This article was originally published in the Fall 2020/Winter 2021 print issue of Chicago Health, and subsequently published September 15, 2020 on Chicago Health Online.
The coronavirus pandemic, with all of its stressors, has triggered anxiety, depression, and other disorders
When Covid-19 caused businesses to send employees home to work remotely, Ashima Bhayana was relieved. The 32-year-old customer success specialist at a Chicago health tech company had struggled at times to “be around colleagues, to put on a brave face” on days when her clinical depression flared. At first, working from home felt like a much-needed break.
However, that soon changed.
“With each passing month, it’s gotten harder because of the isolation,” says Bhayana, who has fought depression for 10 years and lives with her husband and a rescue pup. She misses her colleagues, especially those with whom she had recently begun to form friendships after seven months on the job. The loss of her work routine also has upset her sleep and exercise schedules — both key to her wellness. And she’s been anxious about the virus. “I’m like, oh my God, I don’t want to get Covid-19.”
Bhayana is not alone in having Covid-19 fears exacerbate a pre-existing mental health condition. Each week since late April, about a third of Americans have shown symptoms of anxiety or depressive disorders during the previous week, according to the National Center for Health Statistics. Locally in Chicago, mental health providers say they are seeing more patients with stress, anxiety, depression, and other disorders, either brought on or worsened by the virus and its consequences.
Some of those most affected are healthcare workers and other first responders who have experienced the stress of caring for coronavirus patients — an overwhelming job, given the spiraling number of cases and deaths.
People who have lost loved ones are struggling with grief, while others are mourning other types of loss: of contact with family and friends; of jobs or income; of a sense of security about the world, given the virus’s unpredictable path.
“The pandemic and all of the stressors that have happened with it have triggered new illnesses of anxiety and depression,” says Soo Lee-Samuel, MD, a child and adolescent psychiatrist at Rogers Behavioral Health, which provides mental health and addiction services across the United States. People with existing or previous illnesses also have been affected.
While Lee-Samuel’s caseload has remained about the same, patients are showing more serious mental health symptoms, she says. “Everyone’s struggling more and more. Everything that the pandemic has touched has caused a ripple effect in the stress that people are feeling.”
Some people who were previously in recovery also have been experiencing a resurgence of anxiety, depression, trauma, eating disorders, and substance abuse and have needed to pursue treatment again, Lee-Samuel adds.
Stressors include new rules about social distancing, along with mixed messages about what is and isn’t safe. Should you always wear a mask? Can
you get sick from visiting the grocery store? Is walking along a crowded lakefront path safe? The “new normal” Covid-19 has imposed has changed lives while also raising questions, fears, and stress. Even more worrisome to many is what may lie ahead — what Lee-Samuel calls the “unexpected unknowns.”
“How are things going to look several weeks from now? Several months from now? Several years from now? A lot of it is the uncertainty and not knowing,” she says. And uncertainty leads to “a lot of the anxiety people are feeling.”
Healthcare worker burden
Healthcare workers have been on the front lines of the pandemic, working with patients throughout the various phases of the crisis. But, like everyone else, they are not immune to the increased burden of anxiety and stress.
Christopher McCarthy, 33, a licensed professional counselor for AMITA Health, leads and participates in virtual peer support groups for staff. These sessions, he says, have helped him deal with his own virus-sparked anxiety. Other group members include physicians and nurses who have felt the impact of being on the pandemic’s front lines.
One nurse reported seeing “whole families pass away from the virus,” he says. Many were overwhelmed by the load of critical patients during the first phase of the pandemic. Another reported crying in the car before and after going into work.
About 100 such peer support groups attended by 750 AMITA providers, associates, and leaders had been held as of mid-July, says Clifton Saper, PhD, lead psychologist and director of behavioral clinical services at AMITA Health. Saper says over 40% of AMITA’s healthcare workers experience problems such as anxiety, depression, family conflict, irritability, exhaustion, trouble eating and sleeping, and increased substance use.
“Healthcare workers tend to be self-critical and think they should be superhuman,” Saper says. “They don’t allow themselves to be aware of or feel the anxiety that everybody feels. I’m often saying to them, ‘It’s okay to be not okay. We’re all in this together. We’re all feeling anxiety.’”
Lindsay Fazio, PhD, a psychologist with NorthShore University HealthSystem, supports physician well-being and says she has observed “a spike in anxiety conditions” among staff. Some have been furloughed and had shifts in job responsibilities. Many may be caring for patients who they don’t typically care for, or they have transitioned to work from home, which can cause or heighten domestic strains.
In addition, Fazio says, some health workers have developed obsessive-compulsive behaviors focused around trying to keep themselves safe and decontaminated. “Front-line workers — our nurses and other workers caring for hospitalized patients — have developed rituals around showering and hygiene,” she says. These rituals provide physical safety and also psychological comfort.
A study earlier this year of doctors and nurses treating Covid-19 patients in China found half reported symptoms of depression and 44% symptoms of anxiety. During the 2003 SARS outbreak, hospital workers had a higher risk of post-traumatic stress disorder, and experts anticipate an increase because of Covid-19 as well.
“I think we’ll see quite a bit of it,” Fazio says. “Right now, we’re seeing an acute stress reaction,” with symptoms such as insomnia and appetite changes.
To help, NorthShore instituted procedures to navigate staff through the tough times, especially staff at Glenbrook Hospital, which was the system’s dedicated Covid-19 hospital for several months. They hosted virtual support groups, held qigong meditation sessions, and encouraged walks outside the hospital and retreats to a private respite room, which had an iPad loaded with meditation apps.
Youth losing support
McCarthy from AMITA Health counsels students from kindergarten to 12th grade at five Chicagoland schools, with sessions switched to virtual once the coronavirus closed campuses. In spring, three kids had their conditions worsen during the crisis to the point that they had to be hospitalized for suicide risk, he says.
Other students grappled with lack of structure and the “everyday supports” school had provided, such as routines, teachers, and friends. Some could not adapt to virtual learning and found it stressful. He says those who were graduating high school were upset over the “lack of closure for their school careers,” missing traditions like signing yearbooks and saying goodbye to friends.
Children with special needs, such as autism, also have been affected by the loss of much-needed in-person programs, classes, therapies, and other interventions, Lee-Samuel says. “These can be difficult and challenging to do virtually. We’re seeing a lot of our kids in this patient population who are really struggling and falling apart at home, which is very stressful for parents, too.”
Children with special needs, in particular, benefit from in-person therapies to help with social skills, speech issues, and physical coordination, Lee-Samuel says. “They also need very structured days. [Covid-19] has upended this and has taken away what was previously organized and understandable for these kids.”
Some children with autism also have anxiety and mood disorders, she says, and are experiencing more agitation and depression.
Eating disorders, which primarily (though not exclusively) affect young people 18 to 24, are also on the rise due to Covid-19, says Steven Prinz, MD, regional medical director at Eating Recovery Center and Insight Behavioral Health, which has several locations in Chicago and the surrounding area. Due to social distancing requirements, most inpatient facilities have stayed open but restricted the number of patients and visitors. Outpatient psychiatric facilities have closed, cut back on-site services, or modified overnight services.
People “feel like their lives are out of control with Covid-19,” which causes them to try to control their eating even more — resulting in increased anorexic or bulimic thoughts and behaviors, Prinz says.
People who already have “an intense fear of gaining weight” are not helped by social media messages warning about the “Covid-15” weight gain during quarantining, Prinz says. Going into grocery stores can also be traumatic, especially if “the ‘correct’ foods they are comfortable with” are not available due to Covid-related shortages, he adds.
The compounding effects of Covid-19 are disproportionately impacting Chicago’s underserved communities. Access to mental health care is always a concern, but it’s even more tenuous during the pandemic.
In May, Chicago Mayor Lori Lightfoot presented $1.2 million in mental health funds to four city health organizations serving the South and West sides to help people affected by Covid-19 and added $9.3 million to the city’s budget for mental health services at existing clinics.
Still, Chicago is uniquely underserved when it comes to mental health, says Ronald Wuest, MD, chair of psychiatry and behavioral neurosciences for DuPage Medical Group. Many of the city’s psychiatrists don’t accept insurance or only accept a limited number of insurance carriers, he says — an issue reflected nationwide.
“Providers tend to be polarized toward well-insured individuals or the indigent. But it’s that middle range of people” who may have trouble finding help, he says.
Services are available, but many people don’t realize this, or they find it stigmatizing to seek help, says José Viruet, clinical director of behavioral health for Erie Family Health Centers, a federally qualified health center with 13 locations in the Chicago area. About 70% of Erie’s clientele are people of color — primarily Latinx and Black, Viruet says. For these populations in particular, there is a “huge stigma regarding mental health care” to overcome, he says. Also, many simply don’t know where or how to get services.
Yet even with people not realizing where to turn, behavioral health visits for anxiety, depression, grief, and other issues have doubled at Erie since Covid-19 started, Viruet says. As a result, the centers have added mental health staff.
Some people are experiencing symptoms for the first time and don’t know what they mean or how to handle them, Viruet says. “We get a lot of people experiencing panic attacks, and they don’t know what to do and they don’t know where to go.”
Lee-Samuel worries that, as numbers of people needing mental health care continue to rise, there may not be enough professionals available, especially in more rural areas outside the city.
The protests following the death of George Floyd have presented another layer of unknowns, stresses, and anxieties. “Everyone I talk to is having more nightmares, more underlying anxiety,” Lee-Samuel says. “I tell my patients to try to get through it one day at a time. We’re all trying to make the best of it.”
Making the best of this discomfort will take time. “The current cultural climate is becoming more and more politicized, and we feel it in how we talk about race, how we approach Covid, and how to decide when or if we return our children to schools,” Lee-Samuel says. “This uncertainty in how to manage day-to-day activities has set a new baseline of anxiety and dread as we try to navigate our lives.”
When individuals reach out for mental health care, that counseling is looking different than it ever has before.
Social distancing requirements have meant most counseling is now done virtually. This has helped provide more access to services, especially for those who lack transportation, therapists say. Despite the challenge of virtual visits, counselors are making connections with patients in new ways.
However, finding a private place to hold a session while quarantined at home — especially if living in small quarters with other people — can be a challenge. Lee-Samuel says she has conducted sessions with patients who connect with her from their cars, basements, or relatives’ homes.
Fazio has one patient who likes to walk and talk, so both Fazio and her patient sometimes go outside, in separate locations, and conduct the session on their phones while walking. “It’s quite lovely,” she says, noting that movement can help some people open up emotionally.
Other benefits from video therapy include getting to see a patient in their home setting, which can provide insight into their lives, Fazio says.
On the other hand, Saper has had some supposedly private meetings Zoom-bombed by uninvited visitors. Plus, technology can sometimes falter, with missed or slowed connections.
Indeed, not all patients have internet or smart devices available or know how to master video chat technology. Older people, for example, tend to prefer audio-only telephone calls, which means the clinician loses the ability to see the person’s face as they respond or process feelings.
If there is a thread of hope, it’s in the sense of community that some feel, which has arisen through shared suffering. Saper has found for the first time,
patients routinely ask him how he is doing.
“They’re showing empathy and concern, which you don’t expect from patients who are troubled,” he says. “Yet, I think the pandemic — because we’re all in the same boat — has made everybody more compassionate with each other and concerned for each other’s well-being and health and safety, which is really encouraging.”
Meanwhile, for Ashima Bhayana, the uncertainty continues. Her workplace may open for in-person work again in October. Or it may not. Or only for some employees. Nobody yet knows.
Either way, Bhayana continues to go to virtual teletherapy sessions, work from home, find comfort in playing with her dog, and hope for recovery — hers and the world’s.
Illustrations by Andrea Fowler
Republished with permission from Chicago Health magazine