Mental health crisis looms as US in turmoil
Economy, pandemic, racism strain Americans
The science is screaming: Americans are in turmoil.
More than 80% of U.S. adults view the nation’s future as a significant source of stress, according to a report Thursday from the American Psychological Association. Americans are the unhappiest they have been in 50 years, according to a COVID Response Tracking Study released Monday. And a survey published this month in the medical journal JAMA found three times as many U.S. adults reporting symptoms of serious psychological distress in April as they did two years earlier.
The studies were conducted to better understand how Americans are coping during this unprecedented period, with millions sickened and more than 100,000 dead in a global pandemic, anti-racism protests gripping the country and an economy in tatters after its longest expansion in history.
America is a nation unmoored, and experts said for many people, the negative mental health impacts will outlast the current crises. Research suggests the extreme stress triggered by these events might even lead to longer-term psychiatric disorders. The nation must prepare, experts said, for the mental health crisis that looms next.
“We are facing a culmination of crises unlike anything we have seen in our lifetimes – in coronavirus, economic turmoil and racism,” said Jaime Diaz-Granados, deputy chief executive officer and acting chief scientific officer at the American Psychological Association.
“Each of these crises are taking a heavy psychological toll on Americans and particularly our African American citizens and other people of color. The health consequences could be dire. As we look toward the future, we need to consider the long-term implications of the collective trauma.”
More than 70% of Americans in the APA report said this is the lowest point in the nation’s history they can remember.
“These events absolutely will, for a large segment of our population, have long-term mental health consequences, including leading to diagnosable conditions,” said Vaile Wright, senior director of health care innovation at the APA.
Beth McGinty, lead author of the JAMA study and an associate professor at Johns Hopkins Bloomberg School of Public Health, said in April 2018 about 4% of American adults reported serious psychological distress, which has been typical for the past decade. When she conducted her survey in April, that number had more than tripled.
“It’s huge,” McGinty said. “I expected to see an increase in distress here, but to see such a major increase in this measure of serious distress, as opposed to some more mild or moderate anxiety about the situation – I was surprised by the magnitude of increase.”
To measure psychological distress, researchers used the The Kessler Screening Scale for Psychological Distress, which asks questions about symptoms of depression and anxiety that occurred in the past 30 days, including, “How often did you feel hopeless?” and “How often did you feel worthless?”
In the study, the authors note “acute distress during COVID-19 may transfer to longer-term psychiatric disorders” because serious psychological distress as measured by the Kessler scale has been shown to predict clinical mental illness.
“It’s not a perfect prediction,” McGinty said. “It is not a diagnostic tool. It doesn’t mean that every single person who had serious psychological distress in April is going to go on to develop a clinical diagnosis of depression or anxiety, for example. But it means that they are very much at risk of going on to develop that clinical diagnosis.”
Certain populations are at higher risk of developing serious mental health conditions, experts said.
Those who live in geographic areas severely impacted by COVID-19 are at greater risk, as are those who might have lost a loved one to the virus.
Experts also said those with preexisting depression, anxiety, substance use or eating disorders are likely heavily triggered in the current climate.
Sustained stress also is of particular concern for those suffering from systemic stressors – poverty, discrimination, lack of opportunities – as they have fewer coping resources.
Research showed Black Americans are 20% more likely to report serious psychological distress than non-Hispanic white Americans. According to the APA, the proportion of Black adults who said discrimination is a significant source of stress has increased from 42% to 55% in the past month.
A 2018 survey found that although most American adults said having a mental health disorder is nothing to be ashamed of, a third of respondents agreed with the statement, “People with mental health disorders scare me.” And nearly 40% said they would view someone differently if they knew that person had a mental health disorder. These attitudes could prevent some people from seeking treatment.
For those who know they need care, it might not always be available or sufficient.
The APA said in 2016, 11.8 million American adults believed they needed mental health services but couldn’t access them. Approximately 6.3 million said they received some mental health services, but needed more. Of those who reported an unmet need, 38% said it was because they couldn’t afford it, 28% said they thought they could handle the problem without treatment, and 21% said they didn’t know where to go for treatment.
Experts said it’s crucial that telehealth remain a viable option for people who need and want to use it, even when in-person care becomes available. Telehealth allows providers to reach populations they might not have connected with otherwise.
Communities have a role to play, too. Research shows communities with high levels of social cohesion fare better than socially divided ones, Diaz-Granados said. When people can agree on shared values and goals, when they are inclusive, they are healthier.
Wright said the pandemic has destigmatized some mental health issues. People who never struggled with anxiety or isolation pre-COVID now have greater empathy for those who did. COVID and the protests also have brought necessary attention to racism’s health impacts, but in her view, there isn’t enough national discussion about how profound these crises will be on longterm emotional well-being.
“There’s stress around getting sick or your family getting sick,” Wright said. “There’s the economic piece. It’s the national rhetoric around systemic racism. Stress related to leadership.”