As the effects of the COVID-19 pandemic linger, emotional, physical and financial stressors continue to impact the health and well-being of many Americans, and physicians are starting to see the consequences of that.
As of mid-August, the U.S. reported more than 5.4 million cases of COVID-19, resulting in more than 170,000 deaths. In Kansas, confirmed cases topped 34,600 by mid-August with 406 reported deaths from COVID-19.
While unemployment rates in August dipped slightly to 10.2 percent, extended economic uncertainties continue to fuel some of the highest unemployment rates in U.S. history.
The stress is taking its toll.
“We are beginning to see significantly more anxiety and depression in the community as the added stress, fear and isolation that comes with the pandemic impacts them,” said Rachel Brown, MBBS, professor and chair of the Department of Psychiatry at the University of Kansas School of Medicine-Wichita.
A Commonwealth Fund survey published this month found that Americans record greater mental health and economic challenges from COVID-19 compared with nine other high-income countries that also were surveyed.
The study showed that more than 30 percent of Americans face negative economic impacts due to the pandemic with one-third of U.S. adults experiencing stress, anxiety, and depression that is difficult to cope with on their own. Only about one in three U.S. adults were able to get help from a professional to deal with these feelings, researchers found.
“Nobody has any real information on what this virus means, how long it’s going to stay and what it’s going to feel like to them if they get infected,” said Wichita family physician Joe Davison, MD, who knows of two patients in his practice who have overdosed since COVID began.
“There’s no question in mind that it’s related, with the continual bombardment on TV and the constant conversation about the virus,” Davison said. “People are feeling hopeless. They don’t see a future or end to this. If they already have underlying mental issues, anxiety or depression, this is just aggravating or magnifying them.”
This may be the so-called “fourth wave” of the pandemic that some medical experts predicted would occur as the pandemic surges on. This wave encompasses the mental health and financial fallout from stresses created by the first waves, including the initial mortality and morbidity of COVID-19, the impact of restrictions on local resources, and the impact of interrupted care on chronic conditions.
It includes increased incidences of psychological trauma, mental illness, economic injury and burnout, according to Victor Tseng, MD, a pulmonary and critical care physician-scientist in Atlanta, who illustrated the health footprint brought on by the pandemic (right).
“We’ve absolutely seen an increase in anxiety, depression and even medication management,” said Shawna Allen, LMSW, LMAC, senior director of outpatient and addiction services for the Mental Health Association of South Central Kansas. MHA’s outpatient clinic at Harry and Webb serves 5,000 people in the community with services ranging from medication management to substance abuse treatment.
And while the incidents of mental health issues – including suicides – have gone up, the rate of people accessing services has gone down as people continue to be fearful of getting sick. Mental health experts fear this will create a bottleneck of sorts for services when people reach their breaking point.
“Just like people waiting too long to get help for a stroke or heart attack, they’re doing the same thing with mental health services,” Allen said. “But we know it’s inevitable that people will start walking through everyone’s door seeking help and we’re trying to do our best to prepare to handle mass groups of people.”
Allen and her colleagues are in the process of developing a virtual walk-in clinic, where people can complete a mental health intake from the convenience of their home. But she also encourages physicians who are comfortable prescribing mental health medications to step up and help manage the anxiety they are experiencing within their own patient caseloads.
“It’s a judgment call for each doctor and whether they’re out of their comfort zone,” Allen said. “But there are way more primary care physicians than mental health professionals in Sedgwick County. We’re the specialists. It’s good for us to take a look at it, to do a consultation, then send them back and let the primary care physician manage it.”
It is good for a mental health professional to take a look at the case and do a consultation, but the primary care physician can manage the patient, she said.
For physicians who are feeling the strain themselves – and who are particularly at risk for burnout as COVID-19 carries on – mental health experts strongly encourage a routine of self-care and coping strategies, including getting enough sleep, exercising, eating well, avoiding drugs and alcohol, and giving oneself the time and space to relax and unwind.
“It’s really easy for us to underestimate the toll all this takes on us,” KUSM-W’s Brown said. “But it’s important to stay positive, try to connect with other people, and to try to connect with whatever it is that gives your life meaning. Do all those things we’re always trying to get people around us to do. And do not be afraid to reach out and get help when you need it.”