What level of stress is normal during a global pandemic?

Nadine M. Melhem, PhD, MPH

The year 2020 has been difficult for most people in the United States. The stressors have been both universal and personal, yet heartbreaking and confusing. The COVID-19 global pandemic, the especially high mortality rate in the US, economic losses and individual everyday stressors could affect people’s mental health. No matter how people experience stress, it has been persistent and at unprecedented levels this year. Amid this mental health turmoil, helpers have emerged, including researchers.

To understand how best to help people who are experiencing high levels of stress and mental health problems, researchers must first be able to define and characterize them. What level of stress is normal during a global pandemic? Nadine M. Melhem, PhD, MPH, associate professor of psychiatry at the University of Pittsburgh School of Medicine, studies stress responses.

“From previous studies, we know that natural and human-made disasters are associated with increased risks for depression, post-traumatic stress disorders (PTSD) and prolonged grief reactions,” she says. “Given the pandemic and the different ways that people are affected by it, we wanted to study how people are responding to this stress. Is it an acute, short-lived stressor? Or is it an event that will have long-term mental health consequences?”

Dr. Melhem and colleagues designed the “COVID-19 Stress Response Study”—an online survey—to examine the effects of COVID-19 related stress on teenagers, adults and health care workers. The survey includes well-validated measures that screen for depression, anxiety, PTSD symptoms, grief reactions, suicidal ideation and behavior and sleep problems—all in order to assess clinically significant symptoms.

This past summer, Dr. Melhem analyzed the results at that point from 7,353 participants. Though she says it is not a nationally representative sample, she says the results present a quick look during a pandemic so that public health strategies and interventions can be mobilized. The survey results indicate that, for perceived stress, almost everyone confirmed that they feel stressed. However, Dr. Melhem found high rates of clinically significant symptoms in the overall sample.

“At this point in the study, 18% of respondents reported suicidal ideation and 55% of those who lost loves ones had intense grief reactions,” she says. “The rate of clinically significant symptoms of depression, anxiety, PTSD, and sleep problems ranged between 31% and 58%. These are high rates; I didn’t expect them to be this high.”

Dr. Melhem reports that adolescents in the sample had even higher rates than adults. Adolescence is a time for brain and physiological development and is a developmentally sensitive period for the negative effects of stress; which could be intensified by the social distancing measures of a global pandemic.

In the sample, race and ethnicity were not predictors of stress on their own, but they do enter into the analysis. For example, white adults were more likely to report depression symptoms. PTSD was more likely to be reported in African American and Latinx adults.

“We need to keep in mind that we still don’t know whether these symptoms are intense now but will decrease over time or whether they’ll be long lasting,” says Dr. Melhem. “The pandemic affects people differently; some people have lost loved ones, and some have lost jobs, so it’s going to vary. It also depends on how long the pandemic lasts and what comes next.” It is also important to note that mental health diagnoses include a constellation of symptoms. Thus, different people with the same mental health diagnosis can have different symptoms.

In these unprecedented times, Dr. Melhem reminds readers that while people cope differently, it is important for people to mobilize their support systems to help them cope with their individual stressors.

“Stress is a natural response to a lack of normalcy. We’re all trying to adapt to something we’ve never experienced before.” However, “If people are struggling with symptoms that are affecting their daily lives, they need to discuss their symptoms with a health care professional,” she says.
The study is ongoing. Dr. Melhem says that participation in the study is not just for people who think they are stressed; it is for anyone. For information on how to participate in the study, call 412-246-6517, or the following links will provide more information:

Adults: https://pittplusme.org/studyarms/publicdetails?Guid=3f174f8d-aba6-4bfb-ba69-f539f804f1d7

Adolescents (ages 13-17):

UPMC health care workers:
https://pittplusme.org/studyarms/publicdetails?Guid=f87bf90b-a269-4433-a167-ab6 679b38985

National Suicide Prevention Hotline (available 24/7):
1-800-273-TALK (8255)

suicidepreventionlifeline.org/ (has a chat feature) resolve Crisis Services (24/7, free to residents of Allegheny County):
1-888-7-YOU-CAN (796-8226)

walk-in crisis center 333 N. Braddock Ave., Pittsburgh, PA 15208

Actress Taraji P. Henson has started a campaign to help African Americans, who are disproportionately affected by COVID-19, access free therapy during the outbreak. Henson is operating the campaign through The Boris Lawrence Henson Foundation, which she founded in 2018. It’s named in honor of her father, who suffered from mental health challenges after serving in the Vietnam War. (Photo: Screen capture from Instagram)


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