COVID-Specific Issues & Screening

The COVID-19 pandemic is a traumatic event for everyone. All of us are experiencing chronic stress and trauma in response to the pandemic, with biological and psychological impacts. Quarantine, social distancing, and financial strain also have significant effects on humans. Humans feel less safe when we lack social and physical contact with others; on a physiological level, the isolation required by quarantine is experienced as a threat. The impacts of this chronic stress, and chronic activation of our fight-or-flight systems, will last for years. The most common new-onset mental health disorders among adults during a pandemic are posttraumatic stress disorder and depression. Sleep difficulties are also likely to occur. Rates of suicide also increase during stressful times. Healthcare providers and survivors of COVID are at very high risk for the development of posttraumatic stress disorder. Adults who are experiencing financial stress or strain are also at high risk for mental health issues.

General Screening Procedures

For all visits:

Discuss that COVID-19 and the resulting social isolation are stressful and potentially traumatic. Ask how patients are coping with the current situation. Provide anticipatory guidance to all patients. 

Consider asking these questions:

  1. This has been a difficult time for all of us. We aren’t sure yet what effect the pandemic will have on us, but we want to watch out for changes in mood and behavior that might be related to the pandemic or social distancing measures.
  2. Have you noticed any of the following changes:
  • Change in sleep patterns (e.g. difficulty falling or staying asleep, increased nightmares, sleeping more than usual)
  • Change in eating patterns (e.g. increase or decrease in appetite or types of foods)
  • Increase in aches and pains
  • Changes in mood or behavior (e.g. not feeling good about yourself, difficulty getting along with family or friends, less interest in doing activities)
  • Withdrawal/isolation
  • Difficulty concentrating
  • Increased worry or difficulty focusing

3. Well Visits:

  • Continue with well-visit screening questionnaires utilized in your office.

4. Sick Visits: 

General Guidelines:

  1. Be present and allow yourself to be emotionally available,

  2. Use appropriate physical touch and open body language (turning away from the computer, for example),

  3. Listen without interruption and judgment, and employ active listening skills such as paraphrasing and reflecting patients' feelings,

  4. Instill hope and empower the patient by eliciting how he or she successfully coped with similar challenges in the past,

  5. Express empathy in a genuine, natural manner, thereby fostering a stronger patient-provider relationship.

Below are options to consider using with your patient:

  1. Instill hope and empower the patient. “How have you successfully coped with similar challenges in the past?”
  2. Encourage use of social supports. “Who do you have in your life to support you in dealing with [fill in the issue]?”
  3. Help them to focus on gratitude. “What are you grateful for?” “What positive things have happened for you lately?”
  • Could be past day, past week, past year. Big or small.
  • Ask them to keep a daily/weekly list of positive events (gratitude journaling)

4. Teach them a breathing or mindfulness exercise.

  • 4-square breathing: Breathe in for 4 counts, hold breath for 4 counts, blow out gently for 4 counts, hold the empty breath for 4 counts

5. A simple mindfulness exercise: 

  • “Close your eyes. Take four deep breaths. Focus on the sound of your breath. Imagine that you are in a place where you feel calm and safe. Connect to the emotions that you are experiencing.”
    U-M Psychiatry Mindfulness Site 

6. Prescribe physical exercise: “What are you doing for exercise?”

General information on ways to cope with stress:

List of Adaptive Coping Actions to Provide to Patients:

Adaptive coping actions are those that help to reduce anxiety, lessen other distressing reactions, improve the situation, or help people get through bad times. In general, coping methods that are likely to be helpful include: 

    1. Talking to another person for support
    2. Getting needed information
    3. Getting adequate rest, nutrition, exercise
    4. Engaging in positive distracting activities (sports, hobbies, reading)
    5. Trying to maintain a normal schedule to the extent possible
    6. Telling yourself that it is natural to be upset for some period of time
    7. Scheduling pleasant activities
    8. Eating healthful meals
    9. Taking breaks
    10. Spending time with others
    11. Participating in a support group
    12. Using relaxation methods
    13. Using calming self talk
    14. Exercising in moderation
    15. Seeking counseling
    16. Keeping a journal
    17. Focusing on something practical that you can do right now to manage the situation better
    18. Using coping methods that have been successful for you in the past

    General COVID handouts

    1. National Alliance on Mental Illness COVID-19 Resource and Information Guide
    2. When Terrible Things Happen; En Espanol
    3. Tips for Adults after Disasters; En Espanol
    4. Basic Relaxation Techniques; En Espanol
    5. Alcohol, Medication and Drug Use after Disasters; En Espanol
    6. Coping - Positive Activities; En Espanol
    7. Managing Stress; En Espanol 
    8. Helpful Thinking; En Espanol 
    9. Strategies for families
    10. Grief Reactions; En Espanol
    11. Supporting Someone After a Disaster; En Espanol
    12. Intimate Partner Violence 
    13. Tips for providing support to others during the COVID-19 Outbreak; En Espanol 
    14. Posttraumatic Stress Reactions; En Espanol
    15. Anger and Irritability; En Espanol
    16. Sleep Difficulties; En Espanol
    17. Depressed Mood; En Espanol
    18. Disaster-related Fears; En Espanol