Expert Commentary

COVID-19, Prolonged Toxic Stress, and Mental Health at Work

As we approach 2021, we are still adjusting to the many new ways the COVID-19 pandemic is disrupting just about every aspect of our lives. Many are asking how COVID-19 has impacted workplace well-being. Are we facing a "perfect storm" of risk factors for suicide, or are there aspects of this crisis that give us hope in our resilient human spirit? Finally, what can workplaces do during this time to support workers and their families?


Employee Well-Being
October 2020

Drawing from a training manual for mental health during major disasters, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers this "Phases of Disaster"1 stress curve to help us make sense of why we are experiencing certain emotional states since the pandemic started. In the "pre-disaster phase"—for most of us in the United States, this phase occurred in February 2020 and early March 2020—we experienced anticipatory anxiety as we noticed how the pandemic was impacting other countries. Some had a feeling of impending doom and loss of control, while others shrugged off the forecasts as being false. Many engaged in strange behavior, like hoarding toilet paper and standing in line at Costco for hours.

PHASES OF DISASTER

Phases of disaster diagram

Then by mid-March, we started the "impact phase" where we felt shock, confusion, and even panic, followed by a narrowed focus on protecting ourselves and our family. While intense, the phase was relatively short-lived. Shortly after the abrupt shutdown of many parts of the United States, we started to notice what people had labeled "the heroic phase," when we celebrated our essential workers and made masks for one another. This altruism gave way to a brief "honeymoon phase" when we started to feel as though we were pulling together. We were looking out for our neighbors and bringing food to our elders. Musicians sang from their balconies in Italy. We felt a glimmer of hope and optimism that our kindness and compassion would prevail.

Since late May, however, we seem to be in a downward spiral of the "disillusionment phase," filled with conflict, divisiveness, and discouragement. With the added layers of economic impact, violent social unrest, and countless natural disasters, the mounting stress has led many to feel overwhelmed and desperate.

Hopefully, the rest of the crisis curve will come to fruition. If so, someday in the future, we will experience the "reconstruction phase" and will find pathways to reconciliation. If history repeats itself, at some point, people will begin to rebuild and grow through the lessons learned from the multiple disasters of 2020.

Should we be worried about the impact of all of these prolonged stressors on the risk of suicide? Some have written that COVID-19 really is a perfect storm of risk factors.2 Economic disruption, social isolation, decreased access to health care, and forms of support (e.g., faith communities) are all strong risk factors for suicide. We have good reason to be concerned as many leading indicators are showing warning signs of deteriorating mental health.

The Bad News: Leading Indicators

Here are trends that we are seeing that are very worrisome.

  • Financial hardship. The fluctuation in unemployment not only impacts whether or not people can pay the bills, but it also impacts access to health care and housing. Women, immigrants, young adults, and unpaid caregivers are some of our most affected workers.3 Economic stressors and the loss of one's identity as "provider" are key drivers of our "deaths of despair" trend.4
  • Substance use. Alcohol and drug use are on the rise. Overdoses are also increasing.5
  • Family violence. Intimate partner violence calls have dropped—not because the violence dropped but because people locked at home could not safely access services.6
  • Children and trauma. Kids and young adults are missing important social connections needed for development. Additionally, despite evidence that child abuse and neglect have been on the rise during the COVID-19 pandemic, many states initially reported significant decreases in reports to child maltreatment hotlines—largely due to the fact that kids were no longer at schools, where their abuse and neglect were being identified.7
  • Elder neglect. Older adults, many of whom were already facing loneliness in epic proportions, have been the hardest hit by the isolation caused by the response to COVID-19.8 While many younger adults were already accustomed to digital connections, older adults often have more challenges engaging with new technologies and are not always able to benefit in the same way.
  • Access to lethal means. Gun sales have also spiked. National Public Radio (NPR) reported that people had bought 3 million more guns than normal between March and July in 2020, and almost half of all those sales are to first-time gun owners.9 While owning a gun does not make someone more suicidal, if you are suicidal and you have access to a gun, you are far more likely to die.

The Good News: We Pull Together

As a mental health and suicide prevention speaker and consultant, I am routinely asked if our nation is facing a surge in suicide deaths. Given all of the increased risk factors and warning signs, why are we not making this prediction? Well, for one reason, we had actually seen a dip in suicide deaths during periods of our history when we faced great adversity. For instance, our suicide rate decreased immediately after the 9/11 terrorist attacks, and over the course of history (the most recent conflicts aside), suicide rates during wartime decreased because people pulled together.

Another reason is that sometimes when we predict trends, we run the risk of creating a self-fulfilling prophecy. For instance, when we predict people can't cope, they don't; when we drive a culture of care instead, that is the narrative that plays out.

So, we all need to prepare for the worst and set ourselves up for the best.

10 Action Steps Employers Can Take To Make a Difference

  1. Community. Remind workers that "we're all in this together" as a workplace community. Share stories of how you've pulled together during tough times in the past. Call out examples of when employees are taking care of one another. While it seems like this will go on forever, one day, we will look at it from another side—how would we like to look back at ourselves?
  2. Validation. Normalize and validate workers' emotional experiences. A range of emotions is to be expected: anxiety, anger, frustration, and grief, to name a few. Give workers grace, and encourage them to forgive mistakes without judgment. Offer permission to give themselves a break for being a "good enough" parent, partner, or worker. People bring their whole selves to work, so remember when they show up for work duties, they are still worried about their kindergartener's ability to learn from a screen or about their great aunt, who has been in lockdown for months.
  3. Right-size expectations. Given the level of disruption and distraction, what can be done to adapt expectations? Can workers be honest with their managers about capacity? Encourage workers to ask for help when they need it. Ask yourself the 10-10-10 questions—will this matter in 10 days, 10 months, or 10 years? Prioritize, and let some things go.
  4. Prioritize wellness. Routine and structure can be helpful in getting us grounded. Front-load workdays with opportunities for wellness—walking meetings, yoga breaks, or meditation sessions. Suggest that workers take frequent short breaks to go outside and get sun on their faces. Remind them to prioritize sleep and exercise as key ways to avoid burnout.
  5. Limit media exposure. The constant distressing news coming to us from our phones, computers, and televisions not only overwhelm us, but it also increases our risk for vicarious trauma. When we are bombarded by images, sounds, and storylines of highly distressing information, we can develop anxiety, hopelessness, and even post-traumatic stress—even when we haven't experienced the trauma directly. Suggest that employees take breaks from the news and fill their viewing feed with stories that bring them joy and inspiration instead.
  6. Celebrate people. What gives us hope more than anything? The triumph of the human spirit. At work, share stories of people overcoming obstacles. Lift up examples of people who are creatively solving problems. Recognize and reward those who are unselfishly going above the call of duty to help others succeed. Tell their stories with relish.
  7. Frequent check-ins. Expand your culture of care by encouraging workers to check in with one another. This practice of reciprocity drives the experience that workers have each other's backs. For instance, suggest they send what we call "nondemand caring contacts" to one another. These contacts are brief forms of communication, like unconditional little messages of support they give one another. For example, a coworker can text someone from their team, "I am thinking of you today and wishing you well," or a manager can leave a voicemail to a direct report, "I see how strong you are during this difficult time." Make a game out of how workers can perform intentional acts of kindness with one another.
  8. Find the fun. Bring in micro-joys like surprising workers with donuts or an online trivia game. Start a meeting with a funny movie clip that makes a point. Give out silly awards for creative ways that people are coping.
  9. Provide community service. Whenever we think we are struggling, it's always helpful to connect to others who would benefit from kindness. Find opportunities for workers to contribute to something larger than themselves. This effort could be a clothing drive for a youth homeless shelter or a time together to clean up a community park. The "helper effect" is a real thing—when we help others, we help ourselves.
  10. Bring resources to life. It's not enough to post hotlines and mental health resources on your Web page. Bring them to life by having representatives talk to workers about what to expect, or have users of the services share their experiences. Promote a buffet of resources in addition to your employee assistance program. Be sure to offer online telehealth options and 12-step groups. Crisis resources like the Disaster Distress Helpline ((800) 985–5990), Crisis Text Line (text HELLO to 741741), and National Suicide Prevention Lifeline ((800) 273–8255) are free, anonymous, and available 24/7.

In closing, don't wait until employees' crises are obvious and overwhelming. Proactively put these steps in place to show you care and to give people a pathway through.


1 "Phases of Disaster," SAMHSA, June 17, 2020.

2 Mark Reger, Ian Stanley, and Thomas Joiner, "Suicide Mortality and Coronavirus Disease 2019—A Perfect Storm?," Journal of the American Medical Association Psychiatry, April 10, 2020.

3 "COVID-19 and Its Economic Toll on Women: The Story Behind the Numbers," UN Women, September 16, 2020.

4 Marguerite Ward, "Pandemic-Related 'Deaths of Despair' Were Forecast at about 75,000 Back in May—Now They Could Be Up to 150,000," Business Insider, August 15, 2020.

5 "Issue Brief: Reports of Increases in Opioid- and Other Drug-Related Overdose and Other Concerns during COVID Pandemic," American Medical Association, October 6, 2020.

6 Megan Evans, Margo Lindauer, and Maureen Farrell, "A Pandemic within a Pandemic—Intimate Partner Violence during Covid-19," New England Journal of Medicine, September 16, 2020.

7 Elizabeth York Thomas, Ashri Anurudran, Kathryn Robb, and Thomas Burke, "Spotlight on Child Abuse and Neglect Response in the Time of COVID-19," Lancet. Public Health, Volume 5, Issue 7, E371, July 1, 2020.

8 Sonia Mukhtar, "Psychological Impact of COVID-19 on Older Adults," Current Medicine Research and Practice, July–August 2020, 10(4), pp. 201–202.

9 Chris Arnold, "Sales of Guns to First Time Owners Rise Amid COVID-19 Pandemic," NPR, July 16, 2020.


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