COVID-19 could lead to an epidemic of clinical depression

The health care system isn't ready for that, either.

Coronavirus could lead to a clinical depression epidemic
Victor J. Blue/Getty Images

Isolation, social distancing and extreme changes in daily life are hard now, but the United States also needs to be prepared for what may be an epidemic of clinical depression because of COVID-19.


We are clinical psychological scientists at the University of Washington's Center for the Science of Social Connection. We study human relationships, how to improve them, and how to help people with clinical depression, emphasizing evidence-based approaches for those who lack resources.

We do not wish to be the bearers of bad news. But this crisis, and our response to it, will have psychological consequences. Individuals, families and communities need to do what they can to prepare for a depression epidemic. Policymakers need to consider – and fund – a large-scale response to this coming crisis.

A perfect storm of depression risks

Most of us know the emotional components of depression: sadness, irritability, emptiness and exhaustion. Given certain conditions, these universal experiences take over the body and transform it, sapping motivation and disrupting sleep, appetite and attention. Depression lays waste to our capacity to problem-solve, set and achieve goals and function effectively.

The general public understands depression as a brain disease. Our genes do influence how easily we may fall into clinical depression, but depression is also, for most of us, substantially influenced by environmental stress. The unique environmental stressors of the COVID-19 crisis suggest that an unusually large proportion of the population may develop depression. This pain is likely to be distributed inequitably.

Health care workers are at risk for depression from COVID-19

Health care workers, first responders, and others on the front lines are at risk for depression from COVID-19.

Anthony Kwan/Getty Images

Stress and loss

Exacerbating the widespread stress of this crisis, many of us are suffering significant personal losses and grief reactions, which are robust predictors of depression. The ongoing and unpredictable course of these stressors adds an additional layer of risk.

As this crisis unfolds, death tolls will rise. For some, especially those on the front lines, acute experiences of grief, trauma and exhaustion will compound the stress and place them at even greater risk.

Interpersonal isolation

Prolonged social isolation - our primary strategy to reduce the spread of the virus - adds another layer of risk. Our bodies are not designed to handle social deprivation for long. Past studies suggest that people forced to "shelter in place" will experience more depression. Those living alone and lacking social opportunities are at risk. Loneliness breeds depression.

Families, who must navigate unusual amounts of time together in confined spaces, may experience more conflict, also increasing risk. China experienced an increase in divorce following their COVID-19 quarantine. Divorce predicts depression, especially for women, largely due to increased economic hardship over time.

Financial difficulties

The biggest stressor for many is financial. Unemployment and economic losses will be severe. Research on past recessions suggests that rising unemployment and financial insecurity lead to increased rates of depression and suicide. Home foreclosures during the 2008 recession produced a 62% increased risk of depression among those foreclosed.

The mental health burden of economic recession will be distributed inequitably. When the stock market crashed in 2008, the rich experienced large wealth losses but not increased rates of depression. In contrast, those who experience unemployment, debt and financial deprivation during recessions are at significant risk for depression due to increased stress and difficult life circumstances. Minority-owned businesses may be at particular risk for buckling under the strain.

Recovery will be harder

While the COVID-19 crisis increases risk for depression, depression will make recovery from the crisis harder across a spectrum of needs.

Given depression's impact on motivation and problem-solving, when our economy recovers, those who are depressed will have a harder time engaging in new goal pursuits and finding work. When the period of mandated social isolation ends, those who are depressed will have a harder time re-engaging in meaningful social activity and exercising.

When the threat of coronavirus infection recedes, those who are depressed will face increased immunological dysfunction, making it more likely they will suffer other infections. Depression amplifies symptoms of chronic illness. The inequitable distribution of the burden of the crisis will exacerbate existing racial health disparities, including disparities in access to depression treatment.

What to do?

Self-help suggestions are readily available. A good list, more evidence-based than most, is here. It is our experience, however, that such self-help encouragements for depression are not enough, and at times even insulting, for those who are truly struggling.

We need higher-level shifts in policy and how we approach the problem. Economic relief measures from the federal government are crucial responses both to economic recession and psychological depression. We call for a public health campaign to increase awareness of depression and treatment options, and for improvements in mental health sick-leave policies and insurance reimbursement to minimize barriers to treatment access.

How we talk about depression must change. The distress we feel is a normal human response to a severe crisis. Acknowledging and accepting these feelings prevents distress from turning into disorder. Describing depression solely as a brain disease increases helplessness and substance use among those who are depressed and decreases help-seeking. Emphasizing the causal role of our environmental context, in contrast, matches how depressed individuals across different ethnicities view the causes of their suffering, decreases stigma and increases help-seeking.

Finally, we recommend specific treatment options be prioritized. As we have discussed elsewhere, easy-to-train, cross-culturally applicable and effective treatment options exist. We wish for an army of practitioners to be trained and embedded in community and treatment centers across the country, and this army should represent the great diversity of our country.

Depression costs the U.S. economy US$210 billion yearly. That is under normal conditions. An epidemic of depression requires a multi-faceted, multi-level response.

Jonathan Kanter, Director of the Center for the Science of Social Connection, University of Washington and Katherine Manbeck, Doctoral candidate, psychology, University of Washington

This article is republished from The Conversation under a Creative Commons license. Read the original article.

From Your Site Articles
Related Articles Around the Web
Credit: fergregory via Adobe Stock
Surprising Science
  • Australian scientists found that bodies kept moving for 17 months after being pronounced dead.
  • Researchers used photography capture technology in 30-minute intervals every day to capture the movement.
  • This study could help better identify time of death.
Keep reading Show less
Credit: Willrow Hood / 362693204 via Adobe Stock
13-8

The distances between the stars are so vast that they can make your brain melt. Take for example the Voyager 1 probe, which has been traveling at 35,000 miles per hour for more than 40 years and was the first human object to cross into interstellar space. That sounds wonderful except, at its current speed, it will still take another 40,000 years to cross the typical distance between stars.

Worse still, if you are thinking about interstellar travel, nature provides a hard limit on acceleration and speed. As Einstein showed, it's impossible to accelerate any massive object beyond the speed of light. Since the galaxy is more than 100,000 light-years across, if you are traveling at less than light speed, then most interstellar distances would take more than a human lifetime to cross. If the known laws of physics hold, then it seems a galaxy-spanning human civilization is impossible.

Unless of course you can build a warp drive.

Keep reading Show less

Just when the Middle Ages couldn’t get worse, everyone had bunions

The Black Death wasn't the only plague in the 1300s.

By Loyset Liédet - Public Domain, wikimedia commons
Culture & Religion
  • In a unique study, researchers have determined how many people in medieval England had bunions
  • A fashion trend towards pointed toe shoes made the affliction common.
  • Even monks got in on the trend, much to their discomfort later in life.
Keep reading Show less
Quantcast