When Margot Gage Witvliet, Ph.D., first got sick in March, her doctors chalked her experience — being “the sickest I’ve ever been personally in my life” — up to mental health issues, and not the highly contagious respiratory virus that had just been declared a pandemic. The 38-year-old had several weeks of shortness of breath, a racing heart, and intense fatigue, followed by a seizure. After seeing a female ER doctor for her seizure, she finally got a COVID-19 diagnosis.
“I knew I wasn’t crazy. I knew this wasn’t a mental health issue that was causing these symptoms,” she says.
In addition to being a COVID survivor, Gage Witvliet is an assistant professor at Lamar University in Texas and an epidemiologist whose research focuses on how social factors like family structure, socioeconomics, and geographic location impact public health. She’s now fascinated by the role of mental health in the COVID-19 pandemic, specifically for those who survived what can be a traumatic illness.
“Right now, most people are only focusing on the physical aspects of COVID, but any public health professional will tell you there is no health without mental health, and this is especially true with COVID,” she says.
What Research About COVID-19 & Mental Health Says
It’s no secret that 2020 has been difficult, emotionally, for nearly everyone. “There has been preliminary research that nationwide levels of depression and anxiety are higher than they were a year ago,” says Sabrina Liu, Ph.D., a clinical psychologist who studies trauma and resilience. She adds that while research can’t confirm specifically what the rise is linked to, “it's not a far stretch” to point to the myriad 2020-specific traumas as possible factors: “Contracting COVID, having people around you who have contracted COVID, the fear of contracting COVID, economic challenges, job loss, health disparities, health inequalities, ongoing police brutality, and issues of racial justice.”
For COVID survivors in particular, mental health is a fraught picture. Researchers believe that coronavirus patients are at increased risk of developing post-traumatic stress disorder (PTSD); in general, around 35% of ICU patients develop PTSD, with higher rates among those who’ve been intubated. Italian researchers found that 55% of all COVID survivors developed either depression, anxiety, or both post-recovery.
Liu stresses that it’s “way too early to know” whether mental health impacts are another symptom of COVID-19 the disease, the way a hormone disorder might prompt shifts in mood, or if they’re situational. But the specifics of treating COVID-19 carry specific traumas with it. It’s not just that you survive a life-threatening illness, one that may cause disabling symptoms even after you’ve recovered, but that patients go through treatment in complete isolation. Something as small as being able to see your doctor’s facial expressions through a mask can have an impact on mental health, Liu says. “We’re used to being able to go to a hospital, see a doctor, see a doctor’s full face. That all instills a sense of security,” which can impact resilience to trauma.
How Being Sick Can Impact Mental Health
It’s not just being sick that can affect mental health. Being disbelieved can create a vicious cycle of stress that exacerbates symptoms.
Chimére L. Smith, 38, got sick in March, with symptoms ranging from headaches, sore throats, violent coughs, intense fatigue, the loss of vision in one eye, confusion, memory problems, and nerve pain. Like Gage Witvliet, she’s struggled with doctors passing her symptoms off as anxiety, depression, or paranoia. Though she hasn’t been able to get a positive coronavirus test, she’s very active in long-haul COVID support groups, whose members have validated her symptoms as consistent with their experiences. (False negative rates for COVID-19 tests can range from 2-29% or 11-40%, as different studies have shown, depending on the sample and how sick the patient was when they were tested.)
“Doctors won’t presume me [COVID-19 positive], but then tell me to see a psychiatrist or mental health professional. They say something is wrong with my mental health, but they won’t treat me physically,” Smith says. “I feel a lot of sadness. I feel disappointed. I feel angry.”
Being sick for so long, with so few answers, has taken an enormous toll. Unable to focus on computer screens for longer than 15 minutes, she’s had to take leave from her job as a teacher. The loss of that income, plus the end of a two-year relationship in April, have been additional stressors.
“Being sick has changed so much about my life,” Smith continues. “It has stripped me of every single thing I have known to be true about myself. I have always considered myself to be beautiful, intelligent, kind, loving, graceful, gracious. And I look at myself now and I don’t see who I was.”
Systemic Racism Affects How People Get Treatment
There is also myriad evidence of anti-Black bias in health care that impacts how women like Gage Witvliet and Smith are able to access care. In August, a study found that Black newborns are three times more likely to die when cared for by white doctors than white infants. Given how COVID-19 disproportionately impacts communities of color, Liu expects mental health to be similarly affected.
“The thing about COVID is that it’s bringing to light all these racial disparities in health, but also exacerbating the problems that we already have,” says Irene Lopez, Ph.D., an associate professor at Kenyon College specializing in disaster psychology. Lopez points to early research showing that people of color are more likely to have more complicated cases of COVID, and that Black people who contract COVID are more likely to be hospitalized and have higher mortality rates than their white peers.
As with most aspects of the pandemic, many of its impacts won’t be felt for years. But for those who are dealing with it in the near term, grappling with its effects on mental health has provided a certain amount of perspective.
“This has caused me to be strong in a way that I never imagined for myself,” says Smith. “The recovery and healing process, I’m realizing it takes time.”
Gage Witvliet is just happy that she survived. “There were a lot of times before when I didn’t think I was going to make it. Every morning when I wake up, I am so happy. I think, ‘Wow — I woke up today.’”
If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Illness (NAMI) website, or call 1-800-950-NAMI(6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP(4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) or call 911.