Body dissatisfaction and poor body image have been rising in prevalence continuously fueled by social and popular media channels leading to shifting attitudes among adolescents in particular. Such concerns are frequently reported in mid-adolescence and may be associated with the subsequent onset of mental health symptoms, ranging from disordered eating patterns to depression. As a whole, body dissatisfaction can lead to behaviors among individuals that multiply health risks, including excessive exercise, drug abuse, and often comorbid psychiatric illnesses which have been linked to numerous adverse outcomes.
As many studies have already reported, rates of mental illness symptoms in the population have been rising throughout 2020 due to social distancing measures, increased isolation, and a general upheaval of normal life due to the COVID-19 pandemic. For this reason, the prevalence of seasonal affective disorder (SAD) is also projected to reach an all-time high in the forthcoming months as surges in virus cases coincide with declining options for activities as colder weather encroaches. Alongside the widespread, multi-faceted devastation caused by the pandemic, political concerns and social unrest leave the American population increasingly vulnerable to SAD this fall/winter season.
Seasonal Affective Disorder
According to current estimates, approximately 5% of Americans experience seasonal depression which usually begins during transitions from the summer to fall and fall to winter.
The onset of colder weather and decreased sunlight exposure contribute to a biochemical imbalance in the brain characterized by lowered serotonin levels and altered circadian rhythms. Common symptoms include sadness, loss of interest in activities, changes in appetite or eating patterns, changes in sleep, and loss of energy. The condition typically lasts for approximately 40% of the year although, in some patients it can last even longer.
Seasonal affective disorder is more common among women, young adults, those living further from the equator, as well as those with a personal or family history of depression. Nonetheless, the current environment is not conducive to overall wellbeing, putting more individuals at risk for depression even if they have never experienced mental health concerns before.
SAD Amid COVID-19 Restrictions
The symptoms of seasonal depression are likely to be exacerbated by pandemic conditions across the world as the number of activities decreases and feelings of isolation, compounded by stress and anxiety, increase across populations and age groups. Protective measures against COVID-19, including the closure of many business and limited social contact, contribute not only to declining in-person interactions but also growing financial burden. The lack of physical mobility, reduction in activities, and persisting threat of the novel coronavirus greatly heighten the risk for mental health symptoms in the population.
“There’s less activity, there’s less socialization, there are less mastery activities, there are less pleasurable activities, so in general there is an increase in depression, not to mention job losses and losses of people,” Dr. Lata McGinn, co-founder of Cognitive and Behavioral Consultants told USA Today in a recent article.
It is paramount to find safe ways to socialize and remain active throughout the coming fall/winter season. Individuals are encouraged to maintain a strong support system of family and friends with frequent video and phone calls, socially-distanced visits, and other safe interactions. Experts recommend keeping a consistent exercise routine, which can greatly benefit mental health while also increasing overall emotional and physical wellbeing. Despite the cold, it is important to continue spending time outdoors for sunlight and fresh air exposure in a safe way.
Another potential therapeutic option recommended by psychologists is light therapy, which can be used indoors to mimic sunlight exposure. Daily treatment involves approximately 20 minutes of exposure to the light throughout the winter months with improvements seen between 1-2 weeks after initiating treatment.
In addition, experts recommend pursuing an “activity diet” focused on learning and building new skills – such as studying a new language – in order to derive a sense of accomplishment. CNN outlines several other helpful options and ideas for combating seasonal depression symptoms during this time, including journaling and other meditative practices.
However, some patients may need to undertake more aggressive treatment measures to improve their seasonal depression symptoms. Talk therapy and cognitive behavioral therapy can effectively treat SAD as can antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs). With the rise of telemedicine, there has also been an increase in available options for virtual psychologist and psychiatrist visits bringing mental health support to patients in the comfort of their own home.
Although the National Institute of Health does not recommend diagnosing seasonal affective disorder until symptoms are experienced for two or more consecutive years, if symptoms begin to negatively affect daily functioning individuals are urged to seek professional support. As per the American Psychiatric Association, “anyone feeling severe symptoms of depression or suicidal thoughts to contact a doctor immediately or seek help at the closest emergency room. The National Suicide Prevention Lifeline can be reached at 800-273-TALK (8255) or via online chat.“
Psychiatric disorders have a documented association with lower life expectancy – in some cases shortening lifespan by as much as 10 years – as well as increased risk of comorbid medical conditions. In light of the persisting COVID-19 public health crisis, experts are concerned that psychiatric comorbidity may increase virus-related mortality and predispose patients to poorer outcomes.
Ongoing and emerging research efforts aim to investigate the implications of prior psychiatric diagnoses on COVID-19-related mortality and health outcomes. According to data from a recent Yale University study, patients suffering from mental illnesses may face a higher risk for severe COVID-19 outcomes including death.
Psychiatric Comorbidity and COVID-19 Mortality
Researchers from the Yale University School of Medicine evaluated data obtained from the Yale New Haven Health System. Overall, the study included clinical data from 1,685 patients hospitalized with COVID-19 infection between February 15 and April 25, 2020.
Within that cohort, those who had been diagnosed with prior psychiatric disorders had a significantly elevated mortality risk compared with patients without a diagnosis after controlling for demographic characteristics, comorbidities, and hospital location. Of the 1,685 total participants, 473 (28%) received psychiatric diagnoses prior to hospitalization. This group was significantly older and more likely to be female, non-Hispanic white, and to have medical comorbidities. Overall, 318 patients or nearly 19% of the cohort died. The highest risk for COVID-19 mortality was reported among patients with a psychiatric diagnoses at 2 weeks after their index hospitalization, as well as at 3 and 4 weeks.
South Korean Cohort Study
In a similar study conducted by South Korean researchers, a cohort of patients with mental illness did not have an increased risk for testing positive for COVID-19 compared with the general population. However, the findings, published in Lancet Psychiatry, reveal that patients with a severe mental illness diagnosis had a greater risk of severe COVID-19 outcomes – including death, intensive care unit admission, and use of mechanical ventilation.
In this study cohort, groups with and without mental illness were matched demographically and by the presence of comorbid conditions.
Association Between Psychiatric Diagnosis and COVID-19 Outcomes
The latest studies are the first to characterize the association of psychiatric diagnosis with COVID-19 mortality. Their findings are similar to previous scientific results, confirming that individuals with comorbid psychiatric and medical diagnoses had poorer outcomes and higher mortality rates. However, the reasons underlying this association remain unclear at this time.
“Psychiatric symptoms may arise as a marker of systemic pathophysiologic processes, such as inflammation, that may, in turn, predispose to mortality,” the U.S. study’s authors wrote in the research letter. “Similarly, psychiatric disorders may augment systemic inflammation and compromise the function of the immune system, while psychotropic medications may also be associated with mortality risk.”
The Yale University study’s authors acknowledged their trial’s limitations, including the fact that individuals not hospitalized for COVID-19 as well as those who died outside of the hospital were not included in the dataset. Furthermore, diagnosis codes were used to determine psychiatric diagnosis, which do not account for the status of treatment or whether the patient had an active, in-remission, or recovered psychiatric disorder in both of the studies.
Neither study took obesity or cigarette smoking into account, nor socioeconomic status or patient education level, which may be confounding factors.
Medical experts believe that an underlying biological mechanism related to the immune system may provide an explanation for this association although, further research is needed to confirm.
The author’s stress the importance of the consequences of mental illness as related to poorer health and decreased life expectancy, which may be in part due to reduced access to medical care and treatment adherence. Many individuals with psychiatric disorders lack health insurance or adequate coverage which may delay them seeking medical care; these patients may present at the hospital with more advanced stages of COVID-19. Clinicians should take these factors into consideration when treating patients with COVID-19 and remain aware of the multifactorial risks associated with pre-existing mental illness.