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By Liz Carey
As COVID cases rise in rural areas, a new report found that one in five COVID-19 patients develop mental illness within 90 days of recovery.
That could spell trouble for rural residents who already have a harder time getting access to mental health services.
The report, published this week in the Lancet, found that those who’ve had COVID-19 are likely to develop anxiety, depression, and insomnia, but can also develop post-traumatic stress disorder.
“For people with COVID-19, lack of contact with their families or loved ones during quarantine and hospital stays can produce psychological instability,” the report stated. “High rates of post-traumatic symptoms have been reported in clinically stable people discharged from hospital after recovering from COVID-19.”.
Researchers found that 32.2 percent of COVID-19 patients develop post-traumatic stress disorders, while 14.9 percent develop depression, and 14.8 percent anxiety. Additionally, people who have had COVID can experience post-intensive-care syndrome which includes cognitive, psychological, and neurological symptoms. In some cases, the researchers found, those who have had COVID have significantly higher risks of dementia.
According to the Centers for Disease Control and Prevention, as of November 22, more than 11,843,490 Americans had tested positive for COVID-19, up 192,673 from the previous day. Since the beginning of the pandemic, nearly 253,000 people have died.
Currently, more than 1,800 people a day are dying of the disease that is hitting rural areas particularly hard right now. New cases in rural counties are continuing to climb. During the week of Nov. 2, there were 144,043 new infections in rural counties, up from about 110,000 the week before.
The outcomes of those rural cases, and the possible mental health implications for rural residents, are troubling Carrie Henning-Smith, the deputy director of the Rural Health Research Center and an associate professor in the School of Public Health at the University of Minnesota.
“We have all of this new and emerging evidence about COVID-19, and the more evidence we have, the more concerning the picture is,” she said. “ Most rural areas are at a point now where their case counts are, by all measures, out of control and don’t appear to be going down any time soon…Mental health issues that might emerge from COVID-19 are particularly concerning because rural areas already have such a deficit of mental health care and mental health care providers compared to urban areas. But any additional burden of mental health on top of the mental health issues that already existed is just going to make those barriers to care worse.”
The paper said COVID-19 also affects the mental health of those who have not had the disease.
“The unpredictability and uncertainty of the COVID-19 pandemic; the associated lockdowns, physical distancing, and other containment strategies; and the resulting economic breakdown could increase the risk of mental health problems and exacerbate health inequalities,” the paper said. “Preliminary findings suggest adverse mental health effects in previously healthy people and especially in people with pre-existing mental health disorders.”
The report noted increased symptoms of depression, anxiety, and stress as a result of the life disruption, fear of illness, and fear of negative economic effects brought on by COVID-19 including phobic anxiety, panic buying, binge-watching television (associated with mood disturbances, sleep disturbances, fatiguability and impairment in self-regulation), as well as increases in risky behaviors like online gambling, and increased drug and alcohol use.
Getting people in rural areas access to care to deal with these issues is an ongoing problem, Henning-Smith said. While many hospitals and mental health facilities are pointing to telehealth as a solution, she believes that may not be the right solution for rural areas.
“We have gaps in the Internet and cellular connectivity, and access to technological devices (in rural areas). And so, even if we’re saying that it can be reimbursed, it doesn’t ensure that everyone has equitable access,” Henning-Smith said. “Telemedicine is wonderful and offers a lot of promise, particularly for mental health care, but there are cases where it’s not gonna be the most appropriate form of care.”
Congress has proposed legislation to address the mental health and substance use issues that are expected to come out of the pandemic, including many introduced in April and May that were incorporated into grants provided in the CARES Act.
“I don’t see any indication the gaps in mental health care that we have in rural areas are getting better beyond what’s happening and telemedicine during COVID,” Henning-Smith said. “I think, if anything, healthcare providers in rural areas are doing everything they can just to deal with the exploding cases of COVID-19.”
Lack of staffing is another issue, she said. Henning-Smith believes there are good candidates lined up and what’s needed is a creative approach to funding and resource distribution. Knowing the issue is there, she said, may help in getting the right resources in place to address it.
“We can anticipate what some of the mental health concerns might be recovering from COVID-19, so that we can reduce some of these barriers to care and get treatment in place for when and if people need it,” Henning-Smith said. “I think the more we know, the more we can plan and anticipate.”