Behavioral Health Impacts of Long COVID - Policy to Action

In May 2023, the federal COVID-19 Public Health Emergency ended – reflecting a long-awaited return to normalcy across the United States. However, this has not been the case for millions of Americans who continue to struggle with the economic and social effects of the pandemic, including disruptions to daily life, loss, and grief. For some, physical and mental health effects from the virus continue to persist long after the period of initial infection. These lingering effects of a previous COVID-19 infection are most commonly known as Long COVID.

The symptoms of Long COVID are numerous and varied. Common symptoms include fatigue, difficulty concentrating or “brain fog,” shortness of breath or difficulty breathing, chest pain, heart palpitations, cough, joint or muscle pain, depression, anxiety, and many more side effects. About a quarter of people with Long COVID experience significant activity limitations.

Early population estimates from the Centers for Disease Control and Prevention (CDC) show that in 2022, around 7 percent of the entire U.S. adult population reported having Long COVID. According to U.S. Government Accountability Office estimates, there are likely between 7.7 to 23 million people living with Long COVID in the United States. CDC data also reflects that Long COVID cases are reported in children, though less common than adult cases. One estimate suggests that about 1.3 percent of children aged 17 and under have experienced Long COVID.

Impact of Long COVID on Mental Health

The impact of the COVID-19 pandemic on our nation’s well-being is well-documented, with people of all ages and backgrounds reporting increased stress and behavioral health challenges due to several reasons, including physical and behavioral health symptoms from the effects of the virus, social isolation, financial insecurity, caregiver burnout, and grief. The Substance Abuse and Mental Health Services Administration (SAMHSA), CDC, and others noted that during the pandemic, those with mental health conditions and substance use disorders faced higher risks of complications.

For those with Long COVID experiencing lingering effects from a COVID-19 infection, the impact on both physical and mental health can be particularly challenging, especially when there are no immediate answers or solutions.

Some of the most common mental health conditions associated with Long COVID include fatigue, sleep disturbances, depression, anxiety, psychosis, cognitive impairment, obsessive-compulsive disorder, and posttraumatic stress disorder. Both COVID-19 and Long COVID can result in new onset of behavioral health conditions in those who have not previously reported these conditions and aggravate complications for those with pre-existing mental health conditions and substance use disorders.

SAMHSA’s work during and following the Public Health Emergency illustrate the significant impacts COVID-19 has had on behavioral health for both adults and children.

SAMHSA’s Commitment to Helping Those Impacted by Long COVID

Because of the burden that Long COVID can have on behavioral health, SAMHSA and its federal partners are committed to helping individuals, families and caregivers, health professionals, and others identify and manage this condition. Accordingly, SAMHSA has been engaged in a number of efforts, including participating in the federal response to Long COVID, hosting technical expert meetings, and producing publications on the impacts of Long COVID on behavioral health, as well as guidance for primary care physicians on identifying and managing patients’ behavioral health symptoms. SAMHSA also works closely with key partners including the recently established HHS Office of Long COVID Research and Practice. The federal government, researchers, clinicians, advocates, and policy makers have laid the groundwork to advance progress in the prevention, diagnosis, treatment, and provision of services (PDF | 1.5 MB) for individuals experiencing Long COVID.

SAMHSA’s Policy to Action Initiative

Acknowledging concerns about the behavioral health impacts of Long COVID, SAMHSA hosted its first Policy to Action Initiative meeting on Long COVID in mid-May. This meeting brought together a group of researchers, clinicians, representatives from national organizations, individuals with lived experience of Long COVID, and federal agency colleagues. The Policy to Action Initiative was designed to establish a unique partnership with the goal of translating behavioral health policies and discussions into concrete commitments and on the ground action. During this two-day meeting, participants discussed challenges around the behavioral health effects of Long COVID and worked to identify key messages and strategies for raising awareness among public health practitioners, behavioral health professionals, researchers, policymakers, and the public. During the meeting, attendees discussed and/or committed to the following:

• The importance of ensuring that mental health and substance use disorders receive the same attention and priority as other Long COVID impacts;
• Communication materials and strategies for health providers and patients, continuing education materials for health professionals, and ensuring adequate reimbursement of providers diagnosing and treating Long COVID;
• Commitment to such steps as highlighting Long COVID and behavioral health in agency and organization social media and newsletters, and working collaboratively to support research, communication, and policy steps, educating their respective members and stakeholders about how Long COVID is impacting patients and how to best help them, and amplifying patient voices to both de-stigmatize and humanize the condition; and
• Coordination and expansion among the network of agencies and organizations focusing on doing work to impact the landscape of behavioral health related Long COVID services and supports.

We realize there is much left to do to help the millions of Americans who are struggling to recover from Long COVID and who are feeling isolated, depressed, or experiencing other mental health or substance use conditions as a result. We want you to know that you are not forgotten. SAMHSA leadership is dedicated to continuing its work to support and elevate efforts to address this issue. Long COVID is a complex set of conditions; it is only through openness and collaboration that we can work to make a difference for those in need.

SAMHSA is committed to providing support and resources to those who need them. Visit SAMHSA’s website to find resources like FindSupport.gov, the 988 Suicide & Crisis Lifeline, and more.