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By Lisa M Carlson, MPH, MCHES, President of the American Public Health Association and Johanna M Hinman, MPH, CHES, Past Chair of the Public Health Education and Health Promotion Section of the American Public Health Association

In this very unusual year, nearly half of Americans say the pandemic is harming their mental health. Public health workers are equally affected, if not more so. Research published in JAMA Network Open found Chinese health care workers fighting COVID-19 had significant symptoms of poor mental health:

  • Depression
  • Anxiety
  • Insomnia
  • Psychological distress

While we likely joined the field of public health with the understanding that the work would be hard, it’s less likely that we fully understood what it would mean to work through the greatest public health crisis in a century. In a recent article in The Atlantic, Ed Yong warned: “The pandemic experts are not okay,” noting health care workers are demoralized from:

  • Making the same recommendations over and over
  • ”Shouting evidence-based advice into a political void”
  • The advent of “armchair experts from unrelated fields” as trusted sources
  • Working under a nationally disjointed response
  • Seeing the missed opportunities
  • Feeling “the wrath of a nation on the edge”
  • Experiencing multiple crises at once
  • Exhaustion

Adding to these challenges is the weight of  caring for patients who might not have become ill had they followed public health recommendations. As health care and public health workers, each of us engages daily with people who are making choices that negatively impact their health. Our challenge is to stay true to our core principle of “meeting people where they are” without judgment.  We need to be mindful of what we can control - our own actions - wearing a mask, washing our hands, and watching our distance. Rather than becoming frustrated with those who may not have followed health recommendations, we can focus on doing what we can to help them now. And we need to take stock of our own mental health and acknowledge our own needs, monitoring ourselves for symptoms of anxiety, such as:

  • Feelings of fear, worry, numbness, or disbelief
  • Changes in appetite
  • Difficulty sleeping, concentrating or remembering
  • Being easily frustrated
  • Physical reactions such as increased tension and pain in the body, or headache
  • Increased use of alcohol, tobacco, or substances

What can we do for self-care?

  • Ask for help
  • Take breaks from the news
  • Take care of ourselves by focusing on the basics (sleep, healthy food, exercise)
  • Create structure and maintain routines
  • Wind down and rest
  • Take reasonable steps to protect ourselves, such as washing our hands often
  • Connect with our community to stay grounded
  • Get out into nature

The balm of nature is especially salient when connecting directly with other people may be risky. Jason Mark, in the Sierra Club national magazine, said:

“… even as we must distance ourselves from one another to protect public health, nature remains one place where we can find a feeling of reconnection.”

This is an important time to get outside – taking appropriate precautions – and soothe ourselves amongst the trees.

This pandemic brings us ample sources of frustration, but we can mitigate those stresses. As public health professionals, we need to acknowledge the impact of mental health broadly when talking about COVID-19 – taking care of our patients, ourselves and each other.

REFERENCES

Ettman, CK, et al. Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic. JAMA Netw Open. 2020;3(9):e2019686. doi:10.1001/jamanetworkopen.2020.19686.   Accessed September 3, 2020.

Lai, J, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976. doi:10.1001/jamanetworkopen.2020.397

Yong, E. The pandemic experts are not okay. Health. July 7, 2020. https://www.theatlantic.com/health/archive/2020/07/pandemic-experts-are-not-okay/613879/ . Accessed August 5, 2020.

What mental health statistics can tell us. Howley, EK. US News. June 26, 2019.

Achenbach, J. Coronavirus is harming the mental health of tens of millions of people in U.S., new poll finds. The Washington Post. April 2, 2020. https://www.washingtonpost.com/health/coronavirus-is-harming-the-mental-health-of-tens-of-millions-of-people-in-us-new-poll-finds/2020/04/02/565e6744-74ee-11ea-85cb-8670579b863d_story.html. Accessed May 22, 2020.

White, M.P., Alcock, I., Grellier, J. et al. Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Sci Rep 9, 7730 (2019). https://doi.org/10.1038/s41598-019-44097-3

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