• Pre-Collegiate Global Health Review

The Hidden Cost of COVID-19 in the United States: Depression, Substance Abuse, and Suicide

David Woo, Crean Lutheran High School, Irvine, California, USA


For the past two years, to say that the coronavirus pandemic has dominated the lives of every person on Earth is no understatement. In the United States alone, over 1,000,000 lives have been lost since January 2020 and the death toll continues to rise to this day (Johns Hopkins University, 2022). The Well Being Trust and Robert Graham Center predicted that nearly 75,000 additional people would die from suicide and drug abuse caused by the COVID-19 pandemic (Petterson et. al., 2020). Although governments around the world tried to stop the spread of COVID through public health strategies such as lockdowns, these measures proved to be an immediate source of controversy and discontent. People were cut off and isolated from one another, leading to adverse psychological consequences. Even when lockdowns were lifted, global trade dwindled, supply chains were disrupted, and labor markets experienced severe shortages (Petterson et. al., 2020). COVID-19 has caused a significant increase in emotional and psychological harm which has contributed to an alarming rate of suicide among youth and communities of color (Petterson et. al., 2020). While millions of deaths were directly caused by the virus, it is easy to overlook the negative consequences of drug overdose and suicide, precipitated by the mental stresses of the pandemic.


To contain the spread of COVID-19, many US states enacted shelter-in-place orders, and as a result, people were deprived of social interaction for months on end. This isolation led to a lack of human interaction that ultimately created the conditions for declining mental health (Brooks et. al., 2020). Studies conducted on individuals in isolation report that quarantine procedures have been linked to “negative psychological effects including post-traumatic stress symptoms, confusion, and anger… [and] long-lasting effects”. These psychological effects have been attributed partially to social stigmas and disruptions caused by quarantine (Brooks et. al., 2020).


Furthermore, social distancing policies have had negative economic consequences. Between March and June of 2020, nearly 49 million Americans filed for unemployment benefits in the United States (Fronstin & Woodbury, 2020). This mass lockdown disproportionately affected people from lower socioeconomic backgrounds. The hospitality industry in the US, which typically pays close to minimum wage, was forced to shut down for long periods of time, mostly impacting those under 25 years of age (King et. al., 2021). Since this population typically had little savings and assets, their livelihood and basic needs were threatened. Consequently, the rate of depression among adults began increasing at an alarming pace. Job loss and mounting pessimism in the media both contributed to this dramatic upswing in mental health issues. A 2020 study comparing responses from before and during the COVID pandemic showed that 27.8% of respondents displayed symptoms of depression, a three-fold increase from 2018. The study also found that lower-income individuals, defined as those with less than $5,000 in savings, were at a greater risk of developing depressive symptoms from more frequent exposures to stressors (Ettman et. al., 2020). The pandemic revealed the

pervasive socioeconomic inequalities that led to a depression and suicide crisis among people with low socioeconomic status.


Additionally, COVID-19 has been linked to increased drug use in quarantined populations. The CDC reported that 13% of Americans turned towards drug use to cope with COVID-19, and ODMAP (Overdose Detection Mapping Application Program), a national reporting system for Opioid overdoses, reported an 18% increase in overdoses in 2020 compared to 2019 (Abramson et. al., 2021). According to Professor Stoops of the University of Kentucky, the restrictions have led to “a perfect storm of factors that… increase drug use,” because “[p]eople are more stressed and isolated, so they make unhealthy decisions, including drinking more and taking drugs'' (Huff et. al., 2021). Due to COVID-19 related illness taking up nearly the full capacity of emergency medical services, access to immediate hospital care was limited, making drug overdoses even more dangerous (Huff et. al., 2021).


Other than drug abuse and depression, countless people suffered from some form of mental illness, as their lives were upended by the pandemic. People lost loved ones, jobs, and their self-esteem, as restrictions on daily life and the threat of a highly transmissible virus led to overwhelming stress. Many turned to drugs and alcohol to cope with pain, depression, and loneliness, which were linked with increasing suicidal ideation and self-harm. Studies suggest that substance abusers are six times more likely to commit suicide and that nearly 90% of suicide victims have one or more psychiatric disorders (Dragisic et. al., 2015). Clearly, adequate measures were not taken to treat the loneliness and mental illness exacerbated by the pandemic. If left unattended, these issues will create far-reaching negative consequences for society.


While there is no universal cure-all, the improved access to telehealth medicine during the pandemic is one silver lining. A recent study by the Department of Health & Human Services found that there was a 63-fold increase in telehealth utilization by Medicare patients, while behavioral health providers saw the greatest increase (Department of Human Health and Services et.al., 2021). These statistics are promising. Although telehealth comes with its own set of problems, such as accessibility issues, more health care organizations are continuing to adopt this new mode of care. Telehealth entails no risk of COVID transmission, and with modern biometric technology, such as smartwatches, doctors and psychiatrists are able to give a more holistic medical treatment that is more accessible to all kinds of patients. (Watson et. al., 2020).


Nevertheless, in order to effectively combat rising depression, it is imperative for telehealth to become even more accessible. Americans are more willing than ever to use telehealth, with nearly three-fourths of surveyed Americans stating that they are open to virtual care (Watson et. al., 2020). Improving mental healthcare access could allow more people to get the treatments they need. State and local governments have also funded telehealth initiatives to connect patients with professionals through web conferences or telephone in areas where specific health services are not readily available (Zhou et al., 2020). As new opportunities arise with telehealth, easier access to all forms of care can help combat the significant increase in depression, substance abuse, and suicide caused by the pandemic, particularly among people of low socioeconomic status.


References

Abramson, A. (2021, March 1). Substance use during the pandemic. Monitor on Psychology. Retrieved January 21, 2022, from https://www.apa.org/monitor/2021/03/substance-use-pandemic


Ali, F. (2021, April 27). Covid-19 pandemic results in increased substance use among regular drug users. Pharmacy Times. Retrieved January 21, 2022, from https://www.pharmacytimes.com/view/covid-19-pandemic-results-in-increased-su bstance-use-among-regular-drug-users


Brooks, S. K. (2020, February 26). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet. Retrieved January 21, 2022, from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30460-8/fulltext


Dragisic, T., Dickov, A., Dickov, V., & Mijatovic, V. (2015, June 8). Drug addiction as risk for suicide attempts. Materia socio-medica. Retrieved January 21, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499285/


Ettman, C. (2020, October 28). Six-months after COVID-19: The pandemic and mental health. The American College of Obstetricians and Gynecologists. Retrieved January 21, 2022, from https://www.acog.org/news/news-articles/2020/10/six-months-after-covid-19-pan demic-and-mental-health


Fronstin, P., & Woodbury, S. A. (2020, October 7). How many Americans have lost jobs with employer health coverage during the pandemic? How Many Have Lost Jobs with Employer Coverage During Pandemic? | Commonwealth Fund. Retrieved January 22, 2022, from https://www.commonwealthfund.org/publications/issue-briefs/2020/oct/how-many -lost-jobs-employer-coverage-pandemic


Huff, C. (2021, January 1). Drinking, coping and covid-19. Monitor on Psychology. Retrieved January 22, 2022, from https://www.apa.org/monitor/2021/01/alcohol-covid


Johns Hopkins University. (2022). U.S. Officially Surpasses 1 Million COVID-19 Deaths. Johns Hopkins Coronavirus Resource Center. https://coronavirus.jhu.edu/from-our-experts/u-s-officially-surpasses-1-million-covid-19-deaths#:%7E:text=Experts%20say%20the%20tragic%20milestone,vaccinations%20could%20have%20prevented%20fatalities.&text=The%20United%20States%20officially%20surpassed,Johns%20Hopkins%20Coronavirus%20Resource%20Center


King, B. (2021, May 18). Unemployment rate: How many people are out of work? BBC News. Retrieved January 22, 2022, from https://www.bbc.com/news/business-52660591


New HHS study shows 63-fold increase in Medicare telehealth utilization during the pandemic. HHS.gov. (2021, December 3). Retrieved March 5, 2022, from https://www.hhs.gov/about/news/2021/12/03/new-hhs-study-shows-63-fold-increa se-in-medicare-telehealth-utilization-during-pandemic.html


Petterson, Steve et al. “Projected Deaths of Despair During the Coronavirus Recession,” Well Being Trust. May 8, 2020. WellBeingTrust.org. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://wellbeingtrust.org/wp-content/uploads/2020/05/WBT_Deaths-of-Despair_COVID-19-FINAL-FINAL.pdf

Stephens, S. (2020, October 28). Six-months after COVID-19: The pandemic and mental health. The American College of Obstetricians and Gynecologists. Retrieved January 21, 2022, from https://www.acog.org/news/news-articles/2020/10/six-months-after-covid-19-pan demic-and-mental-health


Watson, Stephanie. “Telehealth: The advantages and disadvantages” Harvard Health, 12 Oct. 2020, www.health.harvard.edu/staying-healthy/telehealth-the-advantages-and-disadvantages.


Zhou, Xiaoyun, et al. “The Role of Telehealth in Reducing the Mental Health Burden from COVID-19.” Telemedicine and E-Health, vol. 26, no. 4, Mary Ann Liebert Inc, 1 Apr. 2020, pp. 377–379. Crossref, doi:10.1089/tmj.2020.0068.


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