This past week, a panel of experts came together to explore the impact of COVID-19 on mental health and how India, China, and the United States are responding to it. The discussion was moderated by Arthur Kleinman, Professor of Medical Anthropology at Harvard Medical School, and hosted by Winnie Yip, Professor of Global Health Policy and Economics at Harvard T.H. Chan School of Public Health and Acting Director of the Fairbank Center for Chinese Studies.
Joining them were four scholars and medical practitioners, including Xiao Shuiyuan, Professor at Central South University; Yifeng Xu, President of Shanghai Mental Health Center and Professor at Shanghai Jiao Tong University; Vikram Patel, Pershing Square Professor of Global Health at Harvard Medical School; and Cindy Liu, Director of the Developmental Risk and Cultural Resilience Laboratory at Brigham and Women’s Hospital and Assistant Professor of Pediatrics at Harvard Medical School.
Professor Vikram Patel assessed the current situation of mental health under the COVID-19 pandemic in India, though he noted that mental health issues were a leading cause of suffering well before the pandemic. “India’s recent National Health Survey found that roughly 10% of the population — that’s about 100 million people — were found to have a significant mental health condition,” he said. “Over 90% of the respondents in the National Health Survey said they had neither sought nor received any form of care for their problem.”
Prior to the pandemic, there was already a crisis of mental healthcare not only in India, but in many other nations around the world. “I believe that this time, this crisis is going to be much worse,” said Professor Patel. He identified two distinct phases of the mental health impact in India, the first phase being the acute phase, in which the country still exists. “I think we all know what that acute phase has done to each and every one of us: the chronic unrelenting uncertainty that has been following all of us. It would be fair to say that everyone faces some form of uncertainty,” he said.
“I believe when it becomes a chronic, enduring, and never-ending kind of uncertainty, it begins to create mental health problems. So, it isn’t surprising that we see a rising reporting of mental health issues across India and many other developing countries,” said Professor Patel. He highlighted a recent nationwide survey performed in Bangladesh, which reported that a third of the adult population experienced clinically significant depression — a staggering rate. “There is now evidence emerging from the region that the care of people with serious mental illness has been profoundly disrupted by the lockdown policies the region conducted,” he said.
Moving on to the second phase, Professor Patel discussed the consequences of the pandemic to India’s economy. “The second phase is just now emerging and is only going to get worse in the coming months and years. More than 80% of the population in India consists of daily wage laborers, and almost all of them have had significant reductions in their incomes, causing huge increases in hunger and poverty,” he said. Across India, the disproportionately affected have also included people with pre-existing mental health conditions, young people, and women.
There is a bright side, however, despite these uncertainties and anxieties that the pandemic has created. In India, throughout the past six months, there has been a transformation in the use of digital platforms in addressing mental health. “It adds a new weapon to improve access to care, and highlights the importance of psychotherapy, which India has previously undervalued — it has become much more widely accepted,” said Professor Patel.
Currently, China has controlled its cases of COVID-19, and therefore lies in a very different situation than the United States and India, where cases are still on the rise. Despite that, Professor Xiao Shuiyuan presented the data that has been collected from various studies across China regarding the impact of the pandemic on the population’s mental health. “Most studies reported high anxiety symptoms and severe mental health problems, such as suicidal behaviors,” he said. In his work, Professor Xiao has noted COVID-related stressors may include the loss of a family member, isolation, loss of employment and income, as well as grief and general attitudes surrounding COVID-19.
Professor Xiao delved into one particular study in China that examined quality of sleep, COVID-19 knowledge, and experiences with generalized anxiety disorder and other mental health issues. “It reported 31% of respondents had anxiety, and more than 20% of people experienced depressive symptoms. About 20% of the participants report poor sleep,” he said. When looking at healthcare workers specifically, they found even higher numbers. “More than half of healthcare participants reported symptoms of depression, and 45% reported anxiety,” said Professor Xiao.
Professor Yifeng Xu delved into the support for mental health during the COVID-19 pandemic, which he noted has been far from sufficient in China. He suggested recommendations to help cope with the mental health issues emerging during the pandemic. “First, we need nationwide, strategic coordination for psychological first aid during major disasters such as a pandemic, potentially delivered through telemedicine. Second, a comprehensive process of prevention and intervention systems, epidemiological monitoring, screening, and targeted intervention should be built up to reduce psychological distress and prevent further mental health problems,” he said. “Third, accessibility to medical resources and mental health services should be further improved. Fourth, more attention needs to be paid to mental health, especially in vulnerable groups.”
He ended by highlighting the need for active collaboration with the World Health Organization and other international mental health agencies, and increasing cooperation between mental health facilities and practitioners around the world to deal with this mental health emergency.
The United States
Mental health has long been an issue in the United States, with one in five individuals experiencing a mental illness in pre-pandemic conditions. Professor Cindy Liu noted that, as the pandemic first spread across the US in March and April, 30–35% of individuals reported significant anxiety symptoms, highest in individuals aged 18–29.
“When we think of the US, we can’t just think about the pandemic. We’ve had the election process the past year, we saw police brutality protests at the beginning of June that lasted a number of weeks as case numbers rose, and our school year began around August and September. We have to take this into account, because these are the things that individuals are reporting are taking a toll on their mental health,” said Professor Liu.
The past year in the US has been unique, with pivotal events that have directly affected the individual. “When we think about the US, we want to think about it as a homogenous group, but there are different groups that are differentially impacted by these events. We see a spike in anxiety for African-American individuals right around May, and the same for Asians. This is just some evidence suggesting that we need to take into consideration the different groups we have here in the US,” said Professor Liu. With young adults reporting higher levels of distress than any other group, Professor Liu noted that major issues for this population included their finances, their future, politics, and the future of the country. “All of this demonstrates that when we think about the pandemic we have to think about it from a political, economic, and social perspective,” said Professor Liu.
Like India, the US has experienced an increase in digital platforms and telehealth use nationwide, in the past not as readily adopted due in part to government regulations and health insurance issue — changing dramatically when COVID-19 arrived. “Telehealth is a major strategy to address mental health. It can provide access to those who may have faced barriers in the past, including transportation and scheduling concerns,” said Professor Liu.
The statistics are clear: the COVID-19 pandemic has had a profound impact on mental health in nations around the world. Medical practitioners and governments face a looming mental health crisis, which will require increased funding and improvements to remote healthcare infrastructure to ensure equitable access. Already, though, the transformation to telemedicine has been rapid, and increased discussion around mental health has helped to de-stigmatize mental illnesses. The pandemic isn’t over, but perhaps it can help us rebuild the provision of mental healthcare for the better.