6 Mental Health Issues Therapists Are Blaming on 2020
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This was a year to remember, or maybe to forget. Mental health experts weigh in on the short and long term impacts and trends emerging from the chaos of 2020.
Mental health and the year no one could have predicted
In April, more than 18 million people were unemployed; the rate still sits at twice the pre-pandemic rate, according to the U.S. Bureau Of Labor Statistics. The death toll from Covid-19 is well above 300,000 in the United States alone.
Most people can’t wait to wish good riddance to 2020, but erasing the mental trauma may take some time. While there are many surprising ways Covid-19 has changed America’s health, these are the trends mental health experts are most concerned about.
Surges in depression and anxiety
It’s clear that people would struggle with mental health during a pandemic, but the actual numbers are staggering. Depression symptoms tripled from their pre-pandemic rates, jumping from 8.5 percent before Covid-19 to 27.8 percent during the pandemic, according to a September study published in the journal JAMA Network Open. (Here’s why mild depression is rising during coronavirus.)
Researchers found that those with lower social and economic resources—and greater exposure to stressors such as job loss—reported a “greater burden” of symptoms, and predicted a “probable increase” in mental illness to come.
More people are struggling with suicidal thoughts, as well, though research suggests that deaths by suicide have not increased during the pandemic. Back in June, the Center for Disease Control and Prevention (CDC) reported that twice as many Americans had seriously contemplated suicide in the previous 30 days compared to 2018: 10.7 percent versus 4.3 percent.
The numbers were significantly higher for the 18-24 age group—one in four had considered suicide—and for Hispanics (18.6 percent), non-Hispanic Blacks (15.1 percent), unpaid caregivers for adults (30.7 percent), and essential workers (21.7 percent). (Here are the things therapists wish you knew about suicide.)
Josh Jonas, a psychotherapist and clinical director of the Village Institute for Psychotherapy in New York City, says that the 2020 increases in suicidal thoughts, but not necessarily a proven increase in suicide, aligns with what he sees in his patients.
“The majority of people who think about suicide don’t actually want to die. They just want the pain to stop. It makes sense that [during the pandemic] more would be feeling a kind of pain they don’t know what to do with,” he said.
He’s been working with patients whose symptoms are flaring based on a variety of pandemic related concerns: “Some are worried about getting sick, some are concerned about their relationship not going well, [some about] not getting their new business off the ground.”
If you or someone you know has had thoughts of self-harm or suicide, contact the National Suicide Prevention Lifeline (1-800-273-8255), which provides 24/7, free, confidential support for people in distress.
And don’t hesitate to reach out for help if you experience any symptoms of depression, such as persistent sadness, anxiousness, feelings of hopelessness or pessimism, loss of pleasure, sleep changes, fatigue, or physical symptoms that don’t respond to treatment. (Here are mental health tips from therapists if you’re dealing with depression during quarantine.)
Eating disorders on the rise
In the face of endless memes about the “quarantine 15” and other eating-related cultural phenomena, eating, exercise, and body image has been on people’s minds in 2020, as we stare at our own reflections in seemingly endless Zoom calls.
Robin Hornstein, a psychologist an eating disorder and body image specialist in Philadelphia, estimates the relapse rate at around 50 to 60 percent for those who have engaged in one official course of treatment. (She notes that the relapse rates vary based on the type of intervention or medical programs.)
“We are seeing an uptick in all eating disorders,” says Hornstein. She also points out that spending all day online doesn’t give people an accurate reflection of what they really look like, and she believes it’s increasing body dysmorphia in which people fixate on perceived flaws in their appearance.
(Here’s how to avoid emotional eating due to coronavirus stress.)
An Australian study published in the International Journal of Eating Disorders in June 2020 found increases in restricting foods, binge eating, and purging for those who had already had an eating disorder in the past; even in people with no history of disordered eating, the researchers discovered a jump in behaviors such as restricting food and binge eating.
The U.K. organization Beat Eating Disorders reported that nearly nine out of 10 people who had previously had an eating disorder experienced an increase in symptoms. The group has also seen an 81 percent increase in contacts to all of their helpline channels.
Triggers abound during the pandemic for those with eating disorder histories, says Hornstein: Isolation is a big one, especially for kids and teens whose social outlets are essential to emotional development.
Other triggers include family dynamics, financial challenges, trauma, and grief. She also blames the societal pressure to lose weight during quarantine, which can quickly spiral into disordered eating habits. (Here’s how one woman is managing her eating disorder during coronavirus.)
If you or a loved one is struggling with obsessive thoughts around food or your body, contact the National Eating Disorders Association helpline at 1-800-931-2237 or a local eating disorder professional.
The long-term impact on healthcare workers
Psychologist Paul Greene, the director of the Manhattan Center for Cognitive-Behavioral Therapy in New York, worries about the long-term impact of unthinkable choices healthcare workers have had to make.
“One thing that has me very concerned worldwide is if health care providers have to make choices about who gets care in the hospital because it’s overrun; this is much more likely to lead to PTSD because of the potential for self-blame,” he said.
Specifically, he worries about the mental health of emergency medical technicians (EMTs). They may have seen unexpected events, which he says is a key factor in how traumatic an event can be. “If you have a 96-year-old patient dying from heart failure, not many doctors have PTSD from that,[as much as from] seeing a 29-year-old patient dying from Covid.”
The increase in telehealth services’ availability increased the convenience of meeting with a mental health professional or asking questions to a doctor or nurse without leaving your home. But for many, losing a job (and health insurance) decreased access. (Here’s how to find a therapist or counselor if you can’t leave your house.)
Mental health programs are overwhelmed as well, and Hornstein said that she had moments where patients struggling with an eating disorder learn there’s a six-month wait for help. She’s responding to patients’ concerned relatives saying, “I’ve called 12 places, and no one has an opening.” She said she’s literally begging her at-capacity provider contacts to take patients. In the meantime, she’s recommending her patients start workbooks to self-treat while they wait.
If you or a loved one feel overwhelmed with emotions like sadness, depression, or anxiety, contact the Disaster Distress Helpline from the SAMHSA via call or text at 1-800-985-5990.
What happens when you mix extensive political and racial unrest with a pandemic? “Sanctimonious righteousness,” Jonas says. “Everybody is so sure that they are doing the right thing and everybody else who isn’t doing what they are doing is stupid or ignorant.”
Greene believes the politicization of Covid-19 is making things worse. “When it comes down to if someone’s going to wear a mask or not, it gets personal. There’s a perceived threat of death or danger,” he says, calling the situation “combustible.”
So if your relative doesn’t believe in the efficacy of masks or debates whether Covid-19 even exists, let them have their say and try to avoid these phrases that make arguments worse. Try some calming tactics like active listening (don’t interrupt, repeat back what you hear them saying), search for common ground, and maybe take a break (even a permanent one) from discussing politics. The divide between the two sides doesn’t seem to any closer than it was before the election.
(Here’s how a BIPOC mental health podcast helped this person through the pandemic.)
Throughout quarantine, couples began to spend more time together than ever before, which brought out the best and worst in couples, says Jonas.
More isn’t always better, he says, comparing relationships to desserts: “If a dessert recipe calls for 2 cups of sugar, I think if I put in 12 cups of sugar, it will be better, right? No, at some point, you get negative returns,” he says. “Relationships are the same way. They are about connection and intimacy. If we are going to be together all the time, that should help with connection, right? No.”
Jonas recommends couples who are experiencing relationship problems due to too much togetherness make space for the other person to have alone time to refuel. “Understanding this dynamic is so important. We have a biological need to recharge.”
Even if you can’t do your typical night out or a weekend with the guys or girls, find smaller and more socially distant ways to get some space, either alone or with friends, to ensure your relationship time can be high quality.
- Beat Eating Disorders: "Research reveals toll of the pandemic on those with eating disorders"
- Centers for Disease Control and Prevention: "Mortality and Morbidity Weekly Report"
- Centers for Disease Control and Prevention: "Using Telehealth to Expand Access to Essential Health Services during the COVID-19 Pandemic"
- Paul Greene, PhD, a psychologist and the Director of the Manhattan Center for Cognitive-Behavioral Therapy in New York
- Robin Hornstein, PhD, a psychologist working in the fields of eating disorders, disordered eating, and body image for 35 years in Philadelphia
- International Journal of Eating Disorders: "Eating and exercise behaviors in eating disorders and the general population during the COVID‐19 pandemic in Australia: Initial results from the COLLATE project"
- JAMA Network Open: "Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic"
- Josh Jonas, LCSW-R, psychotherapist and Clinical Director of the Village Institute for Psychotherapy in New York City
- Travel Medicine and Infectious Disease: "Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis"
- U.S. Bureau of Labor Statistics: "The Economics Daily"
- Anxiety and Depression Association of America: "Depression Symptoms"