Even as America hits a turning point in the pandemic, many Americans are struggling to reconcile a year's worth of "grief, anxiety, isolation, and rolling trauma" with getting "back to normal." It’s an ongoing challenge that could affect Americans for years to come, according to mental health providers.

How Covid-19 will impact behavioral health services

'An ongoing set of cascading collective traumas'

According to NBC News, public health efforts since the start of the pandemic have focused primarily on physical health—efforts to contain the spread of Covid-19 and care for those who contracted the coronavirus. However, as the country hits a turning point in the pandemic, experts say public health initiatives now need to focus on mental health.

"Our research has shown an increase in depressive symptoms, anxiety symptoms, and post-traumatic stress [PTSD] symptoms," Catherine Ettman, director of strategic development in the dean's office at Boston University School of Public Health and a doctoral student at Brown University School of Public Health, said.

According to preliminary results from Ettman's research, rates of depression have more than tripled amid the pandemic, with about 8.5% of the population reporting symptoms of clinical depression before Covid-19 and roughly 27.8% reporting such symptoms during the pandemic.

Similarly, CDC data indicates that the percentage of people experiencing symptoms of anxiety or depression has increased from 11% before the pandemic to 42% during the pandemic. These effects are particularly noticeable among young people. One study cited in the New York Times found that the share of those saying they had "seriously considered suicide in the past 30 days" was more than 25%. That number has increased significantly from 2018, when about 11% said they had considered suicide in the past year. 

Although America has made significant strides against the Covid-19, research suggests that these mental health issues will likely linger for some time to come, NBC News reports. For instance, a 2019 study found that 15 years after the 9/11 attacks, 14% of surveyed New York residents still displayed symptoms of post-traumatic stress disorder.

Further compounding the psychological issues are other events that many found difficult or stressful over the course of the past year, including the deaths of Breonna Taylor and George Floyd, the 2020 presidential elections, the recent wildfire season, and more. "This has been an ongoing set of cascading collective traumas that have really not abated," Roxane Cohen Silver, a psychologist at the University of California-Irvine, said.

"I'm very concerned about the effects being long-term," Luana Marques, an associate professor of psychology at Harvard Medical School, added. "Given that—consistently, globally—you've seen the levels of depression and anxiety high since last March, that tells me that we're going to see an increasing prevalence of mental health (problems) globally."

Radio Advisory episode: How behavioral health in the US is affected by Covid-19

Separately, Marie-Christine Nizzi, a postdoctoral researcher at Dartmouth College and the Brain Institute at Chapman University, said, "What we're likely to see as people 'return back to normal' is that it's not going to feel normal. They're not going to feel normal."

She added, "We're setting people up for failure by saying 'we're back to normal.' Are we? What exactly is 'back to normal'? The beach is open. OK. How does that impact the fact that I'm processing an entire year of a lot of things going wrong?"

How are these mental health issues manifesting?

These increased rates of mental health issues are affecting people in many ways, according to experts.

In particular, experts believe that many of those who were hospitalized for Covid-19 will struggle with PTSD. Based on research from Italy, about one-third of people hospitalized during the "height of the winter surge" in the United States will develop PTSD, the Atlantic reports. 

Meanwhile, families who have lost a loved one to Covid-19 may struggle more than is normal with grief, experts said, in part because the pandemic prohibited many common rituals around mourning and loss, such as funerals, wakes, and family gatherings. According to The Atlantic, as many as half a million Americans—including a dipropionate number of minority populations, who were more hard-hit by the pandemic than white populations—could suffer from so-called "prolonged grief," an "intense, all-consuming grief that persists for more than a year."

And according to USA Today, the "scale and complexity of pandemic-related grief" could linger for years, "leading to more depression, substance misuse, suicidal thinking, sleep disturbances, heart disease, cancer, high blood pressure, and impaired immune function." This prolonged grief could also undermine marriages and relationships, or even result in "broken-heart syndrome," when the heart's pumping chamber alters its shape, Ashton Verdery, an associate professor of sociology and demography at Penn State, said.

"Unequivocally, grief is a public health issue," Holly Prigerson, co-director of the Cornell Center for Research on End-of-Life Care, said. "You could call it the grief pandemic."

The pandemic has also had a notable impact on rates of substance misuse, the New York Times reports, with the number of Americans passing away following an overdose hitting a record-breaking 91,000 for the 12 months ending in October 2020. That increase stems in part from restrictions on in-person counseling and support groups, as well as overall increase social and economic insecurity and increased rates of isolation and loneliness.

3 strategies to build baseline emotional support

According to mental health experts, the increased rates of anxiety and depression may also be playing a part in the increased rates of aggressive behavior in recent months, including upticks in domestic violence, aggressive behavior on planes, and even anti-Asian hate crimes.

"We have seen, during the pandemic, increases in domestic violence and nondomestic violence and just people being too caught with each other and lashing out," Nicole Schramm-Sapyta, associate professor of the Practice at the Duke Institute for Brain Sciences, said. "Certainly anxiety, depression and PTSD can be both causes and results of all of those things."

All these stressors could come to a head as America continues to make progress against the coronavirus, experts said, and people start to return to normal. As experts pointed out, people who have endured long stretches of stress typically "collapse" when they have a moment of calm, according to The Atlantic.

"When you get a chance to realize that your safety or your family's safety is no longer at risk, you think, What was this experience like for me?" Jessi Gold, a psychiatrist at Washington University School of Medicine, said. "Your answer could be I haven't slept in months, or I feel miserable, or my kid is really angry and upset all the time. I think the curve (of mental-health problems) is likely to go up exponentially once people have time to even realize that mental health is part of the equation."

'These long-term effects are not going away'

According to experts, addressing this crisis will require increased access to mental health services. As Nizzi said, the issue cannot be "swept under the rug" once the country fully reopens.

Separately, Soo Jeong Youn, a research psychologist at Harvard Medical School and Massachusetts General Hospital, said the United States was not allocating sufficient resources to mental health care prior to the pandemic, and the country requires even more resources now. "This is not going away," she said. "These long-term effects are not going away."

Other experts noted that in addition to increased mental health care access, people need an overall sense of stability.

"You can't address emotional health if your basic needs are not met," Luana Marques said. According to Marques, that means there is a need in particular to provide necessary resources to communities of color, who have been especially hard-hit by the pandemic (Yong, The Atlantic, 5/20; Benson, NBC News, 5/18; Kristof, New York Times, 5/29; Szabo, Kaiser Health News/USA Today, 5/30; Benson, NBC News, 6/22).