Public Health

What doctors wish patients knew about post-COVID anxiety

Sara Berg, MS , News Editor

Mental health has been negatively impacted during the pandemic. And as states begin to transition back to a pre-pandemic life, it may cause increased anxiety about reopening for many. While stress, fear, worry, sadness, exhaustion and numbness are normal—and expected—emotional responses to a health crisis such as the COVID-19 pandemic, the impact on mental health cannot go ignored.

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In addition, physical distancing and remote work have been necessary to cut the spread of COVID-19, but those measures can take a toll on people’s mental health by making them feel isolated and lonely, further increasing stress and anxiety. As more people become fully vaccinated and states begin to reopen, it is important to learn how to cope, to improve mental health and well-being.

“People are feeling overwhelmed, uncertain, anxious, helpless, frustrated, stressed and exhausted,” said AMA member Lisa MacLean, MD, a psychiatrist at Henry Ford Health System, an AMA Health System Program Partner. “With the worsening of—and gradual decline in mental health—we are also seeing anger, depression, insomnia and increased substance abuse as well as a reported increase in isolation and loneliness.”

In a recent discussion, Dr. MacLean shared what physicians wish patients knew about the pandemic’s effect on mental health and how to cope with this added stress.

“Some people can’t wait to finally feel free and go back to the way we were living without masks. However, for many, the lifting of the mask mandates creates fear and anxiety,” said Dr. MacLean. That’s because “for over a year we’ve been told that masks protect each other. We’ve been trained to fear the virus and that is not something that is going to go away overnight.

“We’ve also been told to distance ourselves from people, so it is going to create stress,” she added, noting that “not knowing who has been vaccinated or not adds additional anxiety.”

To overcome anxiety about reopening, “step back and pause,” but remember to stay up to date on the latest guidance from the Centers for Disease Control and Prevention “and then give yourself permission to take it slow,” Dr. MacLean recommended, emphasizing the need to “respect that everyone might be in a different place when it comes to wearing masks,” but to “be open and try not to fold under social pressure.”

“It’s going to take time for people to feel comfortable again and, for some, they may continue to wear masks indefinitely,” she said. “It’s only with time and people seeing the COVID numbers continue to drop that anxiety will be reduced and people will get more comfortable.”

“We are going to have to go through an uncomfortable stage before we get comfortable again,” Dr. MacLean said.

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Some of the mental health conditions experienced during the pandemic are “anxiety, trauma-related disorders, depression, domestic violence, substance abuse disorders and even suicide,” said Dr. MacLean, adding that “it’s critical right now that people acknowledge the stress of the pandemic.”

But what are the symptoms of stress and how does it affect mental health? They include:

  • Anxiety.
  • Feeling powerless.
  • Low motivation.
  • Feeling tired or burned out.
  • Sadness.
  • Poor concentration.
  • Insomnia.

“For some front-line workers who have witnessed high death volumes, you might see acute stress disorder, post-traumatic stress disorder [PTSD] or secondary traumatic stress,” she said. “We are also seeing compassion fatigue and burnout from chronic workplace stress and exposure to traumatic events related to the COVID-19 pandemic.”

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Even after the pandemic ends, “the mental health fallout from the pandemic will continue to grow,” said Dr. MacLean. “History has shown that the mental health impact of disaster outlasts the physical impact, suggesting that today’s elevated mental health need will continue well beyond the coronavirus outbreak itself.”

Additionally, “many communities are seeing an increase in domestic violence, drug overdose and suicide,” she said, adding that “in some areas, mental health and suicide-hotline use have dramatically increased.”

“Women and people of color seem to be more negatively impacted,” said Dr. MacLean, adding that “the impact of the pandemic on the social determinants of health such as employment, income levels, housing and food security have threatened people’s basic survival.”

“The exacerbation of the social determinants of health will last for years and have a long-term negative implication for mental health,” she said. 

“People are getting tired of physical distancing, mask wearing and other pandemic-mitigation behaviors,” said Dr. MacLean. “Many are feeling exhaustion after months of spending extra time and energy dealing with our new pandemic lifestyle and all the struggles it’s brought on.

“Finding effective ways to address this fatigue and reinvigorate public vigilance is a growing challenge in controlling the spread of the virus,” she added. “Unfortunately, this fatigue can also lead to stress, which over times can result in exhaustion, anger and anxiety.”

Read about what doctors wish patients knew about pandemic fatigue.

“The problem with coronasomnia is real and widespread—it appears to be impacting people across all ages,” said Dr. MacLean. “Some experts say the coronavirus has caused a secondary pandemic of insomnia. This worsening is likely related to stress and anxiety.

“Another contributor is the loss of normal routines. We barely go out and the many things that connected us to the greater world like movies, restaurants and other social places have been negatively impacted,” she added. “For many, our lives have become repetitive. We lack stimulation and activities, and this contributes to our poor sleep.”

“Unfortunately, the more you can’t sleep, the more you worry and the more you don’t sleep,” Dr. MacLean said. “More than ever, it’s important to have good sleep hygiene to manage and prevent insomnia.”

Discover the six things doctors wish patients knew about coronasomnia.

“We are all frustrated that after a year of following the rules, the pandemic is still here and has significantly changed our lives,” said Dr. MacLean. “This change is difficult to accept and, for many, has caused significant distress and suffering.”

“It’s important for us to acknowledge our anger but also take a step back—anger is often a secondary emotion that stems from fear, helplessness, depression and anxiety,” Dr. MacLean said. “We need be aware of and learn to be comfortable with angry feelings but to not lash out in aggressive ways that only makes things worse.”

“Right now, is when you need to lean into self-care,” Dr. MacLean said, noting that “techniques like distraction, giving yourself a break from the endless to do list and exercise are all good ways to manage your negative feelings.”

Read about what doctors wish patients knew about coping with pandemic anger.

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“Children have been impacted by the lack of structure related to home schooling—they need schedules, predictable rules and set expectations,” said Dr. MacLean. “It’s not uncommon to see an exacerbation of behavioral issues when routines are disrupted.

“For kids in high school and college, there is growing concern about the loss of connection as these young adults try to navigate graduation and early college experiences,” she added. “The closing of campuses and online learning has impacted people’s sense of belonging, which can result in increased anxiety and depression.”

Additionally, “for adults, there is the stress of trying to support a family, homeschool children and financial stress,” Dr. MacLean said, adding that “many have experienced job loss or income insecurity” and “the rates of depression and anxiety appear to be worse for mothers with children than for fathers.”

“In terms of our elderly, many report increased loneliness and isolation,” which is “particularly difficult for our older adults,” she said.

“Don’t be afraid to reach out for help if needed,” said Dr. MacLean, adding that “physical distancing doesn’t mean you can’t go outside” because “feeling the sunshine on your face and breathing in fresh air can be rejuvenating.”

Other coping mechanisms include connecting with others, taking a break from the news, sticking to a schedule or routine, being kind to yourself and focusing “on the basics like exercise, hydration and good nutrition,” she explained. “The silver lining is that the pandemic has created space in our lives to slow down, spend time with our immediate family, refocus on what’s important and connect with one another in new ways.

“For some there is post-traumatic growth, where we see people becoming more resilient, dealing with effectively with challenges, and finding new resources they didn’t know existed,” Dr. MacLean added.

“The most important thing you can do to take care of others is make time to take care of you,” said Dr. MacLean, adding that “a few things aren’t canceled: empathy, caring, thoughtfulness, kindness and faith in humanity.”

“Make sure to reach out and stay connected. Consider elderly neighbors and help out when you can,” she said. “Deliver meals, help with lawn care or even help a neighbor take their garbage to the street—find ways to be of service to others.”