April 27, 2020
The COVID-19 pandemic is causing stress for many people. Fear and anxiety about a disease can be overwhelming and cause strong emotions in adults and children, according to the U.S. Centers for Disease Control and Prevention.
Dr. Thad Ulzen is professor and chair of the Department of Psychiatry and Behavioral Medicine at The University of Alabama College of Community Health Sciences. He said people already struggling with mental health issues before COVID-19 might be seeing their symptoms worsen because of increased worry and uncertainty.
Even people who weren’t experiencing mental health issues before COVID-19 might be struggling now, said Ulzen, a psychiatrist who also practices at University Medical Center, which is operated by the College.
“Then we have different varieties of problems depending on whether people have been in contact with individuals who have COVID-19 or have the potential for contact with people with COVID-19 in their line of work, or if they know people who have been ill or have died (as a result of COVID-19),” he said.
Ulzen said people who have anxiety worry a lot, and during a time like this might worry even more. “They might become afraid of getting out of their houses and being involved in their normal activities because of fear they might be exposed or that they might get sick.” He said sleep might be affected because people “could stay up at night worrying about what the next day might be like.” He said while people should be staying home and practicing social distancing, “one of the backdrops of all of this is that before, even if you were home, you knew you were free to go out and do whatever you wanted to do. But now if you do want to go out and do something, you become worried. So, it is a little different.”
Ulzen recommends that people reach out – to a therapist or health provider, or to friends, family and supportive people – if they’re experiencing anxiety. He said there are various tools that can be used so that social distancing is maintained. “We are reaching out to our patients virtually, and they’re also able to reach out to us by phone to set up virtual (telemedicine, phone, and Zoom video) appointments so that we can support them during this period.” He said the tools that many people are already familiar with and used before COVID-19 can be used now (email, texts, FaceTime, Zoom, etc.). “They’ve become an essential part of our wellbeing,” he said.
UMC has offered telemedicine visits for mental health since 2007. “We’ve been doing this for a while, particularly for our clients in rural communities that could not drive (to Tuscaloosa) to see us, so we’re very comfortable doing it,” Ulzen said. He said most patients do quite well with virtual sessions. “If they’re patients that you know already, there’s often not a problem. But even with new patients, because it is their access to help, any initial concerns are easily overcome. And because people already communicate socially by FaceTime and others, talking on a screen to somebody is not that novel anymore in our culture.”
In addition to anxiety, Ulzen said depression is another psychological response to COVID-19. He said, in a way, we have to look at this current crisis almost as a traumatic event. He said the trauma can be the fear people experience about possibly being exposed to the virus, or the worry they have about family members and friends being exposed. “Sometimes people have catastrophic thoughts, like what’s going to happen to the way that we live, and are we ever going to get through this.” He said this can worsen symptoms in people who already have depression, and even people who are not depressed, but because of social distancing and being isolated from people who provided them with good social interaction and support, could become depressed. “Major depression is a medical condition and it is different from just being sad,” Ulzen said. “Patients with major depression need treatments to keep their moods regulated, and external stressors, like being in the middle of a pandemic, can make them worse. So, they do need to see their doctors and their therapists probably more often.”
Depression is treated mostly in two ways, depending on how severe it is, Ulzen said. “If it’s not too severe, psychotherapy and cognitive behavioral therapies are usually good enough to help a person look at things differently and make some changes in their lives. If it (depression) is moderate or more severe, then it means a person has a real neurochemical change in their brain that is making them feel sad and depressed, and those individuals usually require some medication, like an anti-depressant.”
Simple things, like not wanting to get out of bed in the morning, or not getting enjoyment from activities that previously provided enjoyment, Ulzen said. “More importantly, if a person begins to have suicidal thoughts, then they definitely need to reach out to us or to someone,” he said.
It’s understandable that someone might be concerned about asking if a person is suicidal or having suicidal thoughts, but Ulzen said people (with those thoughts) are actually relieved to be asked. “When someone tunes into it and asks, they feel like somebody understands what they’re going through.”
Ulzen said how families cope with social distancing and stay-at-home orders can be another source of stress. He said there can sometimes be increased spousal abuse and child abuse during times like these. “Children who would normally be in school are now at home and parents may not be getting the relief they were getting every day, Monday through Friday, when we were living as we normally did,” he said. “Some parents are not well equipped or well prepared (for this) and it does lead to a negative outcome.” He said there are social services available for victims of abuse, and “these organizations are also adapting to our current situation and advising people as best they can.” Ulzen said an increase in substance abuse and alcoholism can occur during times like these. “The people who are mostly at risk are people whose roles have changed, people who are breadwinners of their families who are no longer getting the kind of validation they were getting from working and looking after their families.”
The pandemic is experienced differently by people in different age groups, Ulzen said. “Children are having a different experience because they are not going to school anymore, they’re at home. So, the challenge for parents is to create enough structure at home so that their (children’s) experiences are as close as possible to what they had in school. Older children and teenagers are probably more concerned about the fact that they’re not able to see their friends as much anymore. Working parents, especially those who may have lost their jobs, that could be a factor in domestic abuse. The people whose lives might not have changed very much may be older people who have sort of gotten used to being not so connected to people, but even then, the fact that people aren’t able to reach out to them like they used to could be a source of stress.”
Ulzen said children are not always able to verbalize feelings of anxiety and depression like adults can. “A young person will feel very overwhelmed, and it would affect their behavior. They might try and leave a place all of a sudden, knock something over because they’re just overwhelmed with anxiety. So, you will see it in new behaviors that may not have been present before all of this,” he said.
Health-care workers and first responders will likely be impacted differently because they “are the folks in our community who are truly on the front line, who are having to provide care for the rest of the population and in doing so who are potentially exposing themselves to risk,” Ulzen said. He said UMC is offering group therapy sessions for its health-care workers and supporting them through this period.
