BACKGROUND: PSYCHOLOGICAL IMPACTS OF THE COVID-19 PANDEMIC
During the COVID-19 outbreak, stress and anxiety levels have increased across the community and particularly for those at higher risk for severe illness and with underlying health conditions. Older adults as well as those with disabilities are at increased risk for having mental health concerns, such as depression. Taking a physical toll, mental health issues often manifest and present themselves as physical ailments, such as headaches, stomachaches and/or cognitive problems (such as difficulty concentrating.) Moreover, doctors are more-likely to miss mental health concerns among those in the increased-risk category as their disability and age tend to be viewed as the primary contributor to presented physical ailments. Namely, depression can be mistaken as a normal part of aging in older adults.12
Aside from overall stress and anxiety, common psychological reactions to COVID-19 have formed due to a myriad of causes. Firstly, there is a concern about protecting oneself as well as family and friends. Further, patients often have a sense of guilt if loved ones assist them with activities of daily living. Disruptions in regular medical care or community services impact those who were already medically challenged in some regard, dependent on frequent appointments and assistance. Moreover, feeling socially isolated takes on a psychological toll particularly for those who live alone or are in need of assistance and who are now facing less interactions due to community-wide stay-at-home orders. Further, those facing increased levels of distress are often those who: have had pre-existing mental health concerns (which began prior to the outbreak); live in lower-income households; have language barriers; and experience stigma because of age, race, ethnicity, disability or perceived likelihood of spreading COVID-19.13
Those coming out of quarantine also tend to face severe stressors, regardless if they may have been exposed to COVID-19 and have not gotten sick. Emotional reactions to coming out of quarantine may include: having mixed emotions, including relief; stress from the experience of being monitored for signs and symptoms of COVID-19; sadness, anger, and/or frustration because friends of those close to you have fears of contracting the disease from contact with you, although you have been determined not to be contagious; and guilt about not being able to perform normal work or parenting duties during quarantine.14 Forced isolation, coupled with the fear of possibly having the Coronavirus, is particularly daunting and can be a significant stressor and manifest with both mental and physical ailments. As such, the CDC has cited common signs of distress during this time, including:
Feelings of numbness, disbelief, anxiety or fear.
Changes in appetite, energy, and activity levels.
Difficulty sleeping or nightmares and upsetting thoughts and images.
Physical reactions, such as headaches, body pains, stomach problems, and skin rashes.
Worsening of chronic health problems.
Anger or short-temper.
Increased use of alcohol, tobacco, or other drugs.15
BACKGROUND: FINANCIAL INSECURITY AND UNEMPLOYMENT
Approximately 10% of workers have lost their jobs mid-March to mid-April, due to the economic effects of the COVID-19 pandemic.16 With over 10 million people currently seeking jobless benefits17, this is one of the largest and fastest incidence of job losses on record in the United States.18 Washington state has been hit particularly hard by the Coronavirus, with nearly 1 million weekly claims filed, as of April 26th. Washington’s Employment Security Department reported receiving 20,000 calls a day19, utilizing extended resources available such as using evening hours and Sundays to process claims.20
A myriad of workers has been affected by the Coronavirus. According to an analysis conducted by the Institute for Women’s Policy Research, about 60% of job losses were experienced by women.21 The IWPR report added that women lost jobs in four sectors, while employment for men rose, within: educational and health services; financial services; construction; and information. However, men lost more jobs than women in the areas of: wholesale trade, mining and logging. Job losses have also disproportionately impacted teenagers in the workforce, with the current rate of unemployment for those aged 16 to 19 at 14.3%, compared with 4% for those aged 20 and older. The American Hotel and Lodging Industry has predicted nearly four million people working in the hotel industry may lose their job. UBS predicts one-in-five restaurants could close due to the virus, with take-out and delivery orders not being enough to sustain business.22 Until the beginning of April, most states were not accepting unemployment claims from people who did not have traditional employers, such as gig workers, freelancers and the self-employed. However, the Pandemic Unemployment Assistance program recently passed by Congress extends much-needed benefits to these workers.23
Despite the surge in those needing medical treatment during this time, job security of those employed by the health care industry have also waned. A report from the Bureau of Labor and Statistics indicated the health care workforce lost 43,000 jobs in March 2020; primarily due to job losses in dental offices and private physician offices. While private practices and smaller health systems were the first to be negatively affected by COVID-19, some of the country’s largest health systems have also faced staggering financial losses – translating into significant job cuts and losses. The Hospital and Health Association of Pennsylvania (HAP) recently highlighted the financial challenge health systems are facing, stating that in March, “hospital operating margins dropped by an estimated $914 million compared to expectations.” The report added that Pennsylvania expects massive losses statewide for the upcoming financial quarter – roughly 4.5 billion dollars. Henry Ford Health System, located in Detroit, announced a mass furlough of nearly 3,000 employees across its six-hospital system, citing net losses of $234.5 million for the first quarter (a decrease of $354.9 million over the same period in 2019.) Johns Hopkins University (JHU), the umbrella organization which owns 50% of the Johns Hopkins Health System, has sought to implement various cost-cutting measures, including salary freezes for all staff and faculty, the suspension of retirement contributions and a sweeping organization-wide hiring freeze. The salaries of higher-level employees like the university president, provost and deans were also cut. Johns Hopkins Health System is the largest health system in Maryland and Johns Hopkins institutions are the largest non-government employer in that state. Before the pandemic, there were projections JHU would bring in $72 million in 2020 – now, it expects to lose $100 million. Since many of the nation’s hospitals’ usual stream of revenue (e.g. elective surgeries) have been postponed and/or cancelled, health care systems claim they cannot financially stay afloat without sacrificing employee jobs or cutting their pay.24 The Coronavirus Aid, Relief, and Economic Security (CARES) Act was signed into law on March 27.25 While $100 billion of the $2 trillion economic relief package earmarked for hospitals has helped, industry leaders have claimed it was not enough to account for the drastic losses they have endured; further, the House approved another relief bill that includes an additional $75 billion for hospitals.26
Job losses and financial instability have led to unprecedented housing insecurity in the United States. Mary Cunningham, a fellow at the Urban Institute, warned that shelter-in-place measures have created a situation in which low-income renters are now at high risk for eviction and homelessness, many of whom work in service industries hit exponentially hard by the pandemic shutdown. Cunningham added that the recent CARES Act, “didn’t do enough to address increases in housing insecurity for the nearly 11 million low-income renter households paying more than half their income toward rent before the pandemic. Low-income renters, especially those who lose employment during the crisis, will have a hard time paying back rent, and they could face housing situations that spiral out of control.” Supporting Cunningham’s claims, Avail, which is an online platform for landlords, conducted a survey of 2,775 landlords and 7,379 tenants; results indicated more than half of renters (53.5%) reported job losses due to measures enacted as a result of the COVID-19 pandemic.27 With 78% of Americans living paycheck-to-paycheck28, job cuts and losses will not only impact renters across the socioeconomic scope, but also homeowners seeking to make their next mortgage payment.
MATERIALS AND METHODS
Our exploratory, empirical research utilized an anonymous, online self-administered survey, that we designed and implemented on the Survey Monkey website. Questions were asked regarding respondents’ level of stress/anxiety/worry both before the pandemic and at current levels, their general concerns at this time as well as what impact the pandemic has had on their employment and health. Answers utilized both open-ended, scaled and multiple-choice format. The sample was obtained via online and social media methods, e.g. the Seattle Anxiety Specialists’ website, SAS Facebook page and Twitter accounts, resulting in a total of 1382 valid completions. Data was collected over a one-week period from April 16-22, 2020 and sought to collect data at one snapshot in time, during the peak of active Coronavirus cases in Seattle. We did not utilize the respondents within the Survey Monkey database as previous experience working in the private research sector has shown us that utilizing paid survey respondents can often result in rushed/inaccurate responses and lessen the validity of data. Additionally, by targeting respondents via SAS’ social media and online presence, there was a higher likelihood of obtaining respondents who suffer from increased stress/anxiety/worry than the general population, which was to assist Seattle Anxiety Specialists pinpoint what specific needs this cohort needs for assistance during this time of crisis.
To qualify for the study, respondents had to meet the following requirements:
Demographically, the sample is fairly balanced regarding respondents’ educational level and age, however, the sample yielded significantly greater females than any other gender – therefore data could not be cross-tabulated for that variable. Data was then cleaned to remove anyone who did not complete the survey after starting it and those who lived out of the target geographical area. Data analysis was conducted utilizing SPSS (IBM SPSS Statistics Subscription.)
Our results found both directional and significant evidence of psychological stressors occurring directly from the Coronavirus pandemic based on comparative data of the sample’s responses on a multitude of measures both prior to and following the outbreak.
Respondents indicated that money/finances as well as work issues/concerns were there primary worries before the COVID-19 pandemic. Following the outbreak of the virus, respondents indicated their concerns shifted to focus on their own health and safety as well as for their family. While there was a shift towards respondents expressing worry towards their own health, as well as the health of those they know, there was also a doubling in expression of care/concern towards the general population and various social issues (homelessness, environmental issues, inequality, etc.) suggesting that the pandemic has caused an increased sense of community and empathetic wanting to take care of ones’ neighbor.
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