Ana Urbina is so afraid of contracting Covid-19 that she even worries about going outside to throw out the garbage. Staying home all the time means Urbina is watching more TV than usual — including the news, which then increases her anxiety.
“I am too stressed,” said Urbina, 60, a Miami resident who’s diabetic, disabled and immunocompromised. “The state of my health is becoming more complicated, and that stresses me.”
Urbina is among the roughly 40 percent of Latinos nationwide who reported experiencing frequent symptoms of anxiety or depressive disorder, according to an analysis from April 23 to Nov. 9 by the National Center for Health Statistics in partnership with the Census Bureau. The rate peaked in mid-July and at the beginning of November when nearly 50 percent of Latinos reported experiencing such symptoms.
Anxiety and depressive disorder symptoms consistently remained at roughly 30 percent among white and Asian Americans while Black Americans reported similar symptomatic patterns, compared to Latinos.
Latinos have been disproportionately affected by the health and economic consequences of the pandemic, including experiencing a disproportionately high percent of Covid-19 deaths, according to the Centers for Disease Control and Prevention.
People “report being very concerned about financial matters, testing positive for Covid-19 themselves, and feeling more isolated,” said Paul Velez, the chief executive of the Borinquen Medical Centers in Miami.
Anxiety and depression can have physical effects like severe headaches, stomach pains, chills and difficulty breathing. These symptoms overlap with those of Covid-19, for instance, so it can create an extra layer of panic. The worrying can worsen the symptoms, said Marisa Echenique, a clinical psychologist at the University of Miami and associate professor in the university’s department of psychiatry.
“This is noticeable among Hispanic elderly females or mothers who try to be superwomen and help everyone all the time," Echenique said. "Everyone’s problem is their problems."
'Grief is actually everywhere'
At Elmhurst Hospital in Queens, New York, Dr. Vladimir Gasca was working closely with many Latino families who had relatives hospitalized with Covid-19, especially during the early days of the pandemic when the city was the epicenter of the coronavirus crisis.
“In our hospital, we had hundreds of deaths, disproportionately among the Latino population,” said Gasca, Elmhurst Hospital’s director of psychiatry and behavioral health services. He said that during the early stages of the pandemic, anyone who was hospitalized and intubated had a low potential for recovery.
"Psychologists would call the families to prepare them for what will be the ultimate demise of their loved ones," Gasca said. "And once they actually passed, we continued to provide treatment services completely for free over the phone to hundreds of families in the community.”
For Dr. Fabrizzio Delgado, an assistant professor of psychiatry at Texas Tech University Health Sciences Center El Paso, the growing mental health toll the pandemic has taken on Latinos in his community has become more apparent since October, when a rise in coronavirus cases and deaths made El Paso, Texas, the new epicenter of the pandemic. More than 80 percent of the city’s population is Hispanic.
Many of Delgado’s patients report feeling excessive worry, inability to sleep, insomnia and lack of energy, he said. “Grief is actually everywhere right now, either because people lost their family members or because they lost their job or because they lost normalcy in their lives.”
Delgado, who is also chief of consultation services at the University Medical Center of El Paso, said the economic instability is taking an increased mental health toll on a lot of Latino small-business owners in El Paso. The economic downturn because of the pandemic has hit Latinos particularly hard after seeing joblessness levels that exceed the previous peak Hispanic unemployment rate of 13.9 percent in January 2010.
“A lot of them have become very anxious," he said. "Some of them have developed depression and a lot of them are coming to the hospital."
Dr. Madeline Avilés-Hernández, vice president of behavioral health and recovery services at the Gándara Center in Springfield, Massachusetts, said a lot of the stress families are grappling with comes from not knowing when the pandemic will end.
“That level of uncertainty that produces a lot of stress,” especially on people “who were part of the ‘normal’ labor force and overnight became essential workers,” Avilés-Hernández said.
Counseling families, even beyond borders
Gasca has seen some of his patients develop depression and others who were already living with chronic conditions such as schizophrenia, bipolar disorder and severe depression saw their conditions worsen. The mental health effect of Covid-19 among Latinos has even transcended borders, he said.
When a young Mexican man was hospitalized with Covid-19 in New York, Gasca started counseling the man’s wife and two young daughters — in Mexico, where they live. The man had been working in the U.S. to support his family.
“Eventually, he died,” Gasca said. “Now, I have this poor woman with two young daughters, not knowing what to do because they didn't have any other relatives here. They would ask me: 'What do I do with the body? How can I get the ashes in central Mexico?' It was really a horrific scene, and I can tell you that repeated hundreds of times throughout the city.”
Four in 10 people who survive coronavirus say it has transformed their life in a major way, making them more likely to develop mental health conditions such as obsessive compulsive disorder and post-traumatic stress disorder, said Gasca, citing multiple studies.
The effects are being felt by younger generations, too.
While Velez has seen a general increase in patient referrals, he was surprised to see an uptick among children and adolescents reporting increased symptoms of depression and anxiety.
“This was totally unexpected,” he said, adding that their population has been hit hard by school closings at an age when their daily routines are tied to their learning environment. Those who have not returned to school are using distance-learning and are isolated from their peers.
“There is no recreational time and no interaction with other children,” Velez said. “There is also an increased fear of acquiring the virus themselves and an increase of self-isolation.”
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Suicide, substance abuse
Echenique said she’s seeing more Latinos in Miami-Dade County, which has a Hispanic population of 70 percent, seeking mental health services during the pandemic.
Miami was a hot spot of the pandemic during the summer and has been among the worst areas in the nation when it comes to its residents experiencing food insecurity and scarcity. But she hasn’t seen an increase in suicidality among those already in care, which “speaks for the importance of being in care.”
Many of those who do consider suicide are not able to get mental health treatment, Echenique added.
Anecdotally in El Paso, suicide attempts have become more frequent during the pandemic, Delgado said.
Avilés-Hernández said the pandemic has exacerbated existing issues related to trauma, depression, anxiety, domestic violence, suicidality and substance abuse among the Latino families she serves.
Velez said he has also seen an increase in referrals for patients seeking treatment for substance use disorders, especially opioids, at his clinic in Miami.
Like Avilés-Hernández and Velez, Gasca said he also saw an increase in Latino patients with substance abuse disorders who relapsed. Many lacked access to consistent outpatient services due to pandemic-related closures or were unable to transition into tele-psychiatry services.
Under normal circumstances, El Paso has a shortage of addiction providers and services, Delgado said, who’s seeing a higher proportion of substances abuse patients.
“The waiting for them to get services are getting longer as we continue to run out of places to send them to get treatment,” he said.
Tips and resources to cope
With the holidays around the corner, Avilés-Hernández said Latino families shouldn't underestimate the impact such celebrations can have on mental health and emotional stability.
"We're in the middle of a pandemic and these celebrations will look a little different, and a lot of individuals are not going to be able to spend it with their families," she said. Talking to a trusted community member or calling one's primary care doctor is a good starting point for those seeking mental health help.
Keeping good lines of communication among family members is also crucial to noticing or identifying relatives who may be struggling and need additional help, Delgado said. There are four steps that can help people at home, he said, cope with coronavirus stress:
- Be kind to yourself.
- Remember why we're doing this: to control the spread of the virus and save lives.
- Keep social connections using any available technology.
- Practice basic self-care activities, such as drinking enough water and sleeping at regular times.
If you or someone you know is at risk of suicide, you can call the U.S. National Suicide Prevention Lifeline at 800-273-8255, text TALK to 741741 or go to SpeakingOfSuicide.com/resources for additional resources.
Nicole Acevedo reported from New York and Carmen Sesin from Miami.