Serious epidemics, like COVID19, affect mental health – both in short and intermediate terms. Let’s talk about this. 1/
Some initial analyses of the COVID19 epidemic suggested that mental health impact might not be as bad as many had feared. Indeed, in early days of the pandemic, people were surprised to not see a stark rise in suicide (though other mental health indicators did show problems). 2/
One study journals.sagepub.com/doi/pdf/10.117… concluded that psychological distress increased early in the COVID-19 pandemic but that most facets returned to pre-pandemic levels by mid-2020, and that there were notable signs of resilience in life satisfaction, loneliness, and suicide. 3/
But I think subsequent data and research into the mental health impact of COVID19 have proved this optimistic initial hope premature. 4/
Plagues, including COVID19, have affected the mental health of human beings for thousands of years, as discussed in #ApollosArrow -- amazon.com/Apollos-Arrow-… 5/
It's no surprise that plagues have mental health effects. During a serious epidemic, we lose our lives, we lose our livelihoods, and we lose our way of life. #ApollosArrow 6/
The Roman emperor and philosopher Marcus Aurelius noted, in 167 AD, that what he called the “corruption of the mind” was much more dangerous during an epidemic than “any such miasma and vitiation of the air which we breathe around us.” #ApollosArrow 7/
Henri Poincare said in 1900: “The plague was nothing: fear of plague was much more formidable.” #ApollosArrow 8/
And so the real-time mental health consequences of the COVID19 pandemic have indeed been material, as is typical of plagues -- including a rise in suicide rates. 9/
Disruptions related to the COVID-19 pandemic – including school closures, social isolation, economic hardship, family loss or illness, and reduced access to health care, let alone viral effects on the brain – pave the way for mental health effects, especially in young people. 10/
The pandemic is not the sole cause of mental health problems. An increase in suicide in young people obtained before COVID19, likely related to increased social media use, social stress (eg, gun violence, economic inequality), decline in religion, and changes in parenting. 11/
According to @CDCgov (cdc.gov/nchs/products/…), overall suicide rates increased from 2000 to 2018, and then declined somewhat between 2018 and 2020, just before COVID19 struck. 12/
Through 2020, the total age-adjusted suicide rate in the United States increased 35.2% -- from 10.4 per 100,000 in 2000 to 14.2 per 100,000 in 2018, before declining to 13.9 per 100,000 in 2019, and declining again to 13.5 per 100,000 in 2020. 13/ 
However, this latter decline from 2019 to 2020 (ie, prior to the COVID19 pandemic) did not apply to the 15-24 year age group, where rates of suicide anyway continued to increase, reaching 6/100,000 in females and 20/100,000 in males by 2020. 14/
From 2009 to 2021, the share of American high-school students who say they feel “persistent feelings of sadness or hopelessness” rose from 26% to 44%, the highest level ever recorded. The number injured during a suicide attempt increased from 1.9% to 2.5% from 2009 to 2019. 15/
Things got worse for the mental health of adolescents during the COVID-19 pandemic, as shown by data from the 2021 Adolescent Behaviors and Experiences Survey (cdc.gov/mmwr/volumes/7…), an online survey of a national sample of USA students in grades 9–12 (N = 7,705) 16/
During the 12 months before the survey in 2021 (in the midst of the COVID19 pandemic), the survey found that 44.2% of high school students had persistent feelings of sadness or hopelessness, 19.9% had seriously considered attempting suicide, and 9.0% had attempted suicide. 17/
And a more focused analysis of Emergency Department visits before and during the COVID19 pandemic found that, compared with the rate in 2019, there was a 31% increase in the proportion of mental-health–related ED visits among adolescents aged 12–17 in 2020. 18/
In June 2020, 25% of surveyed adults aged 18–24 years reported experiencing suicidal ideation related to the COVID19 pandemic in the past 30 days. 19/
During February 21–March 20, 2021, in the middle of the COVID19 pandemic, mean weekly Emergency Department visit counts for suspected suicide attempts were 50.6% higher among girls aged 12–17 years compared with the same period in 2019. (cdc.gov/mmwr/volumes/7…) 20/
The mental health of the elderly was also affected by the COVID19 pandemic — whether by the social isolation or by the direct effects of the virus on the brain — as this UK study documented jamanetwork.com/journals/jamap… 21/
The mental health impact of COVID-19 also relates partly to a direct effect of the virus, since it is known that coronaviruses (including SARS-CoV-1 and MERS) can affect the nervous system, biologically speaking. Here is a 2022 review: academic.oup.com/ijnp/article/2… 22/
With SARS-CoV-2, reports of CNS disorders appeared early, including anosmia, delirium, and stroke. Neuropsychiatric manifestations of SARS-CoV-1 and MERS included depression, insomnia, anxiety, and memory issues, all forewarning the potential for such outcomes with COVID19. 23/
And indeed, a fine cohort study of 236,279 COVID survivors provided evidence for substantial neurological and psychiatric morbidity observable 6 months after COVID-19 infection. via @maximetaquet et al in @TheLancetPsych sciencedirect.com/science/articl… 24/
Among 236,379 COVID19 patients, estimated incidence of a neurological or psychiatric diagnosis in following 6 months was 33.6% (95% CI 33.2–34.1), with 12.8% (12.4–13.3) of COVID19 patients receiving their first such diagnosis (sciencedirect.com/science/articl…). [thread continues...] 25/
Many of the mental health effects of the COVID19 pandemic — whether from the social trauma or viral infection itself — will persist after the immediate pandemic phase, as discussed in #ApollosArrow amazon.com/Apollos-Arrow-… 26/
The mental health consequences that will afflict some fraction of COVID19 patients are part of a larger phenomenon we will witness in our society: a COVID19 #disabilitybump. Perhaps 5M Americans will have some sort of physical or mental disability when the plague is over. 27/
Inventive new work by @ibtihalferwana & @lrvarshney with a difference-in-difference approach & county-level data on COVID cases & lockdown dates (to Dec 2020) suggests that COVID & lockdowns increased mental health care visits (ecologically speaking). medrxiv.org/content/10.110… 28/
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