As millions of Americans lose their jobs and economists predict a slow recovery, mental health professionals warn that the prolonged financial and personal stress caused by the Covid-19 pandemic increases the risk of suicide, especially in people already grappling with depression and anxiety.
For weeks, Americans have been confined to their homes as states across the U.S. have implemented some form of stay-at-home orders aimed at containing the coronavirus outbreak by reducing human contact and shuttering schools, offices and other nonessential businesses. While effective at containing the outbreak, "the potential for adverse outcomes on suicide risk is high," according to an article published in JAMA Psychiatry last month.
The soaring unemployment rate and stock market losses caused by the Covid-19 pandemic, combined with millions of people quarantining at home alone creates the "perfect storm" for an increased risk of suicide for many people, according to the JAMA article, which was led by Dr. Mark Reger, a suicide prevention researcher and chief of psychology services at VA Puget Sound Health Care System.
(If you or someone you know are having thoughts of suicide or self harm, please contact the National Suicide Prevention Lifeline at this link or by calling 1-800-273-TALK. The hotline is open 24 hours a day, 7 days a week.)
Research shows that suicide rates tend to rise after economic recessions. The U.S. unemployment rate stands at around 14.7%, and could be closer to 20%, putting a staggering 20.5 million people out of work in April — the most rapid labor market decline in history. Some economists warn that the economic recovery from these actions will likely be slow and bumpy, and how and when workers will return to their jobs is difficult to predict.
Most adults in an American Psychiatric Association survey in March were already concerned the coronavirus would have a serious negative impact to their finances, and two-thirds feared the pandemic would have a long-lasting impact on the economy.
"We're in for a long-term mental health crisis," said Vaile Wright, director of clinical research and quality for the American Psychological Association.
Some government officials have expanded city mental health services, including in New York where Gov. Andrew Cuomo said thousands of mental health professionals have volunteered to provide free and confidential support through a new hotline and residents can use Headspace, a meditation and mindfulness app. New Jersey has launched a similar hotline.
Suicide rates tend to peak in the late spring and summer in the Northern Hemisphere, according to the JAMA article co-written by Reger.
"The fact that this will probably coincide with peak COVID-19 prevention efforts is concerning and deserves additional study," he wrote.
Suicide rates among working-age adults in the U.S. were increasing before the pandemic began sweeping through the country this year. In January, the U.S. Centers for Disease Control and Prevention reported that suicide deaths among those ages 16 to 64 had increased 40% in less than two decades, totaling near 38,000 people in 2017.
Compared with other traumatic events in the past, such as 9/11 or natural disasters, the coronavirus pandemic has a much broader impact across the country and has caused greater feelings of uncertainty, which increases a person's anxiety, Wright said.
Modeling from previous events of this magnitude suggests that the pandemic has exacerbated underlying mental health disorders, including anxiety, stress, anger and depression, Dr. Simon Rego of Montefiore Health System in New York told CNBC. He said these issues are amplified when there's additional economic or medical stress or increased social isolation. The Covid-19 outbreak has caused all three.
"People become at higher risk for things like greater depressive episodes or increases in problematic coping strategies like substance abuse," Rego said. "You see some correlation data that suggests people are at greater risk for increased feelings and thoughts of suicide."
Essential workers are under tremendous stress since their jobs put them at a greater risk of infection from commuting to work and interacting with the public.
Grocery workers may need more mental health services, including therapy, to help cope with the stress, according to psychologists and the nation's top grocery worker union. Anxiety, depression and other mental health challenges may linger, even as coronavirus cases level out or decline — especially for those on the front lines.
Health care providers are especially vulnerable between the long hours and lack of personal protective equipment that places their own lives at risk, psychiatrists say. Some have had to make difficult decisions about how to allocate life-saving resources to patients, said Dr. Maria Oquendo, chair of psychiatry at Perelman School of Medicine at the University of Pennsylvania.
"They're watching all of this suffering around them and I think that those individuals are at particular risk just due to the degree of stress," Oquendo said.
Oquendo said that research from other traumatic events, such as terrorist attacks and natural disasters, shows that 25% of the population could experience a mental health problem, most commonly depression, post-traumatic stress disorder and anxiety disorders, in the six months following the event.
"I think that one of the things that makes this different is the compounding due to the quarantine and the economic consequences," Oquendo said.
Even if someone's not working, it's important to maintain a daily routine, get enough sleep, eat healthy and exercise regularly, Oquendo said.
It's also healthy to engage in activities that maintain their emotional well-being like staying virtually connected to other people, Wright said.
"They sound very simple, but they provide the structures that need to protect our mental health," Wright said. "When we're able to do that and have some sort of even keel, then we can figure out, 'OK, what do I do about the fact that I don't have a job?'"
Clarification: This report was revised to clarify that Vaile Wright, director of clinical research and quality for the American Psychological Association.