Shelter-in-place and social distancing measures have been critical for “flattening the curve” and managing the spread of COVID-19, but the sudden shock to our economic and social lives is raising concerns about the need to “flatten the second curve” of mental and behavioral health issues. A new report in JAMA Internal Medicine warns, “In the context of the COVID-19 pandemic, it appears likely that there will be substantial increases in anxiety and depression, substance use, loneliness, and domestic violence; and with schools closed, there is a very real possibility of an epidemic of child abuse.”1 Our nation was already on a troubling trajectory of rapidly rising deaths due to drug overdoses, alcohol, and suicides, and research has demonstrated that such “deaths of despair” are accompanied by a measurable deterioration in economic and social wellbeing.2
Prior to the pandemic, low-income communities and communities of color were already more likely to experience risk factors for poor mental health, such as low socioeconomic status and substandard living conditions, which are rooted in historic structural inequities. As we explored in a past issue of Community Development Innovation Review, there are profound connections between poverty, place, and poor mental health which can have important impacts on economic outcomes such as educational attainment and labor force attachment. These issues are more critical than ever, and as low-income communities and communities of color continue to be disproportionately impacted by COVID-19, it is vital that we consider mental health promotion as part of a comprehensive approach to equitable economic recovery.
The Intersection of Mental Health and Community Development
Although researchers are still debating the causal pathways between poverty and poor mental health, it is clear that socioeconomic issues such as unstable housing and unemployment are connected in a complex negative cycle with poor mental health.3 Mental health promotion across the life course is critical for supporting the economic resilience and mobility of low-income people, a key aim of community development efforts. For example, there is clear evidence that poor mental health is associated with reductions in labor force participation and employment.4 Mental health problems among children have a severe negative impact on educational outcomes, which can limit future economic wellbeing. Approximately 50 percent of students age 14 and older who are living with a mental illness drop out of high school, which is the highest dropout rate of any disability group.5 Perhaps most critically, adverse childhood experiences, which include abuse, neglect, having an incarcerated household member, or substance misuse within the household, are risk factors for poor mental health and have been linked to a number of negative health and well-being outcomes, including risky health behaviors, chronic health conditions, and early death.6
COVID-19 Exacerbates Risk Factors for Poor Mental Health
In a recent poll, 45 percent of adults in the U.S. reported that their mental health has been negatively impacted due to worry and stress over the coronavirus. The unprecedented shutdown of economic and social activities has heightened risk factors for poor mental health, including:
- Unemployment and financial insecurity – The economic impacts of COVID-19 have been sudden and deep, causing massive job losses and financial insecurity. Across economic cycles, there are persistent disparities in unemployment across race and education, and early findings suggest the impacts of the current crisis will be no different. A significant body of research demonstrates that unemployment impairs mental health, and longitudinal studies suggest that unemployment is not only correlated to distress but also causes it.7 This could be of ongoing concern as poor mental health has also been shown to affect future employment.8 Job losses and financial insecurity are likely to reduce an individual’s sense of control, which can have negative effects on mental health.9
- Existing Physical Health Conditions – Having a chronic disease is a risk factor for poor mental health.10 There has been an increase in people experiencing two or more chronic health conditions at the same time, and the “comorbidity” of mental and physical health disorders is among the most common.11 Low-income people and people of color are more likely to suffer from chronic disease and other health conditions as a result of structural barriers that have negatively impacted their neighborhoods and economic prospects. COVID-19 is exacerbating these inequities, as evidenced by the devastating impact that is hitting Black and Latinx communities particularly hard.
- Social isolation and loneliness – Shelter-in-place mandates have been a necessary public health measure, but the sudden reduction in human connection will take its toll, particularly for vulnerable populations that were already experiencing high levels of social isolation, such as low-income older adults. A meta-analysis of public health research found consistent evidence linking social isolation and loneliness to worse cardiovascular and mental health outcomes.12 One study even found that the health impacts of strong social relationships were akin to quitting smoking.13
The onslaught of financial insecurity, loss of sense of control, and overall negative impacts to population mental health are already manifesting in troubling ways. For example, there is growing evidence that domestic abuse is increasing across the globe, placing women and children at particular risk. School closures put children at further risk for abuse and mistreatment, as they are removed from teachers and school staff, who are often on the front lines of identifying signs of potential abuse. Given the detrimental and long-lasting impacts of adverse childhood experiences on healthy development and future economic outcomes, protecting vulnerable children during this challenging time is especially critical.
Prevention and Partnerships Matter
Although the current crisis has exacerbated numerous risk factors for poor mental health, there are vital opportunities for strengthening prevention through partnerships. The JAMA Internal Medicine report put forth suggestions for supporting prevention and early intervention in the context of COVID-19 which include: regular outreach to people who are typically marginalized and isolated to address loneliness; mechanisms for surveillance and intervention to address domestic violence and child abuse; and strengthening the mental health system in preparation for the oncoming challenges precipitated by the pandemic.14 The researchers conclude by acknowledging the need for widespread partnerships outside of the mental health sector:
Scaling up treatment in the midst of crisis will take creative thinking. Communities and organizations could consider training nontraditional groups to provide psychological first aid, helping teach the lay public to check in with one another and provide support. Even small signs that someone cares could make a difference in the early stages of social isolation.
As we explored in our journal issue on the topic, there are opportunities for incorporating mental health promotion into existing community development approaches, such as:
- Adopting a trauma-informed lens in affordable housing communities;
- Catalyzing resident community action;
- Incorporating arts and culture as a healing and recovery strategy into community development efforts; and
- Leveraging the expertise of community members to develop locally-driven solutions, such as community-based prevention and Mental Health First Aid strategies
Good mental health is a necessity for achieving the educational and employment outcomes that drive economic resilience and mobility. Partnerships across the community development and mental health sectors will be vital for addressing the mental health implications of COVID-19 for low-income communities and communities of color.
End Notes
1. Sandro Galea, Raina Merchant and Nicole Lurie, “The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention,” JAMA Intern Med. Published online April 10, 2020.
2. Anne Case and Sir Angus Deaton, “Mortality and morbidity in the 21st century,” Brookings Papers on Economic Activity, March 23, 2017.
3. “Breaking the Vicious Cycle between Mental Ill-Health and Poverty,” World Health Organization, Mental Health Core to Development Information Sheet, Sheet 1, 2007.
4. Pinka Chatterji, Margarita Alegria, and David Takeuchi, “Psychiatric Disorders and Labor Market Outcomes: Evidence from the National Comorbidity Survey-Replication,” Journal of Health Economics 30, no. 5 (2011): 858–868.
5. U.S. Department of Education, Twenty-third annual report to Congress on the implementation of the Individuals with Disabilities Education Act, Washington, D.C., 2001.
6. “Adverse Childhood Experiences” Centers for Disease Control and Prevention, April 1, 2016
7. Karsten I. Paul, Klaus Moser, “Unemployment impairs mental health: Meta-analyses.” Journal of Vocational Behavior 74, no. 3 (2009): 264-282.
8. Sarah Olesen, et al., “Mental health affects future employment as job loss affects mental health: findings from a longitudinal population study,” BMC Psychiatry 13, no. 144 (2013).
9. Jack Lam, Wen Fan, and Phyllis Moen, “Is Insecurity Worse for Well-Being in Turbulent Times? Mental Health in Context.” Society and mental health 4, no. 1 (2014), 55–73.
10. “Mental Illness.” Mayo Clinic. June 8, 2019.
11. Elizabeth Walker and Benjamin Druss, “A Public Health Perspective on Mental and Medical Comorbidity,” JAMA 316, no. 10 (2018):1104–1105.
12. N. Leigh-Hunt, D. Bagguley, K. Bash, V. Turner, S. Turnbull, N. Valtorta, W. Caan, “An overview of systematic reviews on the public health consequences of social isolation and loneliness,” Public Health 152 (2017): 157-171.
13. Holt-Lunstad J, Smith TB, Layton JB (2010) Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med 7(7): e1000316.
14. Sandro Galea, Raina Merchant and Nicole Lurie, “The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention,” JAMA Intern Med. Published online April 10, 2020.
Article Citation
Choi, Laura. 2020. “The Mental Health Implications of COVID-19 on Low-Income Communities and Communities of Color,” Federal Reserve Bank of San Francisco Community Development Research Brief 2020-2. doi: 10.24148/cdrb2020-02