Mental Health, ADHD, and COVID-19

An often-overlooked secondary effect of COVID-19 infection is subsequent neurological and psychiatric problems. Last week, we learned from new research published in the Lancet that 1 in 3 survivors of COVID-19 have neurological or psychiatric problems six months after recovery from the illness. For 12% of all survivors, this was their first-ever psychiatric or neurological illness. The psychiatric outcomes studied were anxiety, depression/mood, and psychotic disorder. While worse for those with severe illness, the results held even in patients who were not hospitalized. It remains unclear if the psychiatric outcomes were direct results of the illness (perhaps due to neuroinflammation), or were secondary to the general consequences of infection such as social isolation. However, the rates of psychiatric outcomes were still higher than in matched samples that had the flu or other respiratory illness. From another study, we learned last month that those with pre-existing mental health problems are more likely to get infected with COVID-19. Thus, it’s a vicious cycle, a bi-directional risk.

None of this includes the increase in mental health concerns due to the secondary economic and isolation stressors of people in general, even if they were not infected. Last month, the CDC reported a dramatic increase in anxiety and depression in the U.S. over the past year overall, particularly among young adults. If you are feeling anxious or depressed these days, you are not alone!

But all this translates into a lot more need for mental health care in the near future. These studies that I just mentioned have included children but did not report results for children. Yet millions of children have also been infected with COVID-19. Last week at the international meeting of the Society for Research in Child Development, Dr. Jim Swanson reminded the audience that the neuro-inflammation seen in the 1918 influenza pandemic might have led to an increase in cases of hyperkinesis (ADHD). He asked: will we see a dramatic increase in ADHD in the coming years due to COVID-19 (which also seems to cause neuroinflammation)? Even though COVID-19 (unlike the influenza A of 1918) seems to affect children less than adults, millions of children have still been infected.

An editorial this month in the Journal of Behavioral Health Services Research discusses what to do about the worsening mental health crisis in the U.S. The mental health effects of the COVID-19 pandemic are thought to be due both to the illness itself and to the economic losses, grief at loss of lives, and the social distancing and isolation that has been necessary to contain the pandemic. The commentators emphasized the need for updated mental health policy to address (1) accessibility of mental health care for everyone regardless of ability to pay, (2) adequate mental health services for children and youth—the upstream source of future chronic mental health disorders, and (3) equity of care for mental and physical health, and equity across racial, ethnic, and income groups.

At this writing, the world has seen about 137 million documented cases of COVID-19 infection, with nearly 3 million deaths. While this is doubtless a substantial under-count, that means at minimum well over 130 million COVID survivors worldwide, and still counting. If 12% have a first-ever psychiatric diagnosis afterward, that is over 15 million new mental health patients. In the U.S., we have had over 30 million cases to date—that works out to about 3.5 million first-time mental health patients. About 3.5 million of the U.S. cases were children, according to the American Academy of Pediatrics website (accessed on 4/13/2021). While we don’t know the rate of mental health problems in children related to a COVID-19 infection, even if it is half the rate in adults, that would lead to over 1 million kids needing services—of whom 200,000 are getting first-time diagnosis. Even if these numbers are high, the implication of a significant further crisis of mental health is apparent in an already over-stressed system.

We already know that kids and adults with ADHD tend to be very sensitive to environmental stressors and perhaps tend to experience coping problems more severely at those times. COVID continues to place a particular risk in front of individuals with existing mental health conditions, including ADHD, and to place everyone who gets an infection in a group at risk of diagnosable further mental health problems.

What can we do? At a personal level, continue to pay attention to self-care. Recognize that the social isolation and economic uncertainty of the past year are real stressors affecting a lot of people. You are not alone. While the growing vaccination success and economic indicators suggests a light at the end of the tunnel for many people, stressors remain very high. Continue to be kind to yourself and your loved ones (and strangers). Second, continue taking precautions to avoid COVID-19 infection, while recognizing that children do need to return to school and some activities do have to continue. Third, get vaccinated. Despite recent scares related to some of the vaccines that give pause, the risk of significant side effects remains very low compared to the risks from COVID-19, as documented in the public health statistics summarized in several recent media reports. (A well-documented set of charts was provided in the Los Angeles Times recently). Fourth, for those with existing mental health conditions, including ADHD, stay vigilant to mental and physical health needs.

The good news is that the improving capabilities in telehealth and the increased willingness of insurance to pay for telehealth mental health care means that mental health care remains available to many people who need it. At the same time, as a society, the need for further reforms and investment in mental health care and mental health research is acute. Policymakers should take note, as well.

To find a therapist, please visit the Psychology Today Therapy Directory.

Please note: Dr. Nigg cannot advise on individual cases for ethical, legal, and logistical reasons.