The Comorbidity of Major Depressive Disorder with COVID-19 in Populations

The following piece was written as part of The Pandemic: Science and Society course offered from Aug. 17 – Sep. 4.

Comorbidity is frequently used in psychology and medicine to describe a state in which two or more conditions and/or disorders present together. In the midst of the global COVID-19 pandemic brought on by SARS-CoV-2, there is clearly an alarming trend: while the prevalence of COVID cases is increasing in patients across the world, so too, is the prevalence of major depressive disorder. The data suggests that COVID-19 and major depressive disorder are comorbid in society at large, regardless of whether a particular individual in the population has had either condition.

One study conducted out of Hong Kong found that out of 500 respondents, more than 25% reported a decline in their mental health during the pandemic, and 19% met the clinical criteria for major depressive disorder [1]. Another study conducted in mainland China found that from a 1,210 person sample, more than half felt that the pandemic was very severe and harmful to their mental health, and 15.8% experienced key symptoms of major depressive disorder during the pandemic [7]. In Britain, depression rates are now double what they were last year [6]. As new data becomes available from other nations, it will likely show similar trends around the world: COVID-19 is not only a disease of the body, but a disease of the mind. But why is this happening? And what can be done to help those around us and ourselves?

Social isolation has become commonplace throughout the world. National lockdowns have forced people to shelter in their homes for extended periods of time. Many are far away from loved ones. Children are out of school and missing vital social interaction, particularly in the 3rd grade to 4th grade transition, a critical window for reading development [3]. Activities which were considered normal several months ago now place the population at severe risk. It has become increasingly difficult to interact with peers, friends and even family members—particularly family members in nursing homes or skilled care facilities. Those who are infected with SARS-CoV-2 and in hospital or isolated at home may feel hopeless as they must face loneliness in addition to the many physical symptoms of the virus, such as fever and respiratory distress. Unsurprisingly, a meta-analysis conducted in 2017 found strong correlations between social isolation and declining mental health, which is our current reality [4]. With less social interaction, people can easily lose their sense of self-worth and dwell on negative thoughts. Humans are social beings and thrive in and around the company of others. Lack of social interaction has been shown to cause brain damage, particularly in younger people but also those who may already be isolated [3].

In addition to social isolation, many have faced fear of the virus itself, as well as information overload. Without a clear leader directing a national strategy against COVID-19 in the United States, there is frequent mixed messaging. People begin to question whether the nation’s and the world’s public health leaders truly know what they are doing and what they should do to protect themselves. Some nations have taken great measures against the virus and have succeeded, while nations have failed at containing and stopping infection. With staggering losses of life around the world and constant negativity portrayed in the press, social media and TV, it is difficult to let go of fear and see hope and the light at the end of the tunnel. The raw emotions, driven by fear and a 24-hour news cycle dedicated to this global calamity, can easily result in depression and hopelessness, particularly in the frontline healthcare workers [3]. Many healthcare workers fear going to work, because they, themselves, may face exposure and could potentially bring the virus back home to their families [3,8].

The economic impacts of the virus on the economy have been profound. Countless businesses have closed, and nearly 20 million U.S. workers (⅕ of all workers) have been laid off and have filed for unemployment [2]. Of the workers who have not been laid-off or who are still employed, the so-called ‘essential workers’ are at the highest risk for contracting COVID-19 because, unsurprisingly, many of these positions are low-paying and cannot be done remotely (such as food service work and healthcare technicians). Many essential workers worldwide must decide whether they will potentially put their lives at risk by going to work and facing the virus or whether they will be staying home and facing possible eviction and hunger. It is not difficult to see how encountering a choice like this can easily induce depression in millions of people.

But what can be done to help reduce the mental toll of the virus and to help alleviate potential sources of depression in the population as a whole? There are multiple steps that must be taken. Currently, there is a tremendous negative stigma surrounding COVID-19 all across the world—a stigma bred out of fear, not too different from the stigma surrounding HIV [5]. Those who currently have (and have had) the virus are treated differently from those who have not. In times of fear, people jump to conclusions. If someone acquires COVID-19, it is imperative that others realize it is not his or her fault. Instead of referring to the affected as “COVID-19 victims,” it is much more effective to refer to them as “people who have COVID-19” as this reduces the stigma [5]. Society should focus on fighting the virus, not the people. SARS-CoV-2 can infect everyone; it knows no international boundary. 

In addition to reducing stigma, we must also remain connected to others. It is difficult to make new friends and develop new relationships, and old relationships may strain as stress increases. People must continue to stay in touch with their closest contacts, whether it be through Skype, Zoom or other online platforms. Even if you know someone who has the virus, you should still stay connected remotely, so that they are not fighting the battle alone. Again, loneliness can easily foster depression in the population [3]. Lastly, we must have hope. If we constantly and consistently work together towards eradicating the virus by wearing masks and social distancing as well as treating those who have fallen ill as human beings, we can keep ourselves occupied and focused on having a brighter future and a healthier 2021.

Edited by: Anthi Luong

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