of death and disruption caused by the Covid-19 pandemic, there is mounting evidence accumulating that "a second wave" linked to rising rates of mental health and substance use disorders could be building, according to an article published Monday in the medical journal JAMA.
"A second wave of devastation is imminent, attributable to mental health consequences of Covid-19," wrote authors Dr. Naomi Simon, Dr. Glenn Saxe and Dr. Charles Marmar, all from New York University's Grossman School of Medicine.
"The magnitude of this second wave is likely to overwhelm the already frayed mental health system, leading to access problems, particularly for the most vulnerable persons."
This second mental health wave, the researchers suggested, will bring further challenges, such as increased deaths from suicide and drug overdoses, and will have a disproportionate effect on the same groups that the first wave did: Black and Hispanic people, older adults, lower socioeconomic groups and health care workers.
"This magnitude of death over a short period of time is an international tragedy on a historic scale," the authors said. "This interpersonal loss is compounded by societal disruption."
Of central concern, the authors wrote, is "the transformation of normal grief and distress into prolonged grief and major depressive disorder and symptoms of posttraumatic health disorder."
A grief that lasts longer
Prolonged grief, which affects approximately 10% of bereaved people, is characterized by at least six months of intense longing, preoccupation or both, with the deceased; emotional pain; loneliness; difficulty reengaging in life; avoidance; feeling life is meaningless; and increased suicide risk. These conditions can also become chronic with additional comorbidities, such as substance use disorders, the authors said.
The 10% affected by prolonged grief is likely an underestimate for grief related to deaths from Covid-19, and each death leaves approximately nine family members bereaved, the authors said. This means there are a projected 2 million bereaved individuals in the US and "thus, the effect of Covid-19 deaths on mental health will be profound."
Of particular concern for the authors is the psychological risks for health care and other essential workers. "Supporting the mental health of these and other essential workforce is critical to readiness for managing recurrent waves of the pandemic," the authors said.
Covid-19 is already affecting mental health
The pandemic has already brought with it a mental health crisis, according to data from the US Centers for Disease Control and Prevention. And a new report found that Americans are experiencing more coronavirus-related mental health issues than people in other countries.
The CDC survey data reported that nearly 41% of respondents are struggling with mental health issues stemming from the pandemic. The issues are related to the pandemic and to the measures set up to contain it, including stay-at-home orders and social distancing.
Nearly 41% of respondents reported one or more behavioral or mental health conditions, including substance use, symptoms of depression or suicidal thoughts.
The number of Americans reporting anxiety symptoms is three times the number at this same time last year, according to the CDC, and several studies have shown that the pandemic has hit Black people and other people of color the hardest.
The pandemic has also taken its toll on caregivers, according to the Blue Cross Blue Shield Association. The national analysis of at least 6.7 million caregivers insured by the association found that 26% of unpaid caregivers trying to balance work and family due to Covid-19 are feeling more stress and have poorer physical health than before the pandemic.
The NYU authors suggest the solution will require increased funding for mental health; widespread screening to identify those who are at highest risk; primary care physicians and mental health professionals who are trained in treating people with prolonged grief, depression, traumatic stress and substance abuse; and a diligent focus on families and communities, creatively restoring the approaches they have used to manage loss and tragedy over generations.