Long COVID and Mental Health

Mental health, as defined by the World Health Organization, is a “state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community.” When we consider this definition, we can see how the COVID pandemic has not fostered an environment likely to support good mental health.

Shifting recommendations around the pandemic, mass death and disability, and a lack of community support can all contribute to confusion, grief, and poor mental health.  Many are also experiencing acute cases of COVID-19 and the lingering and life-changing symptoms of Long COVID. This adds to their physiological and psychological burden. Moreover, the effects of the infection itself on the nervous system, immune system, and endocrine system can directly lead to neuropsychological symptoms. But how is the SARS-CoV-2 virus causing these changes and what can we do?

The COVID Pandemic, Long COVID, and Mental Health

The COVID pandemic has had serious effects on individuals’ mental health. According to the WHO’s Global Health Data Exchange, the percentage of those in the United States with anxiety or depression in 2018 was 6.6% and 4.9% respectively. Before the pandemic began, the National Center for Health Statistics reported that between April and June of 2019, 11 percent of Americans experienced anxiety or depression. Fast forward to the start of the pandemic and the same time frame in 2020. The Centers for Disease Control reported the results of the National Center for Health Statistics (NCHS) and the Census Bureau’s Household Pulse Survey to track the mental health impact of the COVID-19 pandemic on Americans. During that same period, the number jumped to 35.6 percent of Americans reporting anxiety or depression. As we move into 2022, the numbers still report between 30-32 percent.

What is Behind the Increase in Mental Health Conditions?

There are many different factors currently contributing to the rise in mental health changes and conditions affecting people worldwide. As the pandemic began, businesses closed, countries imposed strict lockdowns, and most people were forced into unplanned isolation, unable to socialize with friends and family. As the virus spread, the fear of infection increased as much was, and is still, not known.

For others, recovery from an acute COVID-19 infection seemed a relief until they began experiencing the symptoms of Long COVID, leaving them with new fears and questions. All of the stressors combined in such a short period of time have taken their toll on everyone and the numbers of people experiencing changes in mental health reflect that. A closer look at each section shows exactly how COVID and Long COVID are affecting individuals worldwide.

Changes in Daily Living Due to the Pandemic

As the pandemic began, we all experienced significant changes to our daily routines and lifestyles. Lockdowns forced everyone into isolation. Businesses closed, leaving many to struggle with a loss of employment and financial insecurity. People worried about potential exposure and the chance they could spread the virus to a compromised loved one. Others watched as loved ones became sick or lost their life. Many of those who battled COVID in the hospital and survived were left with trauma from their experience. Medical workers continued to work without effective PPE and were unable to do much to help their patients and struggled to see death every day. Any of these scenarios is enough to put a serious strain on anyone’s mental health, let alone when they are experienced together.

Direct Changes to the Brain from SARS-CoV-2

Changes in mental health may also come from direct changes within the brain. As we learn more about the SARS-CoV-2 virus, we see that it can directly impact the brain in a variety of different ways, including

• Direct viral infection through the blood or olfactory bulb
• Blood clots and reduced oxygen to the brain
• Hypoxic injury secondary to lung involvement
• Neuroinflammation and autoimmunity

These changes to the brain have been associated with seizures, stroke, headaches, cognitive dysfunction (brain fog, memory loss, trouble concentrating), and altered mental status. In fact, case reports show that acute psychosis is a possible complication of COVID-19, even in those with minimal COVID symptoms and no history of psychotic episodes. In many cases, these changes in the brain that affect personality and cognitive function are being compared to Huntington’s disease, Parkinson’s disease, and viral-induced dementia.

Adjusting to Health Changes and Chronic Conditions

Unfortunately, contracting the SARS-CoV-2 virus, for many, doesn’t end after recovering from the acute COVID-19 infection. For many, Long COVID symptoms appear within months, leaving them facing the loss of physical and cognitive abilities and unable to find answers as to how to help or how long these symptoms may last. This change in ability often leads to job loss and additional financial insecurity, as well as the loss of ability to do the things you enjoy. People worry they may never return to “normal”, and instead are looking at a life and a future with chronic health conditions.

Common Mental Health Conditions Associated with Long COVID

While depression and anxiety are the most common mental health conditions commonly associated with the COVID pandemic, acute COVID, and Long COVID, we are seeing many other mental health conditions, including:

• Post-Traumatic Stress Disorder
• Substance Abuse
• Sleep Disorders
• Cognitive Impairment
• Eating Disorders
• COVID Psychosis
• Loss of Hope and Suicidal Thoughts

Know the Signs of Anxiety, Depression, and Suicide Risks

Everyone experiences signs of sadness and anxiety from time to time as everyday life can impact our mental state. However, ongoing feelings of anxiety and depression can be signs of an underlying mental health disorder that can benefit from treatment. Understanding the signs and symptoms of anxiety and depression, as well as suicide warning signs can help you understand symptoms you may be experiencing, as well as identify potential signs and symptoms in friends and family members.

While many of these symptoms are common in anxiety or depression, they may occur in other diseases or disorders, so it’s important to get assessed to ensure that this is the diagnostic label that makes the most sense for you.

Symptoms of Depression

• Persistent sad or empty mood
• Feelings of hopelessness, guilt, worthlessness, or helplessness
• Loss of interest or pleasure in activities
• Decreased energy or fatigue
• Insomnia
• Difficulty concentrating, remembering, or making decisions
• Loss of appetite and/or weight loss
• Restlessness or irritability

Symptoms of Anxiety

• Increasing fear or worry
• Sense of dread, doom, or panic
• Irritability
• Restlessness
• Feeling on edge
• Insomnia
• Fatigue
• Difficulty concentrating, remembering, or making decisions
• Increased heart rate
• Hyperventilating
• Trembling or sweating
• Muscle tension

Suicide Warning Signs

• Withdrawal from friends, family, and community
• Dramatic mood swings
• Impulsive or reckless behavior
• Giving away possessions
• Talking about wanting to die
• Talking about feeling trapped or in unbearable pain
• Sleeping too little or too much
• Increased substance use

If you are experiencing thoughts of suicide, you are not alone, and support is available. If you are in crisis, please call the Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Get updates

Join our mailing list