As concerns about COVID-19 wreak havoc with plans for holiday gatherings, feelings of anxiety, depression and hopelessness may intensify, says psychiatrist Karen Swartz, associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and a member of Johns Hopkins Medicine’s Office of Well-Being collaborative team for mental, emotional and spiritual health (MESH).

She points out that mental distress related to the pandemic has already increased throughout the nation in every age group, according to surveys by the Centers for Disease Control and Prevention and the National Health and Nutrition Examination Survey.

In a recent interview, Swartz discussed the psychiatric strains of dealing with prolonged burdens of uncertainty, social isolation and economic stress. She also talked about how to recognize depressive symptoms in family members and co-workers, and about resources available at Johns Hopkins Medicine to support them.

Q. Mental health surveys taken in 2020 show that the number of U.S. residents who describe themselves as depressed has grown dramatically. What worries you the most?

A. I’m most concerned by how much greater the rates of depression and anxiety are now — they have increased threefold — compared with a year ago and two years ago.

The prevalence of depressive symptoms was not only higher in all age groups, but the numbers for those describing “moderately severe” to “severe” symptoms were dramatically higher. That’s particularly true for younger age groups.

On one national survey published in Morbidity and Mortality Weekly Report, half of the 18- to 24-year-olds reported depressive symptoms. Most worrisome is that a quarter of them had seriously considered suicide in the past 30 days.

Additionally, essential workers reported higher rates of depressive symptoms (33%) and suicidal thoughts (21%) than other categories of employed and unemployed people. It is critical that anyone having suicidal thoughts reach out for help. One resource is the National Suicide Prevention Lifeline: 1-800-273-TALK (1-800-273-8255).

Q. People often say they are suffering from COVID-19 fatigue and COVID-19 depression. How does that differ from clinical depression?

A. The level of uncertainty caused by the pandemic is unsettling to everyone. However, there’s a real danger in understanding depression or anxiety as something that everyone is experiencing because of COVID-19. Demoralization is so common that we are at risk of overlooking people with more serious and treatable illness by saying “Well, we’re all going through that.”

While it’s true that many people may feel tired, overwhelmed and sick of the restrictions, it’s not true that everyone is doubting their ability to work, thinking that they shouldn’t be alive and wondering if their families would be better off without them. It is not normal for people to have thoughts of harming themselves. I view that as an emergency. Getting demoralized and overwhelmed does not lead people to have thoughts about ending their lives. They are much more likely to be experiencing a serious kind of depression that could be life-threatening. That’s when it’s important they look into seeking specific care.

Q. What are some of the mental health symptoms to look for?

A. The same symptoms of depression — mood changes, physical changes, changes in your sense of yourself — occur in different ages but manifest a little differently.

A symptom for teenagers, for example, is often irritability and being short-tempered. Something small might trigger a disproportionately giant reaction.

Others might feel numb, or say they feel nothing. Another symptom most people experience is a dulling of their ability to feel joy. They can’t get excited about seeing family and friends or doing something they usually love.

Some of the physical symptoms on every checklist include changes in sleep, changes in energy, changes in appetite and an inability to concentrate. When you’re under stress, it’s easy to write those things off as a response to the situation. But you should pay attention when a number of those symptoms come together in addition to changes in your mood.

Also of concern is a change in self-confidence. When people are depressed, they start doubting their ability to be good at those things they value most. They may think, “I’m not a good mom,” or “I’m not a good doctor.”

When people are depressed, they can only see what they have done wrong. They get a sense that they’ve screwed everything up, which can lead to an even more serious form of negative thinking — hopelessness. They may think, “I don’t see a future for myself, I don’t see a way to get better.”

Q. How is the increase in COVID-19 admissions affecting hospital staff?

A. Another surge of cases sets up front-line health care workers for anxiety, depression and post-traumatic stress disorder. Studies done in this country, Italy and China report high levels of those illnesses.

People are working so hard in such stressful situations. They need to allow time to take care of themselves not only for their own sakes, but also for their families and their patients. In general, health care workers can be a little better at taking care of others rather than themselves.

That is the reason we need to take care of each other. We need to be thoughtful, reach out to each other and support each other. When we see people we care about struggling to act, we can also encourage them to speak to mySupport. Free to all Johns Hopkins Medicine employees and members of their household, it provides a counselor to help callers determine whether they are experiencing a work-related stress or if there is something more serious going on.

If it appears a problem may require more professional help, the Department of Psychiatry has set up a clinic to help faculty and staff members at The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center. MySupport can facilitate referrals at other hospitals.

Johns Hopkins offers an incredible network of emotional support that includes RISE (Resilience in Stressful Events), spiritual support for individuals and teams, and Healthy at Hopkins, which provides resources and programs for better sleep, meditation and relaxation techniques.

I encourage people to use these resources instead of saying, I’m tired, I don’t have the energy and I’m going home. It’s an important investment to make.

Q. What can people expect when they speak with a therapist for the first time?

During a first meeting with a therapist or psychiatrist, the focus would be learning about what you are dealing with and what issues you would like to discuss. The discussion would include asking some questions about what you are feeling and how you are functioning. The mental health provider will also ask specific questions about depression, anxiety and other common conditions to determine how to best help.

Q. The holidays will be very different for many people used to spending time with extended families and friends. What can we do to improve our mental health?

A. Holidays already trigger a lot of strong emotions and reactions, as well as family expectations and obligations. This year, trying to balance the desire to be with and support families and the desire to protect them is extremely stressful. Particularly when you are thinking about supporting older relatives who may already be feeling alone and isolated. These are very food-based, indoor holidays; you have to consider what exposure to a school- or college-aged child might mean for their grandmother or grandfather.

If you can’t be with the people you normally look forward to seeing in person, make other plans to spend time together. One option is a family Zoom call. My family already takes an hour every weekend to bring all of us together with our 90-year-old father. We get silly — and see way too much of my brother’s cat! — but it’s a way to celebrate virtually.

At Thanksgiving, many families have a tradition to talk about things they’re grateful for. We know from positive psychology, [an approach focusing on positive events and influences in life] that taking time each day to list “three things I am grateful for” does boost mood. It helps people to feel better. There’s no reason not to do that.