At press time, COVID-19 had infected more than 234 million people worldwide and contributed to at least 4.7 million deaths.1 Although most of the research on the vast human toll of COVID-19 has referred to death and physical morbidity, analysis of the mental health consequences of the pandemic has surged, with more than 3000 relevant papers and more than 120 review papers published in the past year. This article addresses 4 key issues: 1) impacts on the general population; 2) impacts on individuals with preexisting mental illness; 3) impacts on individuals providing essential services; and 4) impacts on individuals infected with COVID-19.
Although the figures cited in this paper are from different countries, the conclusions may not be generalizable, as regions, continents, and countries have shown somewhat different characteristics in their experience of the pandemic. This is especially true regarding differences between high-income countries and low- and middle-income countries (LMICs). Similarly, important variations (ie, family, ethnic, cultural, and socioeconomic factors and issues) exist within components of the general population that may differentially affect the impact of the pandemic. Thus, this article provides perspectives but is not intended to be an exhaustive review.
Impacts on the General Population
The early consequences of the threat of COVID-19 infection in spring 2020 produced many features of “health anxiety.” There were elevated rates of insomnia, anxiety, and depression; reports of increased alcohol and drug use; and, somewhat understandably, antisocial behaviors such as excessive stockpiling of essential supplies. Increasing numbers of individuals within the general population were directly affected by grief following the deaths of people they loved.
Even in the pandemic’s early months, it was clear that it would be important not to overgeneralize. Data from the United Nations (UN) in mid-2020 showed that, in national surveys, distress was identified among the general population in several countries to differing extents—for example, 35%, 45%, and 60% in China, the United States, and Iran, respectively. During 2021, several systematic reviews were published on the mental health impacts on whole population. These studies found pooled prevalence rates for anxiety of between 32% and 34%, and for depression of 30% to 31%.2,3 These papers also identified risk factors for even higher rates of common mental disorders—namely, preexisting chronic disease, being quarantined, or being infected with COVID-19.
