Daily life is now a juggling act for Misty Richards, MD, MS. As the program director of a rigorous child psychiatry fellowship, a psychiatrist caring for women with perinatal psychiatric disorders, and the mother of three young children, Dr. Richards tries to view these tasks as an opportunity for growth. But some days it feels as if she’s navigating a storm in the middle of the ocean without a life jacket.
In the age of COVID, “the wave of demands has morphed into one giant tidal wave of desperate need,” Dr. Richards, of the department of psychiatry & biobehavioral sciences, University of California, Los Angeles, Semel Institute of Neuroscience & Human Behavior, said in an interview. “The painfully loud and clear message is that our patients need us, and our children – who have been stripped from healthy routines and peer interactions that nourish social-emotional development – rely on us. We cannot turn our backs for even a moment, or else they will suffer.”
Tasked with caring for a much sicker and distressed population, navigating home duties such as child care, online school, and taking care of certain family members, women psychiatrists are feeling the impact of COVID-19.
Many have seamlessly transferred their practices online, maintaining a lifeline with their patients through telehealth visits. Even with this convenience, the emotional labor of being a psychiatrist is still very stressful, Pooja Lakshmin, MD, of the department of psychiatry and behavioral sciences at George Washington University, Washington, said in an interview. Because the nature of work has changed, and many are doing things virtually at home, separating home from work life can be a challenge. “It’s harder to disconnect,” admitted Dr. Lakshmin. “Even my patients tell me that they have no time to themselves anymore.”
– a moving target that remains nowhere in sight, Dr. Richards said. “In this process, we are expected to fill the emotional cups of a broken nation, to provide answers that do not exist, and to do so with never-ending gratitude for a demanding system that has no ‘off’ switch,” she noted.
‘In two places at once’
COVID-19’s physical and emotional toll has swept across the various subspecialties of clinical psychiatry. As some navigate outpatient/telehealth work, inpatient psychiatrists directly interact with COVID patients.
“Our inpatient psychiatry unit regularly takes care of COVID patients, including perinatal patients who are COVID positive,” Samantha Meltzer-Brody, MD, MPH, distinguished professor and chair, University of North Carolina, Chapel Hill, department of psychiatry and director of medical school’s Center for Women’s Mood Disorders, said in an interview. A psychiatry consultation-liaison service also provides psychiatry care to medical and surgical patients, including medically ill COVID patients across the hospital.
“We are on the front lines in the sense that we are dealing with the trauma of the general population and having to be present for that emotional distress,” Dr. Meltzer-Brody said.
The struggle to balance rising caseloads and home responsibilities makes things difficult, she continued. “There’s a never-ending onslaught of patient referrals,” reflecting the anxiety and depression issues people are experiencing in the wake of a global pandemic, frenetic political situation in the United States, and job uncertainty.
Child care and elder care responsibilities affect both men and women, yet research shows that caregiving demands disproportionately affect women, observed Dr. Meltzer-Brody.
Overall, the stress of caregiving and parenting responsibilities for men and women has been markedly higher during the pandemic. Most clinical psychiatrists “have been extraordinarily busy for a very long time,” she added.
Tiffani L. Bell, MD, a psychiatrist in Winston-Salem, N.C., has seen an increase in anxiety and depression in people with no previous history of diagnosed mental illness. “The impact of the pandemic has truly been multifaceted. People are struggling with loss of jobs, loss of wages, and loss of loved ones, along with grieving the loss of the usual way of life,” she said in an interview.
Many of her colleagues report feeling overburdened at work with increased admissions and patient loads, decreased time to see each patient, and the feeling of “needing to be in two places at once.”
“As a female psychiatrist, I do believe that we can sometimes have an increased mental burden due to the emotional and physical burnout that can occur when our routines are shaken,” added Dr. Bell, who specializes in adult, child, and adolescent psychiatry, and obesity and lifestyle medicine. Even in the early months of the pandemic, Dr. Bell said she heard people joke that “they don’t know if they are working from home or living at work.”
Physicians aren’t the only ones who are overwhelmed. “We’re also hearing stories from our patients – those at risk for partner violence, dealing with kids out of school, working full time while providing support at home,” Ludmila De Faria, MD, chair of the American Psychiatric Association’s Committee on Women’s Mental Health, said in an interview.
American mothers in particular spend nearly twice as much time caring for their children and cooking than their spouses, said Dr. Bell, citing recent studies. “Even if one is not a mom, if you couple the increased housework at baseline with the added responsibilities of working as a front-line physician and/or working from home while managing a household, it can lead to increased stress for all involved.”