Former First Lady Michelle Obama broke the internet when she recently announced she had been suffering low-grade depression because of the pandemic and national upheaval. Her declaration appeared to resonate with people across the country suffering from physical illness, isolation, and income and job losses.
A recent study published in the JAMA Network Open found that 3 times more Americans are suffering from depression during the COVID-19 pandemic compared with before. Front-line workers have not been sheltered from this challenge, as borne out by high-profile physician suicides in COVID-19 hotspots.
“What is going on with the pandemic is ongoing and there is uncertainty about when there will be a return to normal,” said Carol Bernstein, MD, vice chair for faculty development at Montefiore Medical Center in New York City. “We are all adapting to a situation where we don’t know what’s coming down the line.”
Burnout or depression?
Burnout is a common malady among physicians as a result of working long hours and dissatisfaction stemming from having less time to spend with individual patients. But with many physicians working fewer hours now, mental health challenges they are dealing with may look more like depression. How can one tell the difference?
Burnout, Dr Bernstein explained, tends to be more transient and is related to work situations. Symptoms can be emotional exhaustion, depersonalization and lack of effectiveness on the job.
“If someone is saying they feel down and disconnected and angry and irritable, but when they get away from work those symptoms go away, that is more indicative of burnout than depression,” she said.
It can be a bit more difficult to detangle those kinds of emotions during a pandemic when there are so many more stressors. But burnout is typically related to system issues in the workplace.
Classic symptoms of depression, however, are feelings of sadness, hopelessness, and loss of sleep or too much sleep. Symptoms tend to come on over a period of time and can stick around longer.
If more serious symptoms arise, like dramatic changes in sleep or appetite, suicidal ideation, and not enjoying things that usually are pleasurable, it is important to seek help from a mental health professional, Dr Bernstein said. This can also be true if symptoms are milder but persist for weeks or months at a time.
A few weeks after the pandemic hit, SBH Health System in the Bronx, New York, began providing debriefings — therapy-like sessions for all departments of the hospital — by psychiatrists and psychologists in its department of psychiatry. The fact that everyone was going through the same kinds of struggles made it easier for people to talk in those early days, said Lizica Troneci, MD, chair and residency program director in the department.
“It was more acceptable to have debriefings and to talk about the feelings and experiences we have had, which, looking back, is different than discussing burnout we had experienced before,” Dr Troneci said. “The COVID-19 experience brought us together because everyone had fears and anxiety, and there was less stigma and more openness associated with talking about this.”
This kind of assistance for physicians is extremely important, Bernstein said. Isolation only contributes to feelings of loss and depression, so acknowledging and talking about stressors can help people get through tough times. The more prominent the people are who talk about feeling burned out or depressed, the easier it is for everyone to acknowledge and discuss their feelings, Dr Bernstein said.
“It’s taboo to say we are struggling, and it’s a particular problem in medicine,” she said. “A lot of what people are feeling right now is normal in these circumstances and normalizing it will help people feel better.”
Taking care of one’s self
When talking about work issues, Dr Bernstein recommends trying not to focus too much on how awful things are because it can be disheartening. Instead, she suggests having what she calls an appreciative inquiry. Here, staff members get together and focus on what is working well and how they can do more of that.
“If you spend all of your time saying, ‘It’s awful and I can’t do this or that,’ it can perpetuate,” she said. “There is a delicate balance between sharing misery and looking at how you can proactively address things together.”
Whether struggling with burnout or depression, it is important to focus on the things that are under one’s control, Dr Bernstein said. Physicians should try to do things they enjoy. During the pandemic, the internet was loaded with people turning to activities like gardening and baking where they could work with their hands and create. Dr Troneci recommends such routine activities as eating well, exercising, and getting healthy amounts of sleep.
It is also important to remember to take one day at a time. “People don’t do that well, and doctors especially don’t,” Dr Bernstein said. “We are always focused on the future. We have to take 1 day at a time because we don’t know what’s coming, and eventually this will get under control.”
Things are slowly starting to return to normal in many areas. Even in New York City, restaurants are reopening for open air dining. Dr Bernstein equates moving forward now with the airline changes after the events of 9/11. At first, it was a hassle to abide with the new encumbrances that went along with flying, but eventually people got used to them.
“It’s important to maintain in your head that this is a time-limited thing and maintaining hope for the future is important,” she said.