Psychiatric Annals

Guest Editorial Free

COVID-19 and Mental Health

Asim A. Shah, MD

Exposure to disasters is associated with a variety of mental health disorders including posttraumatic stress disorder (PTSD), major depressive disorder, (MDD), substance use, anxiety and panic disorders, phobias, and neuropsychiatric disorders.1 Prolonged isolation can increase the risk of domestic violence and child abuse.2 One literature review estimates the prevalence of PTSD to be 30% to 40% among people who are directly affected by disasters versus 10% to 20% among rescue workers and 5% to 10% in the general population.1 After PTSD, depressive disorders have been the second most studied postdisaster mental health disorder.1 It is estimated that 5% of the population affected by Hurricane Ike in 2008 and 10% of adults in New York City post-9/11 met criteria for MDD 1 month after the disaster.2 Research with postdisaster studies has shown that after a major traumatic event the rate of substance use disorders increases, especially the use of alcohol.3 Because physical contact was limited during the coronavirus 2019 (COVID-19) pandemic, especially during the initial months, a condition called “Touch Starvation” or “Touch Deprivation” was also seen, and in some cases we continue to see that condition.4

The COVID-19 pandemic has affected certain population groups more than others. According to the Centers for Disease Control and Prevention, Hispanic respondents reported a higher prevalence of anxiety and depressive symptoms, substance use, and suicidal ideation than non-Hispanic White or non-Hispanic Asian participants.5 Black respondents also had increased substance use and serious consideration of suicide than White and Asian participants.5

Another concern has been an increase in suicidality. Although the full effects of COVID-19 on suicidal behavior are unknown, different studies show that there was a significant increase in suicide after the 1918–1919 influenza pandemic. In 1920, an organization named Save-a-Life reported a 23% increase in suicide from 1920 to 1921 after that pandemic.5 Another study conducted after the 2003 severe acute respiratory syndrome pandemic in Hong Kong showed that during the outbreak, there was a significant increase in suicide deaths among people age 65 years and older.6 Physicians on the frontlines have seen exhausting increases in their workload; initial lack of access to proper personal protection equipment; dealing with sick and dying patients; trying to make sense of conflicting guidance on disease diagnosis, prevention, and treatment; and social isolation causing breakdown of a community of colleagues just to name a few. These issues will result in increased burnout rate for physicians, and suicide trends need to be closely monitored among this group.


  1. Goldmann E, Galea S. Mental health consequences of disasters. Annu Rev Public Health. 2014;35(1):169–183. doi:10.1146/annurev-publhealth-032013-182435 [CrossRef]. PMID:24159920
  2. Galea S, Merchant RM, Lurie N. The mental health consequences of COVID-19 and physical distancing: the need for prevention and early intervention. JAMA Intern Med. 2020;180(6):817–818. doi:10.1001/jamainternmed.2020.1562 [CrossRef] PMID:32275292
  3. Sederer LI. What past disasters tell us about COVID-19 and substance abuse. Accessed November 4, 2020.
  4. Pierce S. Touch starvation is a consequence of COVID-19's physical distancing. Accessed November 4, 2020.
  5. Czeisler ME, Lane RI, Petrosky E, et al. Mental health, substance use, and suicidal ideation during the covid-19 pandemic - United States, June 24-30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1049–1057. doi:10.15585/mmwr.mm6932a1 [CrossRef] PMID:32790653
  6. Yip PS, Cheung YT, Chau PH, Law YW. The impact of epidemic outbreak: the case of severe acute respiratory syndrome (SARS) and suicide among older adults in Hong Kong. Crisis. 2010;31(2):86–92. doi:10.1027/0227-5910/a000015 [CrossRef] PMID:20418214
Asim A. Shah, MD

Asim A. Shah, MD, is the Barbara & Corbin J. Robertson Jr. Chair in Psychiatry, the Executive Vice Chair, and the Professor of Psychiatry, Family and Community Medicine, Baylor College of Medicine; the Chief of Psychiatry, Ben Taub Hospital/Harris Health System; and the Chief, Division of Community Psychiatry & Director of Mood Disorder Research Program, Ben Taub Hospital.

Address correspondence to Asim A. Shah, MD, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Room 2.125, Neuropsychiatric Center, 1502 Taub Loop, Houston, TX 77030; email:

Disclosure: The author has no relevant financial relationships to disclose.


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