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The Many Faces of Stress During the COVID-19 Pandemic

Emerging themes from population-based studies on stress during the pandemic..

Posted November 25, 2020 | Reviewed by Devon Frye

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Prior to the global pandemic, America had already been dealing with a host of pervasive stressors such as health care access, mass shootings , climate change , rising suicide rates, and an opioid epidemic. Fast forward to the present day, as our country continues to struggle with our new reality amidst the global pandemic, select groups of our country are facing greater stress and poorer outcomes. It’s important to consider the many factors that create stress and related mental health issues so we can find new solutions in an increasingly complex time.

There are two recent studies that help shed light on the trends creating increased challenges for many people:

Two months ago, the CDC published a study by Czeisler et al. that identified potential epidemiological trends in mental health amongst adults in the U.S. throughout a several-month period of the COVID-19 pandemic. This month, the American Psychological Association (APA), through its Stress in America initiative conducted by the Harris Poll on behalf of the APA, published their findings based on surveys of people across the United States focusing on how stress has been impacting their lives.

There are inherent limitations to both studies, including measurement bias due to self-reporting of symptoms without a clinician-based assessment and sampling bias. This limits the degree of generalizations we can make to the larger U.S. population.

However, we can identify themes based on these two studies and then examine how these have expressed themselves through individual patient narratives. These include:

Uncertainty of the Future

One of the greatest human fears is that of uncertainty, or loss of our sense of control. The pandemic has introduced a significant amount of stress due to uncertainty for Gen Z adults (ages 18-23) who are unable to attend college on campus or are encountering limited open jobs and career opportunities upon graduating. Gen Z adults report that the future of our nation is a significant source of stress with the majority also citing the U.S. presidential election as a stressful source of uncertainty.

Moral Injury as a Result of Human Injustice

Moral injury is defined as an inner mental conflict that results when one’s actions or obligations are in direct opposition to a person's values and beliefs. Largely due to the pandemic and sociopolitical climate, 2020 has brought increased awareness of systemic racism in our nation. Nearly 2 in 3 adults—regardless of race—report police violence towards minorities as a significant source of stress, up from 1 in 3 adults who responded with the same answer in 2016. Furthermore, minorities, in particular Black Americans, are most likely to report discrimination as a stressor.

Disruption of Customs and Traditions

Traditions offer us a way to celebrate, reflect, grieve, and commemorate milestones in our lives. Young individuals in particular are sacrificing their graduations, college experiences, and social celebrations, making them feel lost and without a sense of belonging. For some young adults, the pandemic has disrupted wedding celebrations which represent a major milestone being postponed or reduced in scope. Across all walks of life, funeral services for loved ones have been greatly limited in attendance, often being performed virtually. These impacts on religious ceremonies and holidays have created a great deal of grief and separation where there was once celebration and togetherness.

Caretaking Overload and Burnout

For many, the mandated sheltering-at-home orders have magnified the duties and responsibility of caregivers. If the caregiver has previously relied on a combination of school and professional care, the COVID-19 pandemic has introduced a larger source of stress of balancing work and family. This has led to fatigue, stress, and—in some cases— depression .

Grief and Loss

The pandemic has brought loss into the forefront. For many Americans, the pandemic has resulted in a loss of jobs leading to financial instability. The drastic reduction in social interactions has led to increasing loneliness . And the loss of loved ones—in some cases without having a chance to sit at a bedside or say goodbye—has led to an overwhelming sense of dread, pessimism , and a lack of closure. For all of us, the pandemic has changed the way that we live our lives and we have had to grapple with and grieve the loss of our “normal” lives.

Trauma Due to COVID-19 Exposure

Studies of frontline health care workers during the COVID-19 pandemic have shown that rates of trauma-related symptoms, depression, and anxiety have increased during the pandemic. These have been related to experienced helplessness related to treating severely ill patients in a stressed and overwhelmed health system that has not yet identified effective and consistent treatments. In addition, the experience of continually exposing themselves (and family) to a virus that can lead to a life-threatening illness creates elevated stress levels in front-line workers.

With all of these factors in play, it can feel overwhelming to support ourselves and others through this challenging time. It’s important to remember that we are resilient as humans and that there are solutions we can turn to.

Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049–1057.

https://www.apa.org/news/press/releases/stress/2020/report-october

Marc Lener, MD, is a psychiatrist in private practice in New York City and Founder and Chief Executive Officer of Singula Institute, a 501(c)(3) organization, whose vision is to transform mental health diagnostics and treatment for individuals at risk for anxiety and depression.

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Home — Essay Samples — Nursing & Health — Stress Management — Stress Cause And Effect

Stress Cause and Effect

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Published: Mar 13, 2024

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Causes of stress, effects of stress.

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The coronavirus ( COVID ‐19) pandemic's impact on mental health

Bilal javed.

1 Faculty of Sciences, PMAS Arid Agriculture University, Rawalpindi Pakistan

2 Roy & Diana Vagelos Laboratories, Department of Chemistry, University of Pennsylvania, Philadelphia Pennsylvania, USA

Abdullah Sarwer

3 Nawaz Sharif Medical College, University of Gujrat, Gujrat Pakistan

4 Department of General Medicine, Allama Iqbal Memorial Teaching Hospital, Sialkot Pakistan

Erik B. Soto

5 Graduate School of Public Health, University of Pittsburgh, Pittsburgh Pennsylvania, USA

Zia‐ur‐Rehman Mashwani

Throughout the world, the public is being informed about the physical effects of SARS‐CoV‐2 infection and steps to take to prevent exposure to the coronavirus and manage symptoms of COVID‐19 if they appear. However, the effects of this pandemic on one's mental health have not been studied at length and are still not known. As all efforts are focused on understanding the epidemiology, clinical features, transmission patterns, and management of the COVID‐19 outbreak, there has been very little concern expressed over the effects on one's mental health and on strategies to prevent stigmatization. People's behavior may greatly affect the pandemic's dynamic by altering the severity, transmission, disease flow, and repercussions. The present situation requires raising awareness in public, which can be helpful to deal with this calamity. This perspective article provides a detailed overview of the effects of the COVID‐19 outbreak on the mental health of people.

1. INTRODUCTION

A pandemic is not just a medical phenomenon; it affects individuals and society and causes disruption, anxiety, stress, stigma, and xenophobia. The behavior of an individual as a unit of society or a community has marked effects on the dynamics of a pandemic that involves the level of severity, degree of flow, and aftereffects. 1 Rapid human‐to‐human transmission of the SARS‐CoV‐2 resulted in the enforcement of regional lockdowns to stem the further spread of the disease. Isolation, social distancing, and closure of educational institutes, workplaces, and entertainment venues consigned people to stay in their homes to help break the chain of transmission. 2 However, the restrictive measures undoubtedly have affected the social and mental health of individuals from across the board. 3

As more and more people are forced to stay at home in self‐isolation to prevent the further flow of the pathogen at the societal level, governments must take the necessary measures to provide mental health support as prescribed by the experts. Professor Tiago Correia highlighted in his editorial as the health systems worldwide are assembling exclusively to fight the COVID‐19 outbreak, which can drastically affect the management of other diseases including mental health, which usually exacerbates during the pandemic. 4 The psychological state of an individual that contributes toward the community health varies from person‐to‐person and depends on his background and professional and social standings. 5

Quarantine and self‐isolation can most likely cause a negative impact on one's mental health. A review published in The Lancet said that the separation from loved ones, loss of freedom, boredom, and uncertainty can cause a deterioration in an individual's mental health status. 6 To overcome this, measures at the individual and societal levels are required. Under the current global situation, both children and adults are experiencing a mix of emotions. They can be placed in a situation or an environment that may be new and can be potentially damaging to their health. 7

2. CHILDREN AND TEENS AT RISK

Children, away from their school, friends, and colleagues, staying at home can have many questions about the outbreak and they look toward their parents or caregivers to get the answer. Not all children and parents respond to stress in the same way. Kids can experience anxiety, distress, social isolation, and an abusive environment that can have short‐ or long‐term effects on their mental health. Some common changes in children's behavior can be 8 :

• Excessive crying and annoying behavior
• Increased sadness, depression, or worry
• Difficulties with concentration and attention
• Changes in, or avoiding, activities that they enjoyed in the past
• Unexpected headaches and pain throughout their bodies
• Changes in eating habits

To help offset negative behaviors, requires parents to remain calm, deal with the situation wisely, and answer all of the child's questions to the best of their abilities. Parents can take some time to talk to their children about the COVID‐19 outbreak and share some positive facts, figures, and information. Parents can help to reassure them that they are safe at home and encourage them to engage in some healthy activities including indoor sports and some physical and mental exercises. Parents can also develop a home schedule that can help their children to keep up with their studies. Parents should show less stress or anxiety at their home as children perceive and feel negative energy from their parents. The involvement of parents in healthy activities with their children can help to reduce stress and anxiety and bring relief to the overall situation. 9

3. ELDERS AND PEOPLE WITH DISABILITIES AT RISK

Elderly people are more prone to the COVID‐19 outbreak due to both clinical and social reasons such as having a weaker immune system or other underlying health conditions and distancing from their families and friends due to their busy schedules. According to medical experts, people aged 60 or above are more likely to get the SARS‐CoV‐2 and can develop a serious and life‐threatening condition even if they are in good health. 10

Physical distancing due to the COVID‐19 outbreak can have drastic negative effects on the mental health of the elderly and disabled individuals. Physical isolation at home among family members can put the elderly and disabled person at serious mental health risk. It can cause anxiety, distress, and induce a traumatic situation for them. Elderly people depend on young ones for their daily needs, and self‐isolation can critically damage a family system. The elderly and disabled people living in nursing homes can face extreme mental health issues. However, something as simple as a phone call during the pandemic outbreak can help to console elderly people. COVID‐19 can also result in increased stress, anxiety, and depression among elderly people already dealing with mental health issues.

Family members may witness any of the following changes to the behavior of older relatives 11 ;

• Irritating and shouting behavior
• Change in their sleeping and eating habits
• Emotional outbursts

The World Health Organization suggests that family members should regularly check on older people living within their homes and at nursing facilities. Younger family members should take some time to talk to older members of the family and become involved in some of their daily routines if possible. 12

4. HEALTH WORKERS AT RISK

Doctors, nurses, and paramedics working as a front‐line force to fight the COVID‐19 outbreak may be more susceptible to develop mental health symptoms. Fear of catching a disease, long working hours, unavailability of protective gear and supplies, patient load, unavailability of effective COVID‐19 medication, death of their colleagues after exposure to COVID‐19, social distancing and isolation from their family and friends, and the dire situation of their patients may take a negative toll of the mental health of health workers. The working efficiency of health professionals may decrease gradually as the pandemic prevails. Health workers should take short breaks between their working hours and deal with the situation calmly and in a relaxed manner. 5

5. STIGMATIZATION

Generally, people recently released from quarantine can experience stigmatization and develop a mix of emotions. Everyone may feel differently and have a different welcome by society when they come out of quarantine. People who recently recovered may have to exercise social distancing from their family members, friends, and relatives to ensure their family's safety because of unprecedented viral nature. Different age groups respond to this social behavior differently, which can have both short‐ and long‐term effects. 1

Health workers trying to save lives and protect society may also experience social distancing, changes in the behavior of family members, and stigmatization for being suspected of carrying COVID‐19. 6 Previously infected individuals and health professionals (dealing pandemic) may develop sadness, anger, or frustration because friends or loved ones may have unfounded fears of contracting the disease from contact with them, even though they have been determined not to be contagious. 5

However, the current situation requires a clear understanding of the effects of the recent outbreak on the mental health of people of different age groups to prevent and avoid the COVID‐19 pandemic.

6. TAKE HOME MESSAGE

• Understanding the effects of the COVID‐19 outbreak on the mental health of various populations are as important as understanding its clinical features, transmission patterns, and management.
• Spending time with family members including children and elderly people, involvement in different healthy exercises and sports activities, following a schedule/routine, and taking a break from traditional and social media can all help to overcome mental health issues.
• Public awareness campaigns focusing on the maintenance of mental health in the prevailing situation are urgently needed.

CONFLICT OF INTEREST

The authors declare no potential conflict of interest.

AUTHOR CONTRIBUTIONS

B.J. and A.S. devised the study. B.J. collected and analyzed the data and wrote the first draft. E.B.S. edited and revised the manuscript. A.S. and Z.M. provided useful information. All the authors contributed to the subsequent drafts. The authors reviewed and endorsed the final submission.

Javed B, Sarwer A, Soto EB, Mashwani Z‐R. The coronavirus (COVID‐19) pandemic's impact on mental health . Int J Health Plann Mgmt . 2020; 35 :993–996. 10.1002/hpm.3008 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]