COVID-19's impact on the mental health of some Australians could be experienced for years to come, according to a report by The Black Dog Institute.

The report comes after mounting uncertainty over several weeks about the spread and economic impact of the disease, which had many Australians in a heightened state of anxiety.

While for most this high anxiety and worry will decline in the post-pandemic future, a significant minority will experience long-term anxiety as a result.

The most at-risk groups for future mental health complications include frontline health care workers, those placed in quarantine, people with life-threatening cases of COVID-19 and those with pre-existing disorders, such as depression, health-related anxieties and PTSD.

The impact of quarantine on individuals due to the disease proved to be a significant factor in mental health outcomes.

Interestingly, the report found that as many as one in four people quarantined due to COVID-19 experienced trauma-related mental health problems that could last years.

The mental health consequences common as a result of a pandemic include anxiety and panic, depression, anger, confusion and uncertainty and financial stress. Further, it is estimated that between 25 and 33 per cent of a community will feel high levels of worry and anxiety during a pandemic.

The report, Mental Health Ramifications of COVID-19: The Australian Context, identified the following groups as being most at risk of mental health complications, directly related to a pandemic (and not as a result of pre-existing anxiety disorders and mental health problems).

Health care workers
This group includes nurses, doctors and auxiliary staff. In past pandemics, this group has experienced high levels of anxiety.

Fortunately, Australia's medical professionals have not had to confront an
overwhelmed healthcare system that would have required difficult decisions on allocating critical care support. 'This type of moral injury is likely to have long-term consequences on the mental health and morale of staff,' the report stated.

For health care professionals working on the frontline during the pandemic, there is likely to be anxiety due to fear of contracting the disease, which may also have consequences for their family and colleagues.

The report also found health care professionals most affected by anxiety due to COVID-19 are nurses and auxiliary staff (reception staff and practice managers) – and to a lesser degree medical doctors.

Support appropriate for this high-risk group included having access to protective equipment, monitoring mental health and receiving ongoing psychological support, which can minimise distress and alleviate fears.

Being placed in quarantine
Quarantine has the potential to impact long-term mental health. In the report, a recent review found the psychological effects of quarantine included depression, PTSD symptoms, confusion, anger, boredom and loneliness.

Poorer outcomes for mental health can be expected when quarantine is compounded by:

• Prolonged duration of time
• Fears of infection (getting sick or infecting others)
• Lack of essential supplies
• Lack of information on the pandemic
• A financial loss
• Stigma

Unemployed and casual workforce
The economic instability brought about by the pandemic will increase mental health risk for those with high job insecurity. This at-risk group may be prone to stress, financial strain, poorer health and increased incidence of depression and anxiety.

Julius Ajayi, a mental health nurse practitioner, said he had seen an increase in the number of patients with anxiety and stress-related conditions due to job losses and business closures.

"There are increased stress levels due to business cutting down on resources, which leads to increased workload and expectation. There is also a management and leadership skills-deficit impacting on staff, leading to psychological distress.

"I also see a lot of adjustment issues with students as a result of adjusting to online learning from face-to-face lectures.

"There has been an increase in alcohol and drug use, gambling behaviours, and depression and increased anxiety due to an inability to exercise and attend gyms with friends and associates," said Mr Ajayi.

Pandemic-related mental health issues are also a result of social isolation, which is limiting social networking and impacting working relationships and daily life.

Elisabeth Shaw, CEO of Relationships Australia NSW, said many people had experienced fear, loneliness, anxiety and stress as a result of the pandemic, especially those who have lost jobs and even those working remotely from home.

"A great deal of video conferencing is leading to significant fatigue and more 'brittle' and business-like conversations, which can feel less relational, and therefore people can lose confidence about how well they are thought of at work, how they are tracking and how liked they are, which can lead to anxiety."

Those with relationship issues have also fared poorly during the pandemic, explained Ms Shaw, with family life also suffering due to the pressure of combining work and home-schooling.

"Those living in poor relationships can be at risk of the relationships breaking down, settling into more entrenched conflict and negative cycles of interaction, which can make people start to fear their relationship is over.

"Negative rumination can be very taxing and can affect sleep, increase anxiety, and lead to less capacity to speak up, and problem solve.

"During the lockdown, many parents felt guilty that they couldn't keep up with home-schooling and work obligations. It was a recipe to feel bad about your performance everywhere you go! Single parents have been doing this particularly tough," said Ms Shaw. 

Who are the most at-risk groups?

The group most at risk during a pandemic are those in disadvantaged situations, whether financially or socially, explained Ms Shaw.

"Worldwide research says that those who are most disadvantaged and experiencing racial bias, for example, tend to become far more marginalised and disadvantaged during such a crisis."

Other at-risk groups include:

• Extroverts "Those that need people and lots of input as ‘fuel’ can suffer during this time, whereas introverts can do comparatively well. People who need people can feel lonely, lose confidence, esteem and become bored and lose morale or motivation to get things done."

• People living in dangerous relationships

• Those who are already experiencing loneliness "The elderly, single parents, and some youth – can feel far worse about their situation."

• Anxiety sufferers "Anxiety suffers are particularly sensitive and can be triggered by the constant reports on the virus but can also experience some comfort by their world becoming smaller and more controllable."

As the pandemic burden and lockdown recedes, there is also growing anxiety about returning to pre-pandemic life, but it can be an opportunity to re-evaluate priorities.

"It is to be expected that on return to normal obligations that people can experience overwhelm, ongoing fear, loss of trust in authority and tiredness as their brain goes back to processing a lot more information.

"This is a chance to reset some boundaries. To think about what your new home and work boundaries are going to be.

"Some have fallen into bad habits with sleep, lack of exercise, overeating, drinking and even online gambling.

"It may take discipline and even some professional support to reset your self-care strategies.

"If your relationships have suffered during this time, it is worth reminding yourself that this could be a false reading of your situation and try and re-evaluate when everyone takes up the reigns of their lives.

"It might also have caused disappointed that when the chips were down, the family fell apart. Again, that could be a reason to seek professional help to gather the pieces together again before further conclusions are drawn," said Ms Shaw.

When it comes to those who have experienced COVID-19 hospitalisation, mental health support will depend on the patient's level of resilience and degree of disease impact, explained Mr Ajayi.

"I believe that those who are struggling with the adjustment issues that come, the infection should be managed with psychological support through referral by the hospital to a mental health clinician or a psychologist who can offer counselling or psychological therapy."