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Covid-19 Depression & Grief

With a catastrophic pandemic as COVID-19 (SARS-CoV2) with exposure to overwhelming circumstances and a high number of deaths, survivors have to manage the aftermath of potentially occurring anxiety, grief, major depression, and PTSD.

Mental health services have, at times, been overwhelmed because of an inadequate number of available trained professionals and preparedness to handle such a high demand on available resources.

Symptoms of Depression & Grief

There needs to be a heightened awareness and a public effort to recognize signs and symptoms of significant depression or insurmountable grief. With recognition, help, and resources get directed to those in need to prevent the adverse consequences of untreated post-trauma major depression and anxiety, with the heightened vulnerability to severe illnesses and possible death.  Those especially affected by the COVID-19 pandemic, are the front-line medical workers, first responders, police, and those affected by the loss of a significant other.

The following story illustrates a personal account of the progression of grief to major life-threatening depression in a person that lost a loved one after a COVID-19 infection:

Picture of a depressed man
© fresnc16/dollar photo club – deep depression and grief

The Story of Helen

“I am profoundly depressed. My wife of 50 years, Helen*, after a valiant fight, died in the ICU of a COVID-19 infection. The two of us were inseparable companions and had lived through many difficult times and challenges. This was to be our golden years of enjoying the fruits of our labors. Then out of the blue, my dear wife developed a cough, shortness of breath, and difficulty breathing. Things progressed rapidly, and we ended up in the emergency room. This was the last time I saw my dear partner as she was whisked away to the ICU and placed on a respirator. She bravely smiled at me with her parting glance. Helen died ten days later, and I’m desolated, I can’t get out of bed, don’t feel like eating, and find myself crying most of the time when I’m awake. Other family members and friends have tried to console me, but their attempts to help just seem to make things worse. I just feel like dying myself and joining my wife and even have had thoughts of taking all the pills in the bathroom cabinet. What can I do?”

The presenting situation here appeared to be beyond the natural grieving process and rapidly progressing to a life-threatening condition, with the presence of suicidal thoughts with a plan. The situation called for immediate steps. Because of the increasing major depression (or in this situation a significant pathological grieving process) associated with physical deterioration from not eating or sleeping, with associated weight loss, it was advised that the person receive immediate psychiatric and mental health evaluation. The evaluating psychiatrist felt that there might be the need for placement in a supervised setting with appropriate medical support, intensive therapy work, especially around the devastating loss, death of his spouse, and use of antidepressant medication as indicated.

(*Helen and her husband are not any specific individuals, but a composite of people with similar stories encountered in past clinical situations presented for educational purposes only. The story was inspired by the death of a community friend who died from complications of COVID-19. His wife and family survived him. My condolence and prayers go to the family, but also to any others with painful losses during the pandemic.)

Heightened Demand for Mental Health Services

With the current overwhelming number of deaths from the COVID-19 pandemic, mental health services and workers will be essential responders to help with the recovery for the many affected by loss and trauma from the high number of tragic deaths and devastating circumstances of the pandemic. Like the ill-preparedness of the regular medical community, mental health programs, resources, and trained providers has been dramatically underfunded and inadequately prepared for such a high demand crisis-situation.

Everyone now will be front line workers because of the overwhelming need for people in the community and significant other to recognize the symptoms of severe life-threatening depression. The first step will be the learning of the early signs of depression – just like people are learning how to recognize COVID-19 infections. Along with recognition of depression will be the education about preparedness, supportive and protective measures, and the emergency response for a severe life-threatening depressive condition. A part of being supportive of someone with depression is to understand the stages of grief and loss better, as presented by Kubler-Ross.

dramatic sky over old lonely tree
© nejron/123RF.com – a dark place with the light breaking through

Stages of Grief and Loss

Elisabeth Kübler-Ross’s book “On Death and Dying” introduced the idea of the five stages of grief and loss. Some aspects of these stages may be experienced after the loss of a loved one or significant other.

  1. A denial stage is what can be experienced after a loss – with intense feelings as a shock, disbelief, confusion, fear, avoidance, and emotional numbing. An avoidance occurs, by which an individual suppresses or represses painful thoughts or feelings into the unconsciousness of the mind. Sometimes, it can be to the extent of a person going on with everyday activities as if nothing significant happened. Other emotions or behaviors, sometimes associated with denial or different stages, are agitation – being “hyper” and highly anxious, or even happy – an inflated relief feeling of being a survivor when others have died.
  2. An anger stage can occur, which begins to be noticed as the reality of the loss returns. There can be associated emotions as the feelings of blame towards ones’ self or others, irritation, frustration, or nervousness. Anger may be felt to the unfairness of life: why now did this have to happen to me. What if questions come up as “if I hadn’t done this,” there would have been a better outcome.
  3. A bargaining stage occurs when the grieving person begins to wonder whether there may have been actions that may have prevented the death. What if I had taken more “appropriate” steps or done things better or differently? During this stage, when guilt arises – being present, reflective, accepting, and open to the experience of the anger or other painful emotions – is a healthy acknowledgment that it is a part of the grieving process. A person might bargain with some personal ideas as, “if I do more of this or that, work more, or pray more, or something, this pain and grief will go away, and I can go back to living my life.”  It is the time to reach out to others, to tell or reflect on the loss, painful happening, and remembrances – with the struggle to find meaning in “all of it.”
  4. A depression stage can be challenging to experience or endure, especially when it shows up frequently or for prolonged periods. 

Recognizing Severe Grief & Depression

Symptoms and Behaviors of Severe Prolonged Grief or Depression may INCLUDE:

  • Feeling grief, down, guilt, hopeless, helpless, sad, or irritable (“pushing people away” or not getting along with others)
  • Loss of one’s usual interests or pleasure in doing things (anhedonia)
  • Changes in sleep patterns as trouble falling asleep, not getting restful sleep, sleeping too much, not wanting to get up, or staying in bed much of the day
  • Feeling tired, loss of vitality, or having little energy
  • Poor appetite, overeating, weight loss or gain
  • Frequently feeling bad about oneself as feeling worthless or as a failure
  • Trouble concentrating or remembering things
  • Slowing down of speech or movements, having a frequent sad face
  • Being fidgety or restless more than usual
  • Thoughts of dying or of hurting oneself
  • Difficulty functioning at home or work
  • Withdrawal and isolating self from others
  • Thoughts of self-harm (suicidal thoughts), or of harming others (homicidal thoughts)

All the listed symptoms or behaviors may be only slightly present, noticed at times, or be very pervasive in a depressed or grieving person’s daily life and activity. When there has been prolonged severe grief, consideration of significant depression and its treatment would be appropriate.

At any time when severe depression or grief is present, one can quickly drop back into denial, hostility, anger, avoidance, wishing to take flight or run away from emotional discomfort. If a person is feeling that life has lost its meaning and not worth living and has suicidal thoughts or feelings about hurting oneself or others, it is time to act and seek outside help from a qualified mental healthcare professional or resource.

In the U.S. for immediate or crisis assistance, call your local suicide hotline or 1-800-273-8255 1-800-273-TALK, 1-800-273-8255 or 1-800-SUICIDE,  1-800-784-2433 for the National Suicide Prevention Lifeline.

5. The acceptance stage is when the residual feeling of loss, sadness, and grief with the reality of the finality of death – comes into a balance with the recognition that life continues. There is an acceptance that returning memories and feelings will appear when triggered by reminders, with varying intensity and time-lengths for months, years, and sometimes a lifetime. This stage or time is when one begins to explore and thinks of choices and options for life without the valued companion and loved one. Many different things can trigger a memory of the deceased as a picture, a personal possession, a grooming aid, or at a time of doing a routine done with the lost loved one. Sometimes a dream will touch on some aspect of the grieving process. Any reminder can be an opportunity for further reflection and working through loss, grief, and painful emotions.

Regrets, Pain, Suffery
background to tears -© John Hain/pixabay.com

Predisposing Factors to Severe Mood Disturbances

Identification and treatment of contributing factors can be as crucial as getting help from a therapist, taking antidepressant medication, or other symptom-oriented treatments. Consultation to uncover risk factors or predisposition to significant emotional or depressive illness is a place to start by a qualified mental health or medical healthcare provider. Some predisposing or vulnerability factor could include:

  • Medical issues as difficulties with nutritional deficiencies, hormone deficiencies as hypothyroidism, other diseases as diabetes, heart disease, obesity
  • Family (genetic history) of depression, or bipolar illness or other mood conditions
  • Adverse lifestyle as inadequate nutrition, sedentary, and chaotic, stressful living, or working in under adverse conditions
  • Traumatic brain injury, chronic pain, multiple surgeries, loss of function or structural integrity of body 2nd to accidents, injury, surgery, congenital disabilities, or paralytic illness
  • Environmental exposure, disease, or sensitivity due to toxic metals, mold, or chemicals as lead and mercury
  • Presence of disabilities or poor social and adaptive skills that make one vulnerable to discrimination, rejection, bullying, and trauma
  • Substance use problems with drugs of abuse as opioids, alcohol, stimulants, sedatives, or hallucinogenic substances
  • Social factors as dysfunctional families, friends, marriages; adverse, toxic, or abusive relationships; divorces; failures in school or work; loss of social support, a significant other, a job or career, a home, financial security; recent move
  • Personality issues or chronic adverse personality disorders as a narcissistic, antisocial, dependent, or paranoid personality disorder that is adverse or disruptive to success and functioning in everyday life activities and that lead to the inability to form significant supportive relations or a social network.

Effects of trauma and its aftermath can occur to anyone at any life stage – childhood or adulthood.  The trauma-experience itself can result from a wide variety of situations and predispose to mood disorders like depression. Different types of trauma can affect each person differently and can underlie or contribute to trauma-related illness and post-traumatic stress disorder (PTSD)

Potential contributory trauma experiences:

  • Feeling helpless during trauma as childhood sexual abuse, rape, physical assault, auto accident with the threat of injury, violence, or death
  • Occurrences of overwhelming adverse life-threatening events (early life or in adulthood) or compounded traumas (i.e., series of traumatic events: as a job loss, divorce, death of a significant other, financial loss, subjugation to violence and imprisonment, or the experience)
  • Being healthcare workers as EFT’s, nurses, and doctors in medical care work, soldiers in combat that are overwhelmed by the witnessing of death and destruction
  • Survivors of a climatic or natural disaster, a war, a holocaust, a mass causality event as a terrorist attack, a pandemic, a mass shooting, or a bombing
  •  Witnessing domestic violence, death or injury to others

Be aware of the signs and presentation of depression and of severe grief states where there is the progression to major debilitating and life-threatening illnesses.

© Amnarj Tanongrattana / 123RF.com - serenity, equanimity, peacefulness - water drop and ripple
© Amnarj Tanongrattana / 123RF.com – returning to serenity and peacefulness

Be prepared to reach out for help and assistance for yourself or someone in need, especially in a time of significant loss and death of significant others or to those served. Healthcare providers, law enforcement, and emergency workers experience much traumatic exposure regularly. Trauma happens with the witnessing of despair and death associated with feeling overwhelmed by the demands of their work. Look for signs of depression and be ready to provide support and assistance. Knowing the stages of mourning after a significant loss or trauma is both critical and helpful to aid someone else in need. There will be much healing needed now for the grieving and depressed in the wake of the COVID-19 pandemic.

Thank you for your interest and review of this article. You are welcome to make comments below.

Ron Parks MD

If you or a loved one needs help or guidance about any mental, emotional, physical, or related spiritual health issues, consultation is available directly with Dr. Parks by telephone or telemedicine services like Skype or VSee. To schedule a session or if you need a question answered, fill in the contact form at https://parksmd.com/scheduling/. Hopefully, I will be able to correspond with you directly about questions or address them in a future article or my periodic newsletters. see the post on Expert Mentoring

**The above is for informational and educational purposes only, not as medical or mental health advice. It is the reader’s responsibility to direct personal medical or mental health questions to their primary care provider and specialty physicians. The information and statements contained in this material are not intended to diagnose, treat, cure, or prevent any disease or to replace the recommendations or advice given to you by your primary or direct care providers.

Your reliance on any information provided by Dr. Parks is solely at your discretion. You are advised not to disregard medical advice from your primary or direct care providers, or delay seeking medical advice or treatment because of information contained in this article. Management of severe mental or physical health problems should remain under the care and guidance of your primary care physicians, specialist, or psychiatrists.

Lead-in photo for the article: ©Geralt/Pixabay.com – Sunset and Completion

References and Information

SEE PRIOR COVID-19, TRAUMA, PTSD, GRIEF, MOURNING, LOSS, AND AWARENESS RELATED ARTICLES BY DR. PARKS:

COVID-19 Wake Up Call

COVID-19 & Polio Past

Coronavirus Anxiety

Coronavirus Natural Approaches

Coronavirus Holistic Health Steps

Remembering the Holocaust

Mourning Pet Loss

Hurricanes, Trauma, and Recovery

Meditation – Mental Health Essential

Hurricanes, Depression, and Recovery

Awareness the Core of Healing

PTSD, Terror, and Trauma

REFERENCES & LINKS

Overcoming COVID-Related Stress https://www.medscape.com/viewarticle/929166

Emotional Distress of Dealing With COVID-19 May Hike Risk of Depression and Anxiety — https://psychcentral.com/news/2020/04/20/emotional-distress-of-dealing-with-covid-19-increases-risk-of-depression-and-anxiety/155823.html

COVID-19: ‘Striking’ Rates of Anxiety, Depression in Healthcare Workers https://www.medscape.com/viewarticle/927581#vp_2

COVID-19: US Initiative Aims to Stem the Tide of Suicide, Mental Illness https://www.medscape.com/viewarticle/929797#vp_1

Elisabeth Kübler-Ross’s book “On Death and Dying” introduced the idea of the five stages of grief and loss.

The Five Invitations: Discovering What Death Can Teach Us About Living Fully
by Frank Ostaseski

I AM That by Nisargadatta

The Tibetan Book of Living and Dying: The Spiritual Classic & International Bestseller: 25th Anniversary Edition

Letting Go: The Pathway of Surrender by David Hawkins

In the U.S. for immediate or crisis assistance, call your local suicide hotline or 1-800-273-8255 1-800-273-TALK, 1-800-273-8255 or 1-800-SUICIDE,  1-800-784-2433 for the National Suicide Prevention Lifeline.

Personality disorders  https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/overview-of-personality-disorders

Narcissistic Personality Disorder — https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/narcissistic-personality-disorder-npd

An antisocial personality disorder —https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/antisocial-personality-disorder-aspd

anxiety, COVID-19, depression, Grief, mental health crisis, PTSD, trauma

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