Pandemic Mental Health

Posted by Nurse Linda in Life After Paralysis on April 16, 2020 # COVID-19, Health

We have all been sheltering in place and staying safe for several weeks. The good news today is that this simple process is working to reduce the spread of COVID-19. Sometimes, we forget that the simplest activities are the best actions. Washing hands meticulously and often, social distancing and sheltering in place is a combination that reduces the spread of all contagious diseases, colds, flus and COVID-19.

These changes in the way we live our lives and our social contacts are challenging. As humans, generally, we want what we want and when we want it. Constraints can be difficult as you are aware with a diagnosis of spinal cord injury. These added restrictions add another level of challenge.

Just prior to the explosion of COVID-19, I was writing about mental health. It is with this added trial of COVID-19 that mental wellness can be affected. We take care of our body’s physical needs but often we overlook our mental health. Assessing mental wellness does not mean you are mentally ill. It is a process to use to ensure your complete wellbeing. At this time, anxiety, stress and depression can creep into your mental wellness.

Anxiety is an intense feeling of worry and fear about something that is impacting your life or something that you think will impact your life. We all have some anxiety at different times about specific situations. Think about being in school with an upcoming test looming. People can become anxious about the test before it occurs even if they have known about it for weeks. When is over, our thoughts turn to other ideas. This is a typical behavior.

When the thoughts become excessive or when you cannot allow yourself to think about anything else is when it is time to think about anxiety as an issue. Anxiety occurs when the thoughts interfere with your daily life, cannot be controlled or are out of proportion to the situation. Anxious feelings most often start in childhood or in the teen years but can also begin with a serious illness, after a trauma such as spinal cord injury or during a pandemic.

It is time to seek help if your anxiety is interfering with your life in general or any specific aspect of your life, if it is difficult to control, you feel depressed or have increased alcohol or drug use (even over the counter medications) or become suicidal. Anxiety can lead to physical health issues. You might find yourself ill but without a specific cause such as headache, tension, upset stomach, etc.

During this pandemic, it can be easy to become anxious. There can be a lot to worry about such as your health, family and friend’s wellbeing. Even going to the store has become a significant challenge due to mask wearing and gloving outside of your home. Hygiene must become a priority.

The threat of COVID-19 is with everyone. Everyone must adapt to these new routines. This takes time. Allow yourself time to adjust. Set up your equipment where you will be using it such as masks and gloves by the door. Add hand sanitizer to your take along bag. It will take some time to become organized but you have been successful in adjusting to spinal cord injury so you can adjust to this as well. Identify your coping abilities and strategies. Put them into use them for your response to COVID-19.

Stress is a period of psychological strain. It is a feeling of being overwhelmed by a situation. The body will trigger responses to stressful situations such as the fight or flight response. When threatened, an individual will either respond with extra energy for fighting or will run away or freeze in response (flight). Most often fight or flight is seen with an immediate threat to self-preservation such as when a person is physically or verbally assaulted. In this time of COVID-19, a person might feel threatened continually leading to stress. The CDC has provided these symptoms of stress as related to the COVID-19 pandemic:

  • Fear and worry about your own health and the health of your loved ones
  • Changes in sleep or eating patterns
  • Difficulty sleeping or concentrating
  • Worsening of chronic health problems
  • Worsening of mental health conditions
  • Increased use of alcohol, tobacco, or other drugs
  • No one can remove COVID-19 as a threat in the world today.

If you have stress in your life, know your triggers so you can confront or withdraw from a situation. You may not have felt stress in the same way as you do now. Reconstruct your thoughts, feelings and responses when you are feeling stress so you can identify triggers that increase your stress level. Stress is felt differently by everyone so what you are feeling might not be the same experience as your family members, friends or others. You can only know how you feel and learn how to control those feelings. It may not be possible to physically remove yourself from the stressor, but you can attempt to manage your mental outlook about them.

Depression is a persistent feeling of sadness. It is more than a passing feeling of being blue or down. We all have moments of sadness. Depression is long lasting and affects daily activities. It can occur from many factors but having a major medical issue or being confined to your home are just a few of many. Depression can affect all areas of your life or just segments.

A pandemic can trigger a new depressive episode, reactivate an old condition or make a current depression more intense. When you find you have lost interest in activities that you used to enjoy, have changes in personal habits, have new or increasing symptoms of medical illness, changes in your sleep, eating or other habits, disproportionate anger, sadness, anxiety, sleep disturbance and thoughts of death.

There are activities that you can do to help your mental health.

  1. If you do perceive an issue with your mental health or someone mentions it to you, call your healthcare professional for a referral. You can see a mental health professional online or on the telephone if you cannot go outside of your home. You might have a resource that you have used previously. They will welcome you back. If needed, call the National Suicide Prevention Lifeline for immediate help: 1-800-273-8255.
  2. Talk about your thoughts and concerns about COVID-19 with a trusted partner or friend. Talking with someone will help put the situation in perspective. Practice mindfulness or meditation to help calm yourself.
  3. Prioritize exercise. Research as many examples of movement helping to improve your mental health. As you move, endorphins (a nervous system chemical) are released in the brain which make you feel good. You also can gain a sense of accomplishment.
  4. Avoid alcohol and drugs. Alcohol is actually a depressant. If you are having mental health struggles, it makes you feel worse. Drugs can do the same. People often ignore over the counter medication which can negatively interfere with your prescribed medication or your specific healthcare issues. You can become dependent on some over the counter medications.
  5. Adequate sleep is a part of improving your mental health. Set a pattern. Go to bed at a regular time and get up at a regular time. About 8 hours per night is average for sleep. Change clothes so you have day clothes and night clothes. Avoid electronics, TV, computer, phone, for two hours before going to sleep. Sleep in a quiet area. If you must get up in the night, for self-care or childcare, avoid turning on a bright light, if possible so your brain still thinks it is night-time.
  6. Limit your access to news about the pandemic. You certainly need to stay informed daily but select other activities to do rather than watching hours of news about COVID-19.
  7. Create social contacts via the internet. Don’t wait for people to call you. Look up an old friend that you have not spoken with for a long time, call someone else who cannot go out and discuss something besides COVID-19. Before your call, think of things interesting to discuss like spring, something you saw on TV or read.
  8. Stay positive. If you look for good things, you will find them and more. Keep reminding yourself that this will be over soon. If you are a spiritual person, look for goodness. Life may not be the same for now, but the situation is already improving. Treatments and vaccines are in the works. Sheltering in place, washing hands and social distancing are working.

I hear a lot of people describe this time as the new normal. This is not the new normal. What we are living through is temporary. There will be a new normal. Most likely, it will be different from what we knew but we will not be in this constrained situation forever. It is already improving every day. We will live in uncertainty for a while but a new normal will appear and it will be ok. We can do this, and we will. Nurse Linda

Pediatric Consideration: Children have already heard about COVID-19 because the discussion is all around us. Normalize a home routine. Set a schedule. You do not have to have it regimented to the minute, but children like to know when things will occur. Have activity time, play time, school work time, rest time, meals, etc. Use whatever they were doing at school as a template.

This time is a great stressor on children as well. Not being able to see friends or go outside to play will be a significant change. Notice changes in their behavior. If they are changing attitudes or showing signs of anxiety, stress or depression, seek help early. As a parent, you know your child best so follow your instincts.

Take care of yourself. After all, you might be working or not (which is another layer of stress), providing child care, educating your child and maintaining the home. This can be quite a switch. Try to find a few moments either in another room if you are able or just to rest for a few moments. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.

For more resources on the coronavirus, visit the Reeve Foundation COVID-19 Information Center.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.