Social and Psychological Consequences of the Covid-19 Pandemic

Social and Psychological Consequences of the Covid-19 Pandemic

The mental health consequences of the COVID-19 pandemic are particularly relevant in African- American communities because African-Americans have been disproportionately impacted by the disease, yet they are traditionally less engaged in mental health treatment compared with other racial groups. Using the state of Michigan as an example, we describe the social and psychological conse- quences of the pandemic on African-American communities in the United States, highlighting commu- nity members’ concerns about contracting the disease, fears of racial bias in testing and treatment, experiences of sustained grief and loss, and retraumatization of already-traumatized communities. Furthermore, we describe the multilevel, community-wide approaches that have been used thus far to mitigate adverse mental health outcomes within our local African-American communities. Social and Psychological Consequences of the Covid-19 Pandemic

Keywords: community mental health, trauma, racial disparities, coronavirus, population health

African-American communities in the state of Michigan have been disproportionately impacted by the coronavirus 2019 (COVID-19) pandemic. Despite making up only 13% of Michi- gan’s population, African Americans account for 32% of con- firmed cases and 41% of pandemic related-deaths (Michigan De- partment of Health and Human Services, 2020). In Michigan’s primarily African-American communities, more than 10% of COVID-19 cases end in death (Michigan Department of Health and Human Services, 2020). A disease that was initially thought to mostly impact older adults and the chronically infirmed has now become a national scourge, devastating African-American com- munities across the United States. Social and Psychological Consequences of the Covid-19 Pandemic

From a mental health perspective, the pandemic has heightened fear in a segment of the population that already faces significant barriers to mental health treatment. Despite having rates of mental

illness similar to Whites, African Americans experience significant disparities in mental health treatment engagement. Among those with any mental illness, only 31% of African Americans receive treatment, compared with 48% of Whites (Agency for Healthcare Research and Quality, 2016). Furthermore, when African Ameri- cans do receive treatment, it is often due to serious mental illness requiring hospitalization rather than mild or moderate illness that can be managed in an outpatient setting. African Americans are less likely than Whites to have ongoing relationships with mental health providers; rather, they are more likely to engage with the mental health care system through emergency departments and primary care visits (U.S Surgeon General, 2001). These disparities are likely due to greater stigma surrounding mental illness, lack of culturally competent mental health care providers, general distrust of the health care system, and lack of insurance/underinsurance (American Psychiatric Association, 2017). Thus, any adverse men- tal health impacts of the pandemic may be particularly devastating in African-American communities because of these preexisting disparities in engagement. Social and Psychological Consequences of the Covid-19 Pandemic

Fear of contracting the virus is high in African-American com- munities. Population-based surveys estimate that 33% of African Americans are very concerned that they will get COVID-19 and require hospitalization, compared with only 18% of Whites. Fur- thermore, African Americans are 2 times more likely than Whites to know someone who has been hospitalized or has died because of COVID-19 (Pew Research, 2020). Fear of the disease is per- vasive, even for those whose social networks have not yet been impacted because news stories produced by most local and na- tional news outlets since March have focused on COVID-19, often with photos and anecdotes featuring African Americans who have been impacted by the disease. Consequently, many African Amer- icans have begun to experience a form of vicarious trauma because

Editor’s Note. This commentary received rapid review due to the time- sensitive nature of the content. It was reviewed by the Journal Editor.—KKT

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This article was published Online First June 11, 2020. X Rodlescia S. Sneed, Department of Family Medicine, and Division of Social and Psychological Consequences of the Covid-19 Pandemic

Public Health, College of Human Medicine–Flint, Michigan State Univer- sity; X Kent Key, Division of Public Health, College of Human Medicine–Flint, Michigan State University; Sarah Bailey, Bridges Into the Future, Inc., Flint, Michigan; Vicki Johnson-Lawrence, Department of Family Medicine, and Division of Public Health, Michigan State Univer- sity, College of Human Medicine–Flint, Michigan State University.

Correspondence concerning this article should be addressed to Rodlescia S. Sneed, Division of Public Health, College of Human Medicine–Flint, Michigan State University, 200 East First Street, Flint, MI 48502. E-mail: sneedrod@msu.edu Social and Psychological Consequences of the Covid-19 Pandemic

In addition to fearing disease, many African-American commu- nity members fear racial bias and discrimination in disease testing and treatment. Racial bias in health care is well documented and thought to contribute to a range of racial health disparities, includ- ing higher rates of maternal mortality (Bryant, Worjoloh, Caughey, & Washington, 2010) and poor pain-related outcomes among African Americans (Meghani, Byun, & Gallagher, 2012). Both empirical and anecdotal evidence suggest that African Americans presenting with symptoms of upper respiratory infection (e.g., cough, fever) have been less likely to get tested for COVID-19 than their White counterparts (Rubix Life Sciences, 2020). Addi- tionally, there have been fewer testing centers located in African- American neighborhoods, further suggesting bias or discrimina- tion in testing. Even after testing positive, many African Americans fear that they may not receive life-saving assistance if they experience severe disease. As medical centers become over- whelmed with COVID-19 patients, some have suggested limiting advanced care protocols for patients with less chance of recovery, such as those with underlying comorbidities. Given that African Americans have greater prevalence of chronic health conditions, many fear being denied care because of discriminatory assump- tions about their likelihood of survival. In epidemiological studies, such perceived racial discrimination has been linked to numerous adverse mental health outcomes, including greater self-reported symptoms of depression, anxiety, and psychological distress (Lewis, Cogburn, & Williams, 2015). Perceived racial discrimina- tion has also been associated with greater clinical diagnosis of posttraumatic stress disorder, generalized anxiety, and major de- pressive disorder (McLaughlin, Hatzenbuehler, & Keyes, 2010) Social and Psychological Consequences of the Covid-19 Pandemic

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