Mental Health Disorders Related to COVID-19–Related Deaths

Since February 2020, the coronavirus disease 2019 (COVID-19) pandemic has led to at least 200 000 deaths in the US and 1 million deaths worldwide.These numbers probably underestimate COVID-19 deaths by 50%, with excess cardiovascular, metabolic, and dementiarelated deaths likely misclassified COVID-19 deaths. 1 In this issue of JAMA, Woolf and colleagues 1 update their previous estimate, suggesting that the number of excess deaths between February and August 2020 attributable to COVID-19 is estimated to be about 225 000.This devastating pandemic has affected nearly every aspect of daily life.While nations struggle to manage the initial waves of the death and disruption associated with the pandemic, accumulating evidence indicates another "second wave" is building: rising rates of mental health and substance use disorders.This imminent mental health surge will bring further challenges for individuals, families, and communities including increased deaths from suicide and drug overdoses.As with the first COVID-19 wave, the mental health wave will disproportionately affect Black and Hispanic individuals, older adults, lower socioeconomic groups of all races and ethnicities, and health care workers.This magnitude of death over a short period of time is an international tragedy on a historic scale.Focusing on the US, the number of deaths currently attributable to COVID-19 is nearly 4 times the number killed during the Vietnam War.This interpersonal loss at a massive scale is compounded by societal disruption.The necessary social distancing and quarantine measures implemented as mitigation strategies have significantly amplified emotional turmoil by substantially changing the social fabric by which individuals, families, communities, and nations cope with tragedy.The effect is multidimensional disruption of employment, finances, education, health care, food security, transportation, recreation, cultural and religious practices, and the ability of personal support networks and communities to come together and grieve.A June 2020 survey from the Centers for Disease Control and Prevention of 5412 US adults found that 40.9% of respondents reported "at least one adverse mental or behavioral health condition," including depression, anxiety, posttraumatic stress, and substance abuse, with rates that were 3 to 4 times the rates 1 year earlier. 2 Remarkably, 10.7% of respondents reported seriously considering suicide in the last 30 days. 2 The sudden interpersonal loss associated with COVID-19, along with severe social disruption, can easily overwhelm the ways individuals and families cope with bereavement.Of central concern is the transformation of normal grief and distress into prolonged grief and major depressive disorder and symptoms of posttraumatic stress disorder.Prolonged grief disorder 3 is characterized by at least 6 months of intense longing, preoccupation, or both