Persistent Psychological Distress Due to COVID-19 Could Lead to Spike in Psychiatric Disorders

As the COVID-19 pandemic nears its one-year anniversary and nations around the world rush to vaccinate their populations, public health officials are sounding the alarm about the possible psychiatric impacts of the vaccine.

In a new research letter published in the Journal of the American Medical Association, corresponding author Emma E. McGinty, PhD, of the Johns Hopkins Bloomberg School of Public Health, and colleagues, report on their findings when they surveyed more 1,337 adults about their psychological stress in the spring and summer months of the coronavirus disease 2019 (COVID-19) pandemic.

The survey respondents were drawn from the NORC AmeriSpeak panel of 35000 US adults over the age of 18. An initial survey was conducted in April, and a follow-up in July. The survey measured psychological distress for the 30 days prior to the survey using the Kessler 6 scale.

They found the prevalence of serious psychological distress (a score of 13 or higher on the 0- to 24-point Kessler scale) was 13.6% in April 2020 and 13.0% in July of 2020. That compares to a rate of just 3.9% in April 2019.

Young adults (ages 18-29) had the highest prevalence of psychological distress of any age group, with roughly a quarter of respondents in that age group reporting serious distress. Those with incomes of less than $35000, and Hispanic individuals also reported high rates of psychological distress, 21.2% and 19.2% in July, respectively.

Beyond the high prevalence of psychological distress, McGinty and colleagues said the fact that the high rate of distress appears to be persisting over time is also worrisome, since persistent distress increases the risk of psychiatric disorders.

In the survey, 72% of adults who reported serious distress in July had also reported serious distress in April.

McGinty told Contagion that it will likely be a while before the psychiatric impacts of COVID-19-related distress are fully known. She said some patients might already be experiencing conditions like depression and anxiety as a result of COVID-19-related distress, but in other patients the effects might develop over time as a result of cumulative distress.

“It also often takes time for people to seek treatment (and you can’t be diagnosed until you seek treatment),” she noted, “so there may be a lag for that reason as well.”

For primary care physicians, the data present an additional challenge – identifying patients whose pandemic-related stress might be leading to more serious psychiatric outcomes. She said physicians can use the Kessler 6 screening tool, the Generalized Anxiety Disorder screening instrument, 7-item (GAD-7), and others to help find patients who might warrant psychological or psychiatric follow-up.

Unfortunately, the physicians can only provide such assistance if the patient shows up in a clinic. And the study’s results indicate that access to care can be a challenge for many of the people most at risk for psychological distress during the pandemic.

McGinty and colleagues found 35% of adults with serious distress said one factor contributing to their stress was an inability to obtain healthcare. The authors concluded that this data point underscores the importance of access to care, not only during pandemics, but all of the time.