The pandemic is taking a toll on Americans' mental health. A new CDC study shows who we need to worry about most.

Alia E. Dastagir USA TODAYPublished 2:25 PM EDT Aug 13, 2020The COVID-19 pandemic is having a significant impa

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The COVID-19 pandemic is having a significant impact on Americans' mental health, according to a new survey out Thursday from the U.S. Centers for Disease Control and Prevention.

It found elevated levels of symptoms of anxiety and depressive disorders, substance use and suicidal ideation among U.S. adults, and identified populations at increased risk, including young people, racial and ethnic minorities, essential workers and caregivers of adults.

More than 40% of respondents who completed surveys during June reported an adverse mental or behavioral health condition, and 11% reported having seriously considered suicide in the 30 days prior.

"We need to recognize the profound effects of the pandemic, of racial injustice, of economic instability," said Nadine Kaslow, a professor of psychiatry at the Emory University School of Medicine. "Those people whose symptoms of anxiety or depression, or substance use or suicidal ideations are really interfering with their functioning, where the symptoms are extreme, those people need help."

Mental health experts say the data offers a helpful snapshot, but in some cases raises more questions than it answers. The survey shows more people are reporting symptoms of anxiety and depression, but the prevalence of anxiety and depressive disorders is unclear. More people may be thinking about suicide, but no one knows if suicidal ideation is leading to more suicidal acts because there's no national data on how the pandemic is impacting the suicide rate.

The data's greatest value, experts say, is the spotlight it shines on vulnerable populations.

"It is showing that this breakdown in our society, the breakdown of the safety net, the breakdown of economic security is taking a massive toll," said Anna Mueller, a suicide researcher and professor of sociology at the Indiana University Bloomington. "These breakdowns really show how crucial economic stability and economic security are to an individual's well being. Because the people who are more vulnerable in terms of their socioeconomic status, people who are being put in harm's way, those are the people who are suffering the most."

More than 20% of essential workers reported suicidal thoughts

More than half of essential workers reported at least one adverse mental or behavioral health symptom, and 22% reported suicidal thoughts. Symptoms of a COVID-related trauma and stressor-related disorder and increased substance use were more prevalent among essential workers than nonessential workers.

Essential workers go beyond nurses and doctors. They are factory workers, hospital custodians, grocery store clerks. Many don't have job security and risk their health and the health of their families to meet basic needs. 

Essential workers: Food workers are scared, but they show up anyway.

"You have a lot of essential workers that often have no choices, don't get paid well, often are people of color," Kaslow said. "They have certainly not in any systematic way gotten what they need in terms of hazard pay, in terms of protection, certainly in terms of accolades."

Percentage of Hispanic and Black respondents who seriously considered suicide higher than whites

The percentage of respondents who reported having seriously considered suicide was significantly higher among Hispanic respondents (18.6%) and Black respondents (15.1%) than among whites (7.9%)

Hispanic respondents reported higher prevalence of symptoms of anxiety disorder or depressive disorder and substance use than whites. Black respondents reported increased substance use more commonly than did whites.

'We're losing our kids': Black youth suicide rate rising far faster than for whites

More than 30% of unpaid caregivers reported increased substance use

Two thirds of unpaid caregivers for adults reported at least one adverse mental or behavioral health symptom. Thirty three percent of unpaid caregivers reported increased substance use compared to 6% of those who are not. And 31% of unpaid caregivers reported suicidal ideation versus 3% who were not.

The elderly are among those at highest risk of dying or having serious complications from COVID-19. Caregivers may have trouble finding additional help, or feeling safe using help that is available. 

"Imagine how hard it is to take care of somebody anyway, but you have all these added stressors with COVID and you're not seeing an end in sight. The sense of overwhelmingness is intense," said Bart Andrews, chief clinical officer at Behavioral Health Response.

75% of young people reported at least one adverse mental health symptom

The survey found 75% of respondents 18-24 reported at least one adverse mental or behavioral health symptom and serious suicidal ideation among this group was 25%.

"This is a time when you are either going to college or you're finishing college or you're going into the workforce, and it's all about building and growing and becoming an adult. Everything that's happening is thwarting that," Kaslow said. "There's no sense of the future. And I think as you enter young adulthood, to feel like your future is foreclosed is really distressing."

Mueller speculates uncertainty may also be a factor.

"They're watching their world crumble, and probably struggling to imagine a future," she said. "I mean, we all are. What is the world going to look like? What is college going to look? What is employment going to look like if they were hoping to enter the labor force?"

Increased risk for some, protection for others

Andrews says it's important not to minimize distress signals, but he cautions against pathologizing emotions. People are stressed, anxious and depressed because they are human, he says. For some people, the universality of the pandemic may end up being a protective factor.

"Of course you're stressed out and anxious and depressed. You're living in the middle of the first pandemic in the United States of America in a hundred years," he said. "The distress signals are very real and people are distressed, but that distress may be mediated because it's normalized. It's connected to a very real event that's external to the person. Nobody's blaming themselves for COVID. This is what's happening to us. Everybody's stressed out and who wouldn't be?"

Andrews says the pandemic likely will increase risk for some and decrease risk for others. Without intervention, it will exacerbate existing disparities, which is why he says social safety nets are critical.

The CDC survey calls for interventions that include "strengthening economic supports to reduce financial strain, addressing stress from experienced racial discrimination, promoting social connectedness, and supporting persons at risk for suicide."

Kaslow said better access to affordable mental health services will be crucial. As will compassion. 

"No matter how tired and burnt out we each are, we need to check in with people, to see how they're doing, to let people know that we care," Kaslow said.  "People did a lot of that at the beginning. ... As we get into this phase that people sort of call the disillusionment phase, I personally think we're seeing a lot less of that. We have to be in this for the long haul. We have to take care of each other for the long haul."

You may also be interested in: 

  • The lifesaving lesson suicidal people can teach a world in a pandemic
  • How to help someone who is suicidal
  • True stories of how survivors cope

If you or someone you know may be struggling with suicidal thoughts you can call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255) any time of day or night or chat online.

Crisis Text Line provides free, 24/7, confidential support when you dial 741741.

Alia E. Dastagir is a recipient of a Rosalynn Carter fellowship for mental health journalism. Follow her on Twitter: @alia_e
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