Outbreaks can be stressful

The outbreak of coronavirus disease 2019 (COVID-19) may be stressful for people. Fear and anxiety about a disease can be overwhelming and cause strong emotions in adults and children. Coping with stress will make you, the people you care about, and your community stronger.

Stress during an infectious disease outbreak can include

• Fear and worry about your own health and the health of your loved ones
• Changes in sleep or eating patterns
• Difficulty sleeping or concentrating
• Worsening of chronic health problems
• Worsening of mental health conditions
• Increased use of alcohol, tobacco, or other drugs

Everyone reacts differently to stressful situations

How you respond to the outbreak can depend on your background, the things that make you different from other people, and the community you live in.

People who may respond more strongly to the stress of a crisis include

• Older people and people with chronic diseases who are at higher risk for severe illness from COVID-19
• Children and teens
• People who are helping with the response to COVID-19, like doctors, other health care providers, and first responders
• People who have mental health conditions including problems with substance use

Take care of yourself and your community

Taking care of yourself, your friends, and your family can help you cope with stress. Helping others cope with their stress can also make your community stronger.

Ways to cope with stress

• Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting.
• Take care of your body.
  • Take deep breaths, stretch, or meditateexternal icon.
  • Try to eat healthy, well-balanced meals.
  • Exercise regularly, get plenty of sleep.
  • Avoid alcohol and drugsexternal icon.
• Make time to unwind. Try to do some other activities you enjoy.
• Connect with others. Talk with people you trust about your concerns and how you are feeling.

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Need help? Know someone who does?

If you, or someone you care about, are feeling overwhelmed with emotions like sadness, depression, or anxiety, or feel like you want to harm yourself or others

• Call 911
• Visit the Disaster Distress Helplineexternal icon, call 1-800-985-5990, or text TalkWithUs to 66746
• Visit the National Domestic Violence Hotlineexternal icon or call 1-800-799-7233 and TTY 1-800-787-3224

Know the facts to help reduce stress

Sharing the facts about COVID-19. Understanding the risk to yourself and people you care about can make an outbreak less stressful.

When you share accurate information about COVID-19, you can help make people feel less stressed and make a connection with them.

Related: Reducing Stigma and Stop the Spread of Rumors

Take care of your mental health

Call your healthcare provider if stress gets in the way of your daily activities for several days in a row.

People with preexisting mental health conditions should continue with their treatment and be aware of new or worsening symptoms. Additional information can be found at the Substance Abuse and Mental Health Services Administration (SAMHSA) Disaster Preparednessexternal icon page.

Related: Taking Care of Your Emotional Health

For parents

Children and teens react, in part, on what they see from the adults around them. When parents and caregivers deal with the COVID-19 calmly and confidently, they can provide the best support for their children. Parents can be more reassuring to others around them, especially children, if they are better prepared.

Watch for behavior changes in your child

Not all children and teens respond to stress in the same way. Some common changes to watch for include

• Excessive crying or irritation in younger children
• Returning to behaviors they have outgrown (for example, toileting accidents or bedwetting)
• Excessive worry or sadness
• Unhealthy eating or sleeping habits
• Irritability and “acting out” behaviors in teens
• Poor school performance or avoiding school
• Difficulty with attention and concentration
• Avoidance of activities enjoyed in the past
• Unexplained headaches or body pain
• Use of alcohol, tobacco, or other drugs

Ways to support your child

• Talk with your child or teen about the COVID-19 outbreak.
• Answer questions and share facts about COVID-19 in a way that your child or teen can understand.
• Reassure your child or teen that they are safe. Let them know it is ok if they feel upset. Share with them how you deal with your own stress so that they can learn how to cope from you.
• Limit your family’s exposure to news coverage of the event, including social media. Children may misinterpret what they hear and can be frightened about something they do not understand.
• Try to keep up with regular routines. If schools are closed, create a schedule for learning activities and relaxing or fun activities.
• Be a role model. Take breaks, get plenty of sleep, exercise, and eat well. Connect with your friends and family members.

Related: Caring for Children and Helping Children Cope

For people at higher risk for serious illness

People at higher risk for severe illness, such as older adults, and people with underlying health conditions are also at increased risk of stress due to COVID-19. Special considerations include:

• Older adults and people with disabilities are at increased risk for having mental health concerns, such as depression.
• Mental health problems can present as physical complaints (such as headaches or stomachaches) or cognitive problems (such as having trouble concentrating).
• Doctors may be more likely to miss mental health concerns among
  • People with disabilities due to a focus on treating underlying health conditions, compared to people without disabilities.
  • Older adults because depression can be mistaken for a normal part of aging.

Common reactions to COVID-19

• Concern about protecting oneself from the virus because they are at higher risk of serious illness.
• Concern that regular medical care or community services may be disrupted due to facility closures or reductions in services and public transport closure.
• Feeling socially isolated, especially if they live alone or are in a community setting that is not allowing visitors because of the outbreak.
• Guilt if loved ones help them with activities of daily living.
• Increased levels of distress if they:
  • Have mental health concerns before the outbreak, such as depression.
  • Live in lower-income households or have language barriers
  • Experience stigma because of age, race or ethnicity, disability, or perceived likelihood of spreading COVID-19.

Support your loved ones

Check in with your loved ones often. Virtual communication can help you and your loved ones feel less lonely and isolated. Consider connecting with loved ones by:

• Telephone
• Email
• Mailing letters or cards
• Text messages
• Video chat
• Social media

Help keep your loved ones safe.

• Know what medications your loved one is taking. Try to help them have a 4-week supply of prescription and over the counter medications. and see if you can help them have extra on hand.
• Monitor other medical supplies (oxygen, incontinence, dialysis, wound care) needed and create a back-up plan.
• Stock up on non-perishable food (canned foods, dried beans, pasta) to have on hand in your home to minimize trips to stores.
• If you care for a loved one living in a care facility, monitor the situation, and speak with facility administrators or staff over the phone. Ask about the health of the other residents frequently and know the protocol if there is an outbreak.

Take care of your own emotional health. Caring for a loved one can take an emotional toll, especially during an outbreak like COVID-19. There are ways to support yourself.

Stay home if you are sick. Do not visit family or friends who are at greater risk for severe illness from COVID-19. Use virtual communication to keep in touch to support your loved one and keep them safe.

What health care providers can do

• Help connect people with family and loved ones to help lower distress and feelings of social isolation.
• Let older adults and people with disabilities know it is common for people to feel distressed during a crisis. Remind them that asking for and accepting help is a sign of strength.
• Have a procedure and referrals ready for anyone who shows severe distress or expresses a desire to hurt him- or herself or someone else.
• See SAMHSA’s Helping Older Adults After Disasters: A Guide to Providing Supportpdf iconexternal icon.

What communities can do

Community preparedness planning for COVID-19 should include older adults and people with disabilities, and the organizations that support them in their communities, to ensure their needs are taken into consideration.

• Many of these individuals live in the community, and many depend on services and supports provided in their homes or in the community to maintain their health and independence.
• Long-term care facilities should be vigilant to prevent the introduction and spread of COVID-19. See guidance for long-term care facilities and nursing homes.

For people coming out of quarantine

It can be stressful to be separated from others if a healthcare provider thinks you may have been exposed to COVID-19, even if you do not get sick. Everyone feels differently after coming out of quarantine.

Emotional reactions to coming out of quarantine may include

• Mixed emotions, including relief after quarantine
• Fear and worry about your own health and the health of your loved ones
• Stress from the experience of monitoring yourself or being monitored by others for signs and symptoms of COVID-19
• Sadness, anger, or frustration because friends or loved ones have unfounded fears of contracting the disease from contact with you, even though you have been determined not to be contagious
• Guilt about not being able to perform normal work or parenting duties during quarantine
• Other emotional or mental health changes

Children may also feel upset or have other strong emotions if they, or someone they know, has been released from quarantine.

For responders

Responding to COVID-19 can take an emotional toll on you, and you may experience secondary traumatic stress. Secondary traumatic stress is stress reactions and symptoms resulting from exposure to another individual’s traumatic experiences, rather than from exposure directly to a traumatic event.

There are things you can do to reduce secondary traumatic stress reactions:

• Acknowledge that secondary traumatic stress can impact anyone helping families after a traumatic event.
• Learn the symptoms including physical (fatigue, illness) and mental (fear, withdrawal, guilt).
• Allow time for you and your family to recover from responding to the pandemic.
• Create a menu of personal self-care activities that you enjoy, such as spending time with friends and family, exercising, or reading a book.
• Take a break from media coverage of COVID-19.
• Ask for help if you feel overwhelmed or concerned that COVID-19 is affecting your ability to care for your family and patients as you did before the outbreak.

Learn more tips for taking care of yourself during emergency response.

Get more information about stress management for first responders from the Disaster Technical Assistance Centerexternal icon (SAMHSA).