High Anxiety in America Over COVID-19

Pauline Anderson

March 28, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's  Coronavirus Resource Center.

A national survey from the American Psychiatric Association (APA) shows COVID-19 is seriously affecting Americans' mental health, with half of US adults reporting high levels of anxiety.

Given the circumstances, this is hardly surprising, said APA president Bruce J. Schwartz, MD, but he cautions that if the pandemic continues much longer the impact on Americans' mental health could become much worse.

Dr Bruce Schwartz

"The survey results show that the majority of the public is reacting appropriately to the coronavirus pandemic, that there is a fear and anxiety, but it looks to me to be within normative levels," Schwartz, who is also deputy chairman and professor, Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, New York City, told Medscape Medical News.

"I would be concerned if the levels of anxiety were too much lower because that would tell me that people are not necessarily taking necessary precautions," he added.

However, he cautioned, rates of mental distress in the country could surge if the pandemic continues for much longer.

"Depending on how long this goes on, you might get into a situation where you have people experiencing chronic stress, which is a very different phenomenon. We have learned from other disasters that chronic stress has an effect on people's physical health and mental health," said Schwartz.

Serious Impact on Daily Life

The survey data were derived from a nationally representative sample of 1004 adults from March 18-19. Respondents were mostly white (74%) and ranged in age from 18 to 91 years (mean age, ~47 years).

Almost half of survey respondents (48%) reported feeling anxious about the possibility of contracting COVID-19 and 40% said they're anxious about becoming seriously ill or dying from the virus.

However, far more respondents (62%) are anxious about the possibility of family and loved ones falling ill.

More than one third of survey respondents (36%) said COVID-19 is seriously affecting their mental health, and most (59%) said it's having a serious impact on their daily life.

Almost half of respondents said they worry about running out of food, medicine, and/or supplies.

Most survey respondents (57%) said they're concerned the pandemic will have a serious impact on their personal finances and two thirds (68%) fear it will have a long-lasting impact on the economy.

In light of this, Schwartz also noted that these rates could well be higher now as the poll was conducted before many Americans started losing their jobs and experiencing the resulting financial effects.

About 19% of respondents reported they are having trouble sleeping, 8% report consuming more alcohol or other drugs/substances, and 12% report fighting more with a partner or other loved ones because they are stuck at home together.

About a quarter of respondents (24%) reported they have had trouble concentrating on things other than the pandemic.

Most respondents (68%) report they feel knowledgeable about COVID-19 and how to prevent its spread. About one third of adults are concerned about not being able to access tests and healthcare if needed.

Interestingly, the poll results shows that older Americans are less anxious than their younger counterparts about the virus.

"Maybe being older means you're a little wiser and a little more worldly," said Schwartz. "If you're of a certain age, you will have lived through the Vietnam war, or 9/11. With age comes perspective."

Practice Changer

The COVID-19 pandemic, which has essentially eliminated face-to-face consultations, has significantly changed the way psychiatrists are delivering care. For example, most therapy sessions are now being carried out over the telephone, with some done via telepsychiatry.

A "terrific benefit" of this is that since patients are essentially homebound, clinicians are very successful at reaching them and "there are very few no-shows," said Schwartz.

"So, in a certain sense, we're delivering more services right now to more patients than we were before."

Patients with anxiety disorders, many of whom have heightened worries now with the coronavirus, are getting proper treatment and counseling, said Schwartz.

However, he is concerned about the two thirds of patients with these disorders who don't typically seek treatment and who might be experiencing increased suffering during the pandemic.

Another important mental health focus is on the frontline healthcare providers who work very closely with those infected with coronavirus, said Schwartz.

"They're clearly experiencing every emotion in terms of anxiety and grief for patients who have died and their families. Clearly, meeting their mental health needs has to be an important focus."

The poll highlights both the anxiety caused by the pandemic and the need for clear, consistent communications on how to prevent the spread of COVID-19, APA CEO and Medical Director Saul Levin, MD, said in a press release.

"In the disruption COVID-19 is causing, everyone needs to make sure they are taking the time to take care of their own physical and mental health, alongside their families, friends, and work colleagues," Levin said.

Social isolation can be prevented, Levin added, by using social media, letters, "or simply the phone to communicate with loved ones and friends."

The poll was conducted online via a Porter Novelli PN View (using Engine's online CARAVAN® Omnibus survey). The margin of error was +/- 3.1% at the 95% confidence level.

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