Mental Health in the Age of COVID-19
Nithya Kasibhatla
Fall 2020
It is late July, and I look out the window of my childhood bedroom, casting my gaze over the peaceful street, lined with neatly mowed lawns and carefully tended gardens. Every now and then, people will pass the house: some are accompanied by friends, who walk alongside them from six feet away, while others are joined by their toddlers or pets. Sometimes, I see a group of kids biking, and, on days like today, I watch as one of them falls off his bike, pulls himself up, wincing and stumbling for a few steps, then gets right back on his bike and continues out of my field of vision.
Such sights have become commonplace for me after five months of social distancing. I can now recognize faces that I’d never before encountered in eighteen years of residence in this home. Like clockwork, I know exactly whom to expect to cross my field of vision, at what time of day. In a way, this constancy has lulled me into a strange sort of comfort. For someone like me, with nonessential-worker parents, living in a firmly upper middle-class neighborhood, such sights remind me constantly of the blessings I may once have taken for granted.
But as the days blend together and the current situation increasingly takes on a sense of pseudo-normality, the comforting constancy has become monotony; with it have come thoughts--of the future, my relationships, my identity--that, aided by the dearth of human contact, rarely fail to turn to negativity.
I am not alone in feeling such effects from our crisis and the consequential policy of social distancing. In times like this, it is only natural that people are worried: about their health and that of their loved ones, their financial situation, and what the future—never more obscure—will look like. And with social distancing, as well as the current political, social, and economic climate and our precarious position in an uncertain election season, there is no doubt that this is an extremely stressful time for people of all ages, cultures, and classes. Such stress can contribute greatly to the development or exacerbation of mental health struggles, especially depression, and anxiety (Loades et al., 2020).
Despite its significant benefits to preserving physical wellbeing, social distancing can be particularly dangerous to mental health. Humans are naturally social creatures: we benefit from physical touch, in-person communication, and the sense of intimacy and companionship that they bring. Studies on primate grooming habits have revealed that one primate’s contact with hair follicles of another can trigger axons that directly stimulate the reward system through the release of endorphins. While humans don’t necessarily have the need for the same sort of grooming, physical contact can still trigger such receptors and lead to a perceived emotional closeness with others that brings us pleasure (Bzdok & Dunbar, 2020). The coronavirus’s indomitable spread has made such positive physical contact risky and limited to the people with whom one is quarantined; for people quarantining alone or in a toxic familial environment, even that is deprived—an unfortunate albeit sometimes necessary evil.
Furthermore, studies on rodents have implied that social interaction is linked to oxytocin receptors in the brains of voles. Oxytocin, which is released by physical contact in both men and women, plays a role in bonding, trust-building, relaxation, and psychological stability (“About Oxytocin,” 2018). Antisocial montane voles were found to have fewer oxytocin receptors than the more social prairie voles. In humans, studies like the Trier Social Stress Test, which mimics high-stress situations with negative outcomes (i.e. doing poorly in a job interview, giving a speech and receiving criticism) by causing an increase in stress hormone cortisol have shown that oxytocin, along with social support, can reduce the cortisol spike normally triggered by such unpleasant social interactions (Ozbay et al., 2007).
More recent studies on the effects of the coronavirus have indicated that changes in interactions have led to a decrease in oxytocin levels and a subsequent increase in anxiety, fear, and loneliness in people. Interestingly, though, research has revealed that oxytocin levels can actually increase in response to stressful and isolating times, and possibly induce a person to engage in more social interaction. To this seemingly contradictory data, Emory University behavioral neuroscientist Larry Young says that oxytocin may help us connect the social information that we perceive to our reward system. As such, the effect it has on us—evoking stress or a desire for affection—often appears to hinge on our social context (Camero, 2020).
In a sense, we are better off than we might have been twenty years ago—and certainly more prepared than during the 1918 influenza pandemic. Many of us not only have access to Internet, cell phones, and video-calling technology, but also to broadcast news: a connection with the rest of the world, even as we hunker down in our own homes. But is virtual contact enough? Does it make up for the in-person contact we’ve lost access to?
Research has shown that in-person interaction—which allows for increased focus on one’s colleague or friend, direct eye contact, and attention to body language, gestures, and other such cues—leads to the greatest increase in oxytocin levels (“Virtual Meetings,” 2017). Video calls are not far behind, producing 80% as much of the hormone as face-to-face interaction (Camero, 2020). While virtual meetings are certainly far better than no contact, they don’t provide the same quality of interaction that we, as social creatures desirous of interpersonal networks (be they compact or extensive), might have enjoyed before the advent of COVID-19.
Reduced levels of oxytocin and endorphins from loneliness have been linked to increased stress, depression, anxiety, or both, along with a host of other health issues (cardiovascular disease, inflammation, functional decline, etc.) (Cochran et al., 2013; Berry, 2018; Singer, 2018). These negative effects associated with isolation, combined with those of the additional stressors that we as a society have faced over the last several months—backlash against police brutality, various environmental crises, the economic downturn, and the ever-present fear of COVID-19, to name a few—it is unsurprising that depression and anxiety have begun to run rampant throughout our society.
Prime evidence of this can be seen in studies from past pandemics: one study found that “children who had experienced enforced isolation and quarantine were five times more likely to require mental health service input and experienced higher levels of post-traumatic stress” in the aftermath of their isolation (Loades et al., 2020). Such findings suggest that our current social distancing efforts may similarly be followed by a rise in mental health challenges. Furthermore, preliminary data from China’s COVID-19-related enforced isolation shows that children and young adults have commonly begun to exhibit anxiety symptoms, such as clinginess and irritability, during and following quarantine (Loades et al., 2020).
In particular, isolation seems to pose a greater problem for the mental health of younger people (up to the age of 24), likely because many are at an age where their peers and social connectedness play an important role in shaping their sense of identity. As such, they appear to be especially vulnerable to the loneliness that comes with social distancing in the COVID-19 era, along with associated depression and social anxiety (Loades et al., 2020). Also at high risk are seniors, according to a report from the National Academy of Sciences: in addition to their high-risk standing in this pandemic, loss or separation from family and friends, chronic illness, and other impairments can make interaction more difficult and increase their stress levels (“The Health and Medical Dimensions,” n.d.; Miller, 2020).
That said, even in the face of the seemingly apocalyptic state of our world, most people are holding up well and making the best out of a bad situation. It is important that everyone is aware of how to take care of themselves in times of crisis, and in our technological age, the options for self-care have never been more abundant. Some experts’ recommendations--propagated efficiently through social media--on coping with stress are learning how to access treatment or support services, taking breaks from the (often grim) news through other distractions, staying active and taking care of one’s physical health, and keeping in contact with others (“Coping with Stress,” 2020).
Zoom, Microsoft Teams and other virtual conference applications are especially helpful for the latter recommendation, as, while they may not be as effective in connecting to others as face-to-face contact is, they are far better than cutting oneself off completely--an inadvisable path that is all too easy to fall into (“Coping with Stress,” 2020). Many people have turned to new hobbies, like knitting, yoga, or reading; others have constructed new routines to keep themselves grounded. Yet others make time to go outside (following social distancing rules and wearing masks, of course) and get some sun and fresh air.
Whatever the course taken, it is so important that every one of us tries to stay optimistic and pay particular attention to our mental health. We are living in a truly challenging, unprecedented time, and it is not difficult to get lulled into a sense of monotony and futility, or overwhelmed by the stress of uncertainty and fear. It has never been more vital to be sensitive to our own emotional state—after all, when we finally beat this virus, we’ve got the rest of our lives to live!
As I come to the end of my writing, I feel an urge to spend time with the people I miss. I message my friends to start a Zoom call, and while waiting for a response, I let my gaze shift out my window to my front yard. A woman walks past my house, cell phone to her ear. Apart from that, the only motion is the smooth swaying of the trees lining the streets. The occasional car passes—a reminder that life goes on, even in a pandemic. The sun shines down over my street, and though it casts rippling shadows, all I can see is the light.
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