Acute Mental Distress in Pandemic Could Up Future Psychological Disorders

Pharmacists should prepare themselves for helping to care for more patients in the future with severe mental illness. That is based on a survey finding significant increases in psychological distress during the COVID-19 pandemic. Authors warn that the situation could lead to higher rates of psychiatric disorders in coming years. Here are more details.

BALTIMORE – When the immediate health crisis of the novel coronavirus pandemic is finally under control, pharmacists and other healthcare professionals are likely to be dealing with another one.

A report in JAMA warns of  a more-than-threefold increase in the percentage of U.S. adults who reported symptoms of psychological distress -- from 3.9% in 2018 to 13.6% in April 2020, apparently related to the COVID-19 pandemic.

Johns Hopkins Bloomberg School of Public Health researchers fielded a survey online April 7 to April 13 to reach those conclusions.

 Researchers used the AmeriSpeak Panel from the National Opinion Research Center at the University of Chicago. That is a probability-based panel designed to be representative of the U.S. adult population and includes approximately 35,000 members. Response to the psychological distress survey was 70.4%, with a final sample of 1,468 adults.

The prevalence of symptoms of serious psychological distress was measured in the overall sample and among demographic subgroups using the Kessler 6 Psychological Distress Scale, with the validated measure of serious distress defined as a score of 13 or higher on the 0- to 24-point scale. The survey also measured the proportion of respondents who reported that they always or often feel lonely in response to the item “How often do you feel lonely?” with response options always, often, sometimes, rarely, and never.

Those results were compared to the 2018 National Health Interview Survey (NHIS), which used the Kessler 6 scale among 25,417 adults in household interviews.

Researchers found that, in April 2020, 13.6% (95% CI, 11.1%-16.5%) of US adults reported symptoms of serious psychological distress, relative to 3.9% (95% CI, 3.6%-4.2%) in 2018. Among the subgroups examined, in April 2020, symptoms of psychological distress were highest among young adults aged 18 to 29 years (24.0% [95% CI, 16.3%-33.8%]), adults with household income of less than $35 000 per year (19.3% [95% CI, 14.2%-25.6%]), and Hispanic adults (18.3% [95% CI, 11.2%-28.3%]).

Comparison revealed corresponding prevalence estimates for those three groups in 2018 were 3.7% (95% CI, 3.0%-4.6%), 7.9% (95% CI, 7.1%-8.6%), and 4.4% (95% CI, 3.7%-5.4%), respectively.

The lowest prevalence of serious psychological distress was observed in adults aged 55 years or older (7.3% [95% CI, 4.8%-10.9%]) in 2020.

“The prevalence of reported symptoms of psychological distress among US adults was higher in 2020 during the COVID-19 pandemic than in 2018,” the authors note. “This finding builds on prior research documenting psychological distress among health care workers responding to COVID-19.”

Those results don’t bode well for the future, with the authors pointing out, “The measure of serious psychological distress derived from the Kessler 6 scale has been shown to accurately predict serious mental illness, suggesting acute distress during COVID-19 may transfer to longer-term psychiatric disorders.”

A relatively smaller change in reports of loneliness in adult – it was 13.8% in 2020 and 11% in 2018 – suggests the cause of psychological distress is unlikely to be related only to that, according to the researchers.

"We need to prepare for higher rates of mental illness among U.S .adults post-COVID," suggests corresponding author Emma E. McGinty, PhD, of the Department of Health Policy and Management at Johns Hopkins Bloomberg School of Public Health. "It is especially important to identify mental illness treatment needs and connect people to services, with a focus on groups with high psychological distress including young adults, adults in low-income households, and Hispanics."

McGinty cautions that “distress experienced during COVID-19 may transfer to longer-term psychiatric disorders requiring clinical care. Healthcare providers, educators, social workers, and other front-line providers can help promote mental wellness and support."