Disasters such as the COVID-19 pandemic can radically disrupt healthcare and community services and trigger widespread population distress. The increasing rates of mental illness, substance use disorders (SUDs), fatal drug overdoses, and domestic violence now being reported in the United States represent a synergistic “shadow epidemic.” Although concerns about worsening mental health and SUD trends predate the COVID-19 pandemic, it is clear that increased social isolation, economic hardships, loss of support mechanisms, and the significant trauma created by living with a prolonged pandemic are worsening this crisis. For example, recent data in the United States show:
- There were 92,000 drug overdose deaths in 2020—the highest number ever recorded—representing a nearly 30% increase from 2019
- About 40% of adults reported symptoms of anxiety or depression in January 2021, compared with about 11% in the first half of 2019
- Adults’ rates of new or increased substance use and serious thoughts of suicide were nearly double prepandemic rates, and the number of heavy drinking days reported by women has increased by 41%
- Mental-health-related emergency department visits among adolescents increased 31%, and visits for suspected suicide attempts among girls increased nearly 51% between February and March of 2019 and the same period in 2021
- The COVID-19 disease process itself triggers persistent neuropsychiatric sequelae for some individuals who have recovered from an acute infection
While this epidemic impacts individuals across all socioeconomic groups and locations, pandemic-related stressors often fall disproportionately on vulnerable and medically underserved populations and essential workers, compounding preexisting health disparities.