Intramural NIMH Looks at Pandemic’s Mental Health Impact
The Covid-19 pandemic’s impact on daily life has negatively affected people’s mental health, said Dr. Joyce Y. Chung during a recent virtual Clinical Center Grand Rounds.
“We know why things have changed,” said Chung, NIMH deputy clinical director. “But do we really know how these changes have affected us? It’s something that we really need to understand.”
Public health actions, such as physical distancing and mask wearing, are critical to slowing the spread of Covid-19, but they have rapidly and dramatically changed our lives.
Schools transitioned to remote learning. Office employees teleworked while frontline workers, such as health care providers and grocery store employees, became essential. Large indoor social gatherings were discouraged. Families—especially those with older relatives in long-term care facilities—experienced isolation.
“It’s quite odd to consider our lives one year ago today, what we were doing, what we took for granted and how we are living today,” Chung said.
One survey conducted by the Centers for Disease Control and Prevention found that 40.9 percent of respondents experienced at least one adverse mental or behavioral health condition, including depression or anxiety, trauma or stress related to the pandemic, increased substance use to cope, or thoughts of suicide. She noted younger adults, racial and ethnic minorities and essential workers had disproportionately worse mental health outcomes.
Another study found the pandemic disproportionately affected older adults, frontline health care workers, people with pre-existing poor physical health and those unemployed with income insecurity.
NIMH’s intramural research program quickly launched several projects in response to the pandemic. Specifically, the program wanted to study effects of Covid-19 stressors on mental health.
Chung led one project, a survey called the “Mental Health Impact of Covid-19 Pandemic on NIMH Research Participants and Volunteers,” which enrolled more than 3,600 participants from all 50 states and 15 countries. Every 2 weeks for 6 months, participants completed a questionnaire about Covid-19, mental health symptoms and stress.
“One of the best things about the study, for me, was the connections we made across NIMH labs,” she said. “Rather than working in silos, we formed a team that had people who had not necessarily worked this closely before.”
The study has three aims:
- to describe the relationship between stressors related to Covid-19
- to determine whether mental health status moderates the relationship between stressors related to Covid-19
- to identify risk and resilience factors among study participants
At the beginning of the study, Chung and her team asked participants about their medical and mental health history, functional impairment and alcohol and drug use. Then, participants answered questions about their mental health, symptoms, distress and loneliness every 2 weeks for 24 weeks. They also had the opportunity to answer open-ended prompts about their mental health. Once the study ended, participants completed an end-of-study assessment.
After the death of George Floyd and the racial injustice protests that followed across the United States, Chung and her team tried to increase the racial and ethnic diversity of the study population. They changed the design of recruitment materials and conducted a direct-mail campaign.
The participants included 194 patients who had enrolled in prior NIMH studies, so Chung knew their medical and mental health histories. She compared their responses to mental health symptom surveys before and after the pandemic started to “benchmark how our group of individuals were doing compared to published reports of increased anxiety and depression.”
Fifty-nine percent of respondents reported higher levels of anxiety, while 41 percent of respondents reported higher depression symptoms.
Chung noted that 174 of the participants who had enrolled in prior NIMH studies had undergone an in-person, comprehensive clinical evaluation. Of this subsample, 61 had a positive lifetime history of mental disorder and 113 healthy volunteers had a negative lifetime history of a mental disorder.
With the help of Dr. Francisco Pereira, an NIMH expert in machine learning, Chung is using data from the subsample to predict the mental health status of participants based on survey responses. This approach allows researchers to control for mental health status.
Going forward, having the ability to control for mental health status will help determine how the mental health effects of the pandemic are distributed. A preliminary analysis suggests the “consequences of Covid-19 are not evenly distributed across the study population.” Researchers hope to release a more detailed analysis in the future.
The research team will be examining longitudinal patterns over the course of the pandemic using the repeated measures of mental health and distress to look for different clinical trajectories. They also want to identify risk and resilience factors that increase or decrease the mental health impact of pandemic stressors.
“There are broad and significant social and environmental stressors imposed by the Covid-19 pandemic on the general public,” Chung concluded. “A focus on mental health is warranted and is an important area of clinical and research inquiry.”