The mental state of Americans amid the COVID-19 crisis: How socially vulnerable populations face greater disparities during and after a crisis

Elisabeth Dubois, MBA; Xiaojun (Jenny) Yuan, PhD

doi:10.5055/jem.0605

Authors

Elisabeth Dubois, MBA
Xiaojun (Jenny) Yuan, PhD

DOI:

https://doi.org/10.5055/jem.0605

Keywords:

COVID-19, mental health, public health, socially vulnerable populations

Abstract

The coronavirus-2019 (COVID-19) public health crisis has accentuated divides and caused millions of Americans to suffer from increased mental health challenges. Although these challenges are seen throughout the country, socially vulnerable populations including frontline workers, older adults, and children, among others, face increased risk of mental health issues. There has been a notable mental health crisis in the country due to the isolation, stay-at-home orders, and preventive measures put in place to curb the spread. This study investigates the mental health challenges that socially vulnerable populations often face during crises and presents the factors affecting these populations during (and following) the COVID-19 pandemic. Based on an analysis of these factors, several recommendations are made to aid emergency managers, public health officials, policymakers, and academics in better addressing mental health challenges as we continue to battle COVID-19 and in preparation for future public health crises.

Author Biographies

Elisabeth Dubois, MBA

College of Emergency Preparedness, Homeland Security and Cybersecurity, University at Albany, State University of New York, Albany, New York

Xiaojun (Jenny) Yuan, PhD

College of Emergency Preparedness, Homeland Security and Cybersecurity, University at Albany, State University of New York, Albany, New York

References

Gloster AT, Lamnisos D, Lubenko J, et al.: Impact of COVID-19 pandemic on mental health: An international study. PLOS ONE. 2020; 15(12): e0244809. DOI:10.1371/journal.pone.0244809.

Williams RD, Shah A, Tikkanen R, et al.: Do Americans face greater mental health and economic consequences from COVID-19? Comparing the US with other high-income countries. The Commonwealth Fund. DOI:10.26099/w81v-7659.

McIntyre M: Coronavirus and mental health: How COVID-19 is affecting millions of Americans. Psycom.net - Mental Health Treatment Resource Since 1996. Published August 14, 2020. Available at https://www.psycom.net/coronavirus-mental-health. Accessed January 8, 2021.

Jones B, Woolfenden S, Pengilly S, et al.: COVID-19 pandemic: The impact on vulnerable children and young people in Australia. J Paediatr Child Health. 2020; 56(12): 1851-1855. DOI:10.1111/jpc.15169.

Bradford J, Coe E, Enomoto K, et al.: The implications of COVID-19 for vulnerable populations. McKinsey & Company. Published May 20, 2020. Available at https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/the-implications-of-covid-19-for-vulnerable-populations. Accessed January 8, 2021.

Gupta S: Social distancing comes with psychological fallout. Science News. Published March 29, 2020. Available at https://www.sciencenews.org/article/coronavirus-covid-19-social-distancing-psychological-fallout. Accessed January 8, 2021.

Wisner B, Blaikie P, Cannon T, et al.: At Risk: Natural Hazards, People’s Vulnerability and Disasters. 2nd Edition. Routledge, 2003.

Aday LA: At Risk in America: The Health and Health Care Needs of Vulnerable Populations in the United States. 2nd Edition. Jossey- Bass, 2001.

Aday LA: Health status of vulnerable populations. Annu Rev Public Health. 1994; 15(1): 487-509. DOI:10.1146/annurev.pu.15.050194.002415.

Mechanic D, Tanner J: Vulnerable people, groups, and popula¬tions: Societal view. Health Aff (Millwood). 2007; 26(5): 1220-1230. DOI:10.1377/hlthaff.26.5.1220.

CDC: COVID-19 and your health. Centers for Disease Control and Prevention. Published February 11, 2020. Available at https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html. Accessed January 8, 2021.

Sample I: Covid poses “greatest threat to mental health since second world war.” The Guardian. Available at https://www.theguardian.com/society/2020/dec/27/covid-poses-greatest-threat-to-mental-health-since-second-world-war. Published December 27, 2020. Accessed January 11, 2021.

Mastroianni B: How life will (and won’t) change after getting COVID-19 vaccine. Healthline. Published December 15, 2020. Available at https://www.healthline.com/health-news/how-your-life-will-and-wont-change-after-getting-the-covid-19-vaccine. Accessed January 11, 2021.

Baker LR, Cormier LA: Disasters and Vulnerable Populations: Evidence-Based Practice for the Helping Professions. Springer, 2014.

Rufat S, Tate E, Burton CG, et al.: Social vulnerability to floods: Review of case studies and implications for measurement. Int J Disaster Risk Reduct. 2015; 14: 470-486. DOI:10.1016/j.ijdrr.2015.09.013.

Linares C, Paricio R: Mental health and vulnerable populations in the era of COVID-19: Containment measures effects on preg¬nancy and childbirth. Ariz State Law J. 2020; 2020: 175-190.

Santhanam L: Why your mental health may be suffering in the COVID-19 pandemic. PBS NewsHour. Published March 19, 2020. Available at https://www.pbs.org/newshour/health/why-your-mental-health-may-be-suffering-in-the-covid-19-pandemic. Accessed January 8, 2020.

Collis A, Scott N, Ross D: Workers on the Move 2: European Migrant Workers and Health in the UK: A Review of the Issues. Keystone Development Trust, 2010.

Peek L, Stough LM: Children with disabilities in the context of disaster: A social vulnerability perspective. Child Dev. 2010; 81(4): 1260-1270. DOI:10.1111/j.1467-8624.2010.01466.x.

Zahran S, Peek L, Snodgrass JG, et al.: Economics of disaster risk, social vulnerability, and mental health resilience. Risk Anal. 2011; 31(7): 1107-1119. DOI:10.1111/j.1539-6924.2010.01580.x.

Canino G, Bravo M, Rubio-Stipec M, et al.: The impact of disas¬ter on mental health: Prospective and retrospective analyses. Int J Ment Health. 1990; 19(1): 51-69. DOI:10.1080/00207411.1990.1144 9153.

Norris FH, Friedman MJ, Watson PJ: 60,000 disaster victims speak: Part II. Summary and implications of the disaster mental health research. Psychiatry Interpers Biol Process. 2002; 65(3): 240-260. DOI:10.1521/psyc.65.3.240.20169.

Fergusson DM, Horwood LJ, Boden JM, et al.: Impact of a major disaster on the mental health of a well-studied cohort. JAMA Psychiatry. 2014; 71(9): 1025-1031. DOI:10.1001/jamapsychiatry. 2014.652.

Drydakis N: The effect of unemployment on self-reported health and mental health in Greece from 2008 to 2013: A longitudinal study before and during the financial crisis. Soc Sci Med. 2015; 128: 43-51. DOI:10.1016/j.socscimed.2014.12.025.

Uutela A: Economic crisis and mental health. Curr Opin Psychiatry. 2010; 23(2): 127-130. DOI:10.1097/YCO.0b013e32833 6657d.

Marshall RD, Galea S: Science for the community: Assessing mental health after 9/11. J Clin Psychiatry. 2004; 65 Suppl 1: 37-43.

Greenberg N, Wessely S, Wykes T: Potential mental health con¬sequences for workers in the Ebola regions of West Africa – A lesson for all challenging environments. J Ment Health. 2015; 24(1): 1-3. DOI:10.3109/09638237.2014.1000676.

CDC: Coronavirus disease 2019 (COVID-19) – People at increased risk. Centers for Disease Control and Prevention. Published February 11, 2020. Available at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/index.html. Accessed November 25, 2020.

Pfefferbaum B, North CS: Mental health and the Covid-19 pandemic. N Engl J Med. 2020; 383(6):5 10-512. DOI:10.1056/NEJMp2008017.

Taylor S: The Psychology of Pandemics: Preparing for the Next Global Outbreak of Infectious Disease. Cambridge Scholars Publishing, 2020.

CDC: Morbidity and Mortality Weekly Report (MMWR) | MMWR. Centers for Disease Control and Prevention. Published January 8, 2021. Available at https://www.cdc.gov/mmwr/index.html. Accessed January 8, 2021.

Tulane University: Understanding the effects of social isolation on mental health. Tulane University. Published December 8, 2020. Available at https://publichealth.tulane.edu/blog/effects-of-social-isolation-on-mental-health/. Accessed January 13, 2021.

Smith M: A fine balance: Individualism, society and the preven¬tion of mental illness in the United States, 1945–1968. Palgrave Commun. 2016; 2(1): 1-11. DOI:10.1057/palcomms.2016.24.

Talevi D, Socci V, Carai M, et al.: Mental health outcomes of the CoViD-19 pandemic. Rivista di Psichiatria. Published May 1, 2020. Available at https://www.rivistadipsichiatria.it/archivio/3382/articoli/33569/. Accessed January 8, 2021.

Bloch DA, Silber E, Perry SE: Some factors in the emotional reaction of children to disaster. Am J Psychiatry. 1956; 113(5): 416-422. DOI:10.1176/ajp.113.5.416.

Breton JJ, Valla JP, Lambert J: Industrial disaster and mental health of children and their parents. J Am Acad Child Adolesc Psychiatry. 1993; 32(2): 438-445. DOI:10.1097/00004583-199303000-00028.

Liu JJ, Bao Y, Huang X, et al.: Mental health considera¬tions for children quarantined because of COVID-19. Lancet Child Adolesc Health. 2020; 4(5): 347-349. DOI:10.1016/S2352-4642(20)30096-1.

Santavirta T, Santavirta N, Betancourt TS, et al.: Long term mental health outcomes of Finnish children evacuated to Swedish families during the second world war and their non-evacuated siblings: Cohort study. BMJ. 2015; 350: g7753. DOI:10.1136/bmj. g7753.

Lu BY, Onoye J, Nguyen A, et al.: Increased elderly utilization of psychiatric emergency resources as a reflection of the growing mental health crisis facing our aging population. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 2017; 25(6): 680-681. DOI:10.1016/j.jagp.2017.02.003.

Jia Z, Tian W, Liu W, et al.: Are the elderly more vulnerable to psychological impact of natural disaster? A population-based survey of adult survivors of the 2008 Sichuan earthquake. BMC Public Health. 2010; 10(1): 172. DOI:10.1186/1471-2458-10-172.

The National Academies of Sciences, Engineering, and Medicine: Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. The National Academies Press, 2020. DOI:10.17226/25663.

Lee K, Jeong GC, Yim J: Consideration of the psychological and mental health of the elderly during COVID-19: A theoretical review. Int J Environ Res Public Health. 2020; 17(21): 8098. DOI:10.3390/ijerph17218098.

Meng H, Xu Y, Dai J, et al.: Analyze the psychological impact of COVID-19 among the elderly population in China and make corresponding suggestions. Psychiatry Res. 2020; 289: 112983. DOI:10.1016/j.psychres.2020.112983.

Bills CB, Levy NAS, Sharma V, et al.: Mental health of workers and volunteers responding to events of 9/11: Review of the literature. Mt Sinai J Med N Y. 2008; 75(2): 115-127. DOI:10.1002/msj.20026.

Greenberg N: Mental health of health-care workers in the COVID-19 era. Nat Rev Nephrol. 2020; 16(8): 425-426. DOI:10.1038/s41581-020-0314-5.

Galindo KB, Eslami ZR, Bashir H: Culture’s influence on social network vulnerabilities for ethnic minorities in rural disaster events. J Int Humanit Action. 2018; 3(1): 17. DOI:10.1186/s41018- 018-0047-2.

Lindell MK: Disaster studies. Curr Sociol. 2013; 61(5-6): 797-825. DOI:10.1177/0011392113484456.

Adams RE, Boscarino JA: Differences in mental health outcomes among Whites, African Americans, and Hispanics following a community disaster. Psychiatry Interpers Biol Process. 2005; 68(3): 250-265. DOI:10.1521/psyc.2005.68.3.250.

Norris FH, Alegria M: Mental health care for ethnic minority individuals and communities in the aftermath of disasters and mass violence. CNS Spectr. 2005; 10(2): 132-140. DOI:10.1017/S1092852900019477.

Smith K, Bhui K, Cipriani A: COVID-19, mental health and ethnic minorities. Evid Based Ment Health. 2020; 23(3): 89-90. DOI:10.1136/ebmental-2020-300174.

Rogers JP, Chesney E, Oliver D, et al.: Psychiatric and neu¬ropsychiatric presentations associated with severe coronavirus infections: A systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020; 7(7): 611-627. DOI:10.1016/S2215-0366(20)30203-0.

Stough LM: The effects of disaster on the mental health of individuals with disabilities. In: Neria Y, Galea S, Norris FH, eds. Mental Health and Disasters. Cambridge University Press, 2009: 264-276. DOI:10.1017/CBO9780511730030.015.

Wood VT, Weisman RA: A hole in the weather warning system improving access to hazardous weather information for deaf and hard of hearing people. Bull Am Meteorol Soc. 2003; 84(2): 187-194. DOI:10.1175/BAMS-84-2-187.

Van Willigen M, Edwards T, Edwards B, et al.: Riding out the storm: Experiences of the physically disabled during hurricanes Bonnie, Dennis, and Floyd. Nat Hazards Rev. 2002; 3(3): 98-106. DOI:10.1061/(ASCE)1527-6988(2002)3:3(98).

Campbell VA, Gilyard JA, Sinclair L, et al.: Preparing for and responding to pandemic influenza: Implications for people with disabilities. Am J Public Health. 2009; 99 Suppl 2: S294-S300. DOI:10.2105/AJPH.2009.162677.

Ayers K, Fober-Pratt A, Kushalnagar P, et al.: How COVID-19 impacts people with disabilities. https://www.apa.org. Published May 6, 2020. Available at https://www.apa.org/topics/covid-19/research-disabilities. Accessed January 13, 2021.

CDC: Caregiving for Family and Friends—A Public Health Issue. Centers for Disease Control and Prevention. Published July 31, 2019. Available at https://www.cdc.gov/aging/caregiving/caregiver-brief.html. Accessed January 13, 2021.

Pfender E: Caregiver statistics broken down by age, gender, race + infographic. CaregiverConnection.org. Published June 15, 2018. Available at https://caregiverconnection.org/caregiver-statistics/. Accessed January 13, 2021.

Czeisler MÉ: Mental health, substance use, and suicidal idea¬tion during the COVID-19 pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69. DOI:10.15585/mmwr.mm6932a1.

Lemyre L, Gibson S, Zlepnig J, et al.: Emergency preparedness for higher risk populations: Psychosocial considerations. Radiat Prot Dosimetry. 2009; 134(3-4): 207-214. DOI:10.1093/rpd/ncp084.

Burke JA, Spence PR, Lachlan KA: Crisis preparation, media use, and information seeking: Patterns across Hurricane Ike evacu¬ees and lessons learned for emergency communication. J Emerg Manag. 2010; 8: 27-38. DOI:10.5055/jem.2010.0030.

Jin Y: Making sense sensibly in crisis communication: How publics’ crisis appraisals influence their negative emotions, coping strategy preferences, and crisis response acceptance. Commun Res. 2010; 37(4): 522-552. DOI:10.1177/0093650210368256.

Jin Y, Liu BF, Austin LL: Examining the role of social media in effective crisis management: The effects of crisis origin, information form, and source on publics’ crisis responses. Commun Res. 2014; 41(1): 74-94. DOI:10.1177/0093650211423918.

Ulmer RR, Sellnow TL, Seeger MW: Effective Crisis Communication: Moving From Crisis to Opportunity. Third edition. SAGE Publications, Inc, 2014.

Tierney K: The Social Roots of Risk: Producing Disasters, Promoting Resilience. 1st edition. Stanford Business Books, 2014.

Coombs WT: Ongoing Crisis Communication: Planning, Managing, and Responding. SAGE Publications, 2014.

Tumpey AJ, Daigle D, Nowak G: Communicating during an outbreak or public health investigation. Centers for Disease Control and Prevention. 2019. Available at https://www.cdc.gov/eis/field-epi-manual/chapters/Communicating-Investigation.html. Accessed April 7, 2021.

Waisel DB: Vulnerable populations in healthcare. Curr Opin Anaesthesiol. 2013; 26(2): 186-192. DOI:10.1097/ACO.0b013e3 2835e8c17.

CDC: Crisis and Emergency Risk Communication (CERC) Manual. Published online 2014. Available at https://emergency.cdc.gov/cerc/ppt/cerc_2014edition_Copy.pdf. Accessed September 30, 2020.

Schumaker E: How COVID-19 is exposing--and widening--cracks in the US health system. ABC News. Published May 8, 2020. Available at https://abcnews.go.com/Health/covid-19-exposing-cracks-us-health-system-experts/story?id=70408044. Accessed January 9, 2021.

Artiga S, Orgera K, Pham O: Disparities in health and health care: Five key questions and answers. KFF. Published March 4, 2020. Available at https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-five-key-questions-and-answers/. Accessed April 7, 2021.

Dubois E, Bright D, Laforce S: Educating Minoritized Students in the United States During COVID-19: How Technology Can be Both the Problem and the Solution. IT Professional. 2021; 23(2): 12-18. DOI:10.1109/MITP.2021.3062765.