13 potential long-term effects the coronavirus pandemic could have on mental health

"Initially for all of us, there [was] a lot of uncertainty and people feeling out of control. Part of that is all the confusing information we're receiving," Karestan Koenen told Business Insider. Koenen is an epidemiologist and professor of psychiatric epidemiology at the Harvard T.H. Chan School of Public Health. She studies the effects of trauma and stress.

Koenen has been hosting mental health forums that are open to the public. She's been noticing a lot of stress and anxiety among the general population. She said stress and discouragement can lead to a sense of burnout.

"Events that are threatening, are uncontrollable, and have a lot of uncertainty are really toxic to mental health," she said.

Dr. Samantha Meltzer-Brody, a professor studying mood and anxiety disorders at University of North Carolina at Chapel Hill, told Business Insider that anxiety and stress, left unchecked, can turn into depression.

"What starts as anxiety and mood swings [that] people perceive as very temporary," she said, "can develop [into] more persistent anxiety disorders or depression, the longer this goes on."

Dr. Jessica Gold, an assistant professor in psychiatry at Washington University, told Business Insider that healthcare workers may be at a higher risk of being quarantined due to the virus, and that can affect mental health.

Based on data from the 2013-2016 ebola epidemic and the SARS pandemic of 2003, those who are quarantined are at risk of developing mental disorders like depression.

"Those that were quarantined [due to ebola or SARS], also had a higher risk of severe depression, not just depression," Gold said. "We don't know overall what the risk of something like depression or distress [for the coronavirus pandemic] would be. We assume that it would go up."

Compounding the issue, Gold said that healthcare workers already had high rates of depression and suicide before the coronavirus pandemic.

According to Meltzer-Brody, survivors may have a difficult time coping with the trauma related to a quarantine or potential hospitalization.

"All of this is heightened or worsened for people where it has hit very close to home or impacted personally," she said.

PTSD develops when a person experiences a traumatic event and finds themselves affected by it years later. According to the American Psychiatric Association, people with PTSD may experience strong thoughts or emotions long after the event. They may relive the traumatic event through nightmares or flashbacks, and they may find themselves feeling anger, fear, or sadness.

"There are people who have lost multiple family members or friends," Meltzer-Brody said. "Those people are going to be at a much greater risk for having complicated bereavement and PTSD."

"If you look at what we know about the very few healthcare workers that had ebola or the people who had to be quarantined for SARS for the same reason, I think we would assume they would be at higher risk for stigma," Gold said.

"There's a higher stigma to them coming back to work, and they could infect [co-workers] or they could infect patients. And the person's feeling anxious going back to work for the same reason. Are they going to infect patients? Are they going to infect their loved ones? Are they going to infect their colleagues? It can be emotionally taxing and draining and traumatizing in its own way, and it has the potential to cause additional psychological outcomes in that way."

Gold is worried a number of healthcare workers will leave the industry because of the anxiety of going back to a place where they experienced trauma or fear of infection.

According a study by the Kaiser Family Foundation, healthcare workers may be at an increased risk of burnout due to the pandemic. Gold believes that whether they realize it in the moment or not, healthcare workers will have to deal with the trauma they experienced once things quiet down. People can even experience mental health effects years later.

"I think there's a lot of not dealing with that right away, but will that become something like PTSD in the long run? Maybe," Gold said. "I think when they get time to focus on themselves, that's when they realize: They're not sleeping as well, or they are more stressed, or they are drinking more. They are sad, or they are having feelings they weren't expecting to be feeling."

Gold said that in addition to developing PTSD, healthcare workers were also at a risk of developing a substance abuse issue.

Since the pandemic, Meltzer-Brody said, the rate of people using substances has gone up, and alcohol sales have increased during the pandemic.

"There's a lot of concerns about what this means for people self-medicating with substances during the pandemic," she said. "For some people, the longer this goes on, it increases the chances of this being really traumatic and people experiencing PTSD. People struggling with addiction, they have mal-adaptive or destructive ways of coping that persist and become a real problem."

"I think the people who have a history of mental illness, it puts them at risk of a relapse," Koenen said. "If someone has a history of depression, they're more at risk of having depression again."

For those dealing with a chronic mental illness, Koenen said, they may find it increasingly difficult because institutions and programs that gave them structure or treatment have been shut down in areas due to the coronavirus.

"Those folks are at even more risk of feeling isolated and lonely and disconnected," she said.

"Some families are being separated from loved ones because their loved ones don't want to be infected, and because of that, that can lead to additional stress or strain on various groups," Gold said.

"It wouldn't surprise me if it is additionally stressful or burdensome, or causes more trauma or nightmares for people who are worried about their loved ones either bringing something back to them or getting sick and hurt themselves."

How children react to the coronavirus and any effects they experience long-term depends on their age and how affected they are, both Koenen and Meltzer-Brody said.

"For school-aged kids, one of the hardest things has been the online schooling and figuring that out. I think that's varied a lot and how connected they can stay with their friends is really important," Koenen said. "For teenagers, they know a lot more about what's going on in the world and they're taking in information and not all of it is good information."

Teenagers may also experience a sense of loss or grief at missing out on coming-of-age milestones that mark their progress into adulthood.

"This time of year there's a lot of sadness because they're missing their friends. They're missing graduation. They're missing prom. They're missing a lot of things that they planned or looked forward to," Koenen continued. "If you're going off to college in the fall, first of all you don't know what that's going to look like, and also you didn't get to say goodbye to your friends."

"For a young person, it might have meant independence from their parents. There's also that loss of meaning, and that increases the risk for people to feel depressed," Koenen said.

According to Meltzer-Brody, that loss of independence could cause young adults to feel more isolated than they otherwise would.

"Moving in with parents, having much more restrictions on their lives can lead to enormous amounts of feeling isolation, not being able to have normal development at older ages," Meltzer-Brody said. "The loss of freedom, the concerns about 'Am I going to get a job?' — all of these things can be extremely difficult."

Based on data from the Great Recession, Koenen said, people who experienced home foreclosures or job loss in 2008 experienced an increased risk of depression and anxiety. Job loss can cause stressors that are toxic to mental health, such as food insecurity and an inability to pay their bills.

"A lot of people do cope through their work or help them manage stress," Koenen told Business Insider. "It can be stressful, but it makes them feel like their life has meaning. It's their way of connecting with people, especially during the pandemic when many of us are still under some stay-at-home orders. The loss of job is a loss of income, but it can further be a loss of social connection. You lose whatever identity that was associated with your job, whether it's the work itself or your identity as a breadwinner."

"The study from SARS [showed] the longer people were quarantined, the worse the outcomes were. Quarantine means you were infected and put in a quarantine, but that's different from self-isolation. And that's different from what we are all experiencing right now so it's pretty hard to apply," Gold said.

But she believes burnout is a real issue — not just for healthcare workers, but for the general population.

"Being constantly on alert has to have long-term effects," she said.

Rather than depending on substances like alcohol or caffeine, Koenen said, people should be practicing positive coping habits like taking a walk or meditating. She said it's also important to be aware of your emotions and reach out to someone if you need to.

Gold also recommends exercise, deep breathing, watching TV, or whatever you do to relax even if it's just for a moment or a short period of time.

"In the moment when you're trying to cope with a lot of stress and go back to work, you have to figure out a quick decompression technique," she said. "You really need to figure out what is comforting and what can sort of feel light for you and something relaxing."

• Read more:
• 10 things you can do to improve your mental health during isolation
• I'm a psychologist treating doctors during the coronavirus pandemic. They're already in a mental health crisis — and they need as many resources as we can offer.
• 7 simple things everyone can cut out of their life to reduce anxiety, according to a psychotherapist
• Depression doesn't take time off for a pandemic