Mental Health, Substance Use, and Family Distress: COVID-19’s Penumbra

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On June 7, 2021, Governor Henry McMaster declined to extend the public health emergency declaration related to the coronavirus in South Carolina. However, data indicates the long-term effects of the pandemic are far from over.  More than 33 million cases and nearly 600,000 deaths have been attributed to COVID-19 in the United States as of June 15, 2021, according to the Centers of Disease Control and Prevention (CDC). [1] These two data points only begin to tell the story of COVID-19’s true magnitude. This brief article examines the pandemic’s deleterious impact on mental health, substance use, and the family unit in South Carolina.

Mental Health

Social isolation, financial strain, unemployment, food insecurity, caregiving, and housing displacement are stressors COVID-19 brought to bear widely upon the American psyche, in addition to concerns about viral exposure. These stressors have created risks for future mental health challenges, as well as current adversities.

A recent New York Times article [2] by organizational psychologist Adam Grant discussed the widespread experience of “languishing” as the “dominant emotion of 2021.” Corey L.M. Keyes defines “languishing” as a “state in which an individual is devoid of positive emotion toward life, and is not functioning well either psychologically or socially, and has not been depressed during the past year.”[3]  Keyes asserts languishing is a critical predictive risk factor of future mental illness. Languishing health workers from Lombardy, Italy, who provided care during the COVID-19 pandemic were found to be three times more likely than their peers to be diagnosed with post traumatic stress disorder.[4]   

A study conducted between April and June of 2020 found symptoms of anxiety disorder and depressive disorder increased considerably in the United States compared with the same period in 2019. Younger adults, racial/ethnic minorities, unpaid caregivers for adults, and essential workers are the most adversely affected, according to the study. “Overall, 40.9% of respondents reported at least one adverse mental or behavioral health condition, including symptoms of anxiety disorder or depressive disorder (30.9%), symptoms of a trauma- and stressor-related disorder (TSRD) related to the pandemic (26.3%), and having started or increased substance use to cope with stress or emotions related to COVID-19 (13.3%). The percentage of respondents who reported having seriously considered suicide in the 30 days before completing the survey (10.7%) was significantly higher among respondents aged 18–24 years (25.5%), minority racial/ ethnic groups (Hispanic respondents [18.6%], non-Hispanic black [black] respondents [15.1%]), self-reported unpaid caregivers for adults (30.7%), and essential workers (21.7%).”[5]  The study’s 5,470 respondents reported “prevalence of symptoms of anxiety disorder was approximately three times those reported in the second quarter of 2019 (25.5% versus 8.1%), and prevalence of depressive disorder was approximately four times that reported in the second quarter of 2019 (24.3% versus 6.5%).” Id. “Suicidal ideation was also elevated; approximately twice as many respondents reported serious consideration of suicide in the previous 30 days than did adults in the United States in 2018, referring to the previous 12 months (10.7% versus 4.3%).” Id. The pandemic’s long-term impact on Americans’ mental health is particularly concerning when one considers that COVID did not hit its peak in the United States until January 2021, some seven months after this survey was conducted.

Substance Use in South Carolina

Data indicates that South Carolinians, like their fellow Americans, have turned to substances to cope with COVID-related stressors. In March 2020, Nielsen reported an increase of as much as 55% in retail alcohol sales over the preceding year. By March 23, 2021, with restaurants and bars reopening around the country, Nielsen reported the first week that retail alcohol sales did not increase since the pandemic’s inception, but retail alcohol sales still exceeded those from March 2019 by 20% to 30%. The S.C. Department of Revenue (SCDR), which oversees licensing of the State’s alcohol wholesalers and retailers, provided figures to The Charleston Post and Courier indicating a 27% uptick in sales for the period of March 15 – June 30, 2020, when compared to the same timeframe in 2019.[6]

Provisional mortality data from the CDC for South Carolina predicts 1,625 drug overdose deaths for the 12-month period ending in September 2020, a 45.3% increase over the 12-month period ending in September 2019. This is well above the national average increase of 28.8% percent and is the fifth-highest reported an increase for this time period, behind the District of Columbia, Louisiana, Kentucky, and West Virginia.  Illicitly made synthetic opioids, which can include fentanyl, are largely responsible for this increase, with 62.4% of those predicted overdose deaths estimated to involve synthetic opioids. Preliminary data also suggest that deaths involving psychostimulants outpaced deaths involving prescription drugs in 2020. Final overdose fatality data for 2020 will be reported in the fall of 2021.

Impact on the Family

COVID-19’s mandatory social isolation drove adults and children alike away from public spaces, such as schools, employers, healthcare providers, and places of worship, and into their homes for an extended period of time.  The increased shared domesticity convinced many South Carolinians that home is not always where the heart is.

Between March 1, 2020, and February 28, 2021, parties filed 17,994 actions for dissolution of marriage by divorce throughout the state, according to the South Carolina Judicial Department. This reflects a 7.4% increase over the divorce actions filed between March 1, 2019, and February 28, 2020.   The number of Separate Support and Maintenance actions filed during this comparative timeframe increased from 3,527 to 4,240.  The total of all marital dissolution actions filed during the first year of the pandemic increased by almost 9.5%. The number of all South Carolina Family Court filings from February 28, 2020, through March 1, 2021, more than tripled, from 64,375 to 195,503. In the category of Juvenile Delinquency, the total number of filings rose from 11, 987 to 21, 379.

Despite these marked increases, there were notable decreases in the data from the South Carolina Judicial Department for the same timeframe in other categories. The number of filings for Visitation Involvement Parenting (VIP) (DSS Only) fell from 74 to 14 and the Termination of Parental Rights (DSS) cases fell from 404 to 291. In the category of Protection from Domestic Abuse, the Intimate Partner case filings fell from 3,749 to 2,752. In the category of Abuse and Neglect, the number of filings for Child Protective Services fell from 5,112 to 3,500, and in the Adult Protective Services category, filings fell from 697 to 519. When “Other” Abuse and Neglect filings are included, the filing category total fell from 5,946 to 4,318. One possible explanation for these decreases in the face of such dramatic increases across the board is the pandemic-related social isolation that removed vulnerable individuals from the view of mandatory reporters in worksites, schools, churches, physician practices, and other public places. 

Conclusion

While the public health emergency declaration may have expired in the Palmetto State, the extent of the mental health, substance use, and family crises triggered by the pandemic remain to be seen.