Emerging data on mental health during the pandemic suggests a troubling future. Surveys show Americans have become more depressed and anxious, and experts in a variety of fields have argued that Covid-19 has changed society forever.
While the pandemic has undeniably caused extraordinary stress and sadness, research on human resilience suggests people will recover from the trauma of the pandemic faster than many realize. And while some groups may need longer-term mental health care, it is also true that the ability of humans to overcome adversity is often underestimated and that an overwhelming majority of people who suffer from trauma will not develop. no mental illness but will ultimately feel better.
As a psychiatrist, I see this firsthand with patients and colleagues. Most of my patients who suffered from clinical depression and anxiety before the pandemic did not deteriorate during the pandemic. Yes, they were stressed and worried, but I was struck by how this group has remained fairly stable.
Earlier in the pandemic, I also ran a support group for anesthesiologists at the hospital where I work. Every day, this group of men and women intubated people with severe Covid-19, exposing themselves to the virus and to the immense suffering of patients. But eventually the support group disbanded because the members felt they could cope without my help.
This is not to say that the impact of Covid-19 on mental health is not real, nor that it will not be lasting in some cases. It is real and it will persist for many. But it’s also important to stress that most people exposed to stress and trauma don’t necessarily develop clinical depression or post-traumatic stress disorder. Sure, they experience anxiety and sadness, but these mental health states can go away soon after the stress has subsided.
Studies suggest that up to about 90 percent of Americans have experienced a traumatic event, but the prevalence of PTSD is estimated at 6.8 percent. So, although exposure to traumatic events is common, only a small minority of people develop PTSD as a result. Follow-up studies of trauma victims with PTSD in the general population show that symptoms decrease dramatically within three months of the trauma and that about 66 percent of people with PTSD eventually recover.
Trauma does not reliably produce disease, which is important to remember when examining how people are responding to the pandemic as it unfolds. A recent study by the Centers for Disease Control and Prevention found that between August 2020 and February 2021, the percentage of adults with recent symptoms of anxiety and depression increased from 36.4% to 41.5% .
But most surveys like this assess symptoms at some point, which can be transient. These surveys are also conducted online, using rating scales that do not reliably establish a clinical diagnosis. Other research on people with diagnosed mental health problems has not found an increase in the severity of symptoms during the pandemic.
I have found that many patients find comfort in learning that most traumatized people do not develop psychopathology. The ability to cope with adversity is the essence of resilience – but that doesn’t mean there isn’t psychological distress. On the contrary, anxiety and sadness are common reactions, but these responses are generally manageable and temporary.
This is why many people who experience severe stress or trauma continue to lead healthy and productive lives. Not all stress is harmful to the brain, and many people locked in their homes during the pandemic largely faced some sort of manageable stress. Once normal life can resume, many people will start to feel much better.
Chronic uninterrupted stress that is not easily resolved, however, leads to a sustained increase in adrenaline and cortisol and can be harmful. Frontline workers have been exposed to this type of chronic stress during the pandemic and are therefore at much higher risk of developing clinical depression and anxiety. The pandemic has also had a disproportionate impact on people of color, who saw an increase in suicide rates in 2020, while overall suicide rates in the country plummeted. Ensuring that these groups have access to care will be essential for their mental and physical health.
Experts have long been interested in why some people are more resilient than others in the face of stress, including after events like wars and natural disasters. Part is genetic, and part is the circumstances of a person’s life. Things like having a stable income, family support, and access to health care can affect the way people deal with traumatic events.
But there are things people can do to promote emotional and physical resilience, including maintaining social connections, exercising regularly, and finding ways to reduce stress, among others. Social support, for example, has been shown to build resilience by increasing self-esteem and feelings of control. Social connection also inhibits the activation of fear and anxiety circuits in the brain.
There is no doubt that this has been a stressful and brutal year marked by untold loss and grief. I lost my gorgeous 94-year-old mother to Covid-19, and I’m still sad. But people should feel some relief from having sailed Covid up to this point, and remember the fact that humans are more resilient than we realize. We can bounce back.