COVID-19's second curve, psychological effects

DR. C.J. DAVIS, president of Burrell Behavioral Health, shared an illustration of what mental health professionals call “the second curve” associated with the COVID-19 public health pandemic and its potential psychological consequences.

The leader of one of the most prominent mental health organizations in southwest Missouri calls it “the second curve,” a set of challenges that will follow months and even years after stay-at-home orders tied to COVID-19 are allowed to expire.

Some actions taken now could flatten that second curve, and help everyone enjoy a better future, the experts say.

During an online webinar put on by economic development group Show Me Christian County, Burrell Behavioral Health president C.J. Davis explained what is known as the second curve, the mental health issues or even crises that Davis says will follow the worst of the COVID-19 pandemic. People who have never before sought treatment for mental health issues or counseling will experience concerns about their mental health for the first time.

“There is a growing number of individuals that currently are experiencing new mental health symptoms,” Davis said. “How many times in the last four weeks have you felt anxious? Have you felt nervous? Have you experienced your mind racing, where you started to think about the worst or you felt isolated and down?”

If you experienced any of the above, you certainly are not alone.

“A couple weeks ago, 35 percent of us indicated that our mental health symptoms have worsened over the past week,” Davis said, citing data from Ipsos Group, an international market research firm. That number is up from 22 percent of respondents reporting worsened mental health conditions in February 2020.

“I think that number is going to continue to grow,” Davis said. “Fifty-five percent of Americans right now have a concern about their own mental health, or the mental health of a loved one.”

The phrase “social distancing,” should not equate to social isolation, a practice commonly linked to mental health issues such as depression, anxiety and substance misuse. Instead, Davis recommends people seek to practice physical distancing while maintaining emotional connections.

“Isolation is going to load on a whole host of other mental health concerns. We know that isolation impacts hopelessness, we know that isolation impacts helplessness,” Davis said.

Isolation linked to loneliness was already an issue for many Americans before the COVID-19 virus arrived in the United States. Now, it’s been amplified, with loneliness rates growing about 200 percent across the U.S.

“We are a world that lives in loneliness,” Davis said. “Those are the kind of factors that generally lead to someone experiencing suicidal ideation and the thought of taking their life, so isolation is very concerning to us.”

In Missouri, behavioral health providers are experiencing a 65-percent increase in the practice of online therapy. App-based treatment programs are also seeing about a 50-percent traffic increase. On April 14, for example, Davis said that 79 percent of Burrell’s appointments were either conducted by teleconference or telephone.

Davis said that about 80 percent of the people who suffer from feelings of depression or anxiety do not seek care.

Flatten the second curve

To lessen the sociological impact of the second curve, Dr. Davis recommends that everyone take some initiative to look out for their own mental health, and to help family, friends and colleagues cope with the challenges that stay-at-home orders, social distancing guidelines, job loss and economic uncertainty.

“Living in COVID is sort of like if you had a fear of flying and you had to get on an airplane every single day,” Davis said, warning of a practice called catastrophic thinking, in which a person’s mind races through all possible negative outcomes. “The what-ifs, unfortunately, are truly endless in this particular environment.”

People are spending an inordinate amount of time watching television or scrolling their social media feeds, because they aren’t experiencing as much human interaction as they are accustomed to.

Keep a schedule, Davis advises. That also goes for kids.

Davis recommends families reduce their screen time. Instead, put together puzzles, play or listen to music, draw or create art, read a book, or have some other structured downtime.

It’s also important for full-time parents, or people who suddenly find themselves playing the role of full-time parents, to reach out to friends, family, and persons in similar situations to develop support systems.

To look out for others, Davis recommends a practice abbreviate Q.P.R. — question, persuade and refer. Ask someone how they are doing, and get beyond a downplayed, “I’m fine,” persuade them to engage in mental health care if they need it, and then refer someone to a counselor or service provider.

“We have to check in on each other,” Davis said, “and we have to make sure that it’s more than an update.”

It’s important to encourage friends, employees, colleagues and family members to engage in mental health care, not order or manipulate them to seek care.

Davis said that people suffering from loneliness, anxiety, depression or feelings of isolation often have a strong fear of being judged, often leading to the long length of time it takes to get care.

However, access to care is extremely easy because providers are legally able to offer more services by teleconference or telephone than they ever have before.

Dark consequences 

Davis cautioned employers that 3 out of every 10 employees experience some sort of mental health condition that impacts their performance at work, but as a result of the COVID-19 pandemic’s impact, that ratio is more like 5 out of 10.

Mental health issues stemming from COVID-19 may manifest in many forms.

“We are going to experience and witness increased addiction. We have already seen alcohol sales have started to rise, and that people often use substances as a way to deal with feelings of loneliness and isolation,” Davis said.

Burrell Behavioral Health also projects an increase in domestic violence instances in the Springfield metro area, though domestic violence and sexual violence often go unreported.

Freedom’s Rest Family Violence Center in Ozark has an 11-county service area which serves Christian County and surrounding Barry, Dallas, Douglas, Greene, Lawrence, Ozark, Polk, Stone, Taney and Webster counties.

The Freedom’s Rest 24-hour hotline received 960 calls in 2018. The Freedom’s Rest shelter served more than 400 clients for more than 15,000 bed nights in 2018. All of those statistics are expected to climb upward each year in Christian County.

Davis said that child abuse is also expected to increase as a result of stay-at-home orders, though the percentage of cases that are reported will drop.

“The number of child abuse and neglect hotline calls is only 40 percent of what it would be right now, and so we’re having some interesting things happening within the family dynamic that are leading to a spike on top of all of the people that just experienced some anxiety of COVID,” Davis said.

Using data from the SARS pandemic, mental health experts can project that the psychological aftermath of COVID-19 could last between a year to three years.

“It’s going to take a while for our world to get back into emotionally connecting with each other, and so the symptoms that you are experiencing now—we anticipate that some of those symptoms will be with us for one to three years,” Davis said.

Some employers may notice that employees are experiencing higher-than-usual job performance, Davis said, but there will likely be a rebound associated with that. That’s why he advises employers to watch for unusual behaviors amongst their employees, and to ask them three basic care questions: How are you doing? What kinds of challenges are you experiencing? How can I help you?

Not all of the consequences of the COVID-19 pandemic are negative, Davis said. Some couples and families are experiencing closer connections with each other because many of their past distractions like work and outside social events have been eliminated.

“It’s creating some benefits to marriages and to families that were unexpected,” Davis said. “At the end, I think we’re going to look back and say that even though there were some pretty significant challenges, there were some pretty significant benefits, as well.”


Symptoms of adjustment

-Difficulty concentrating

-Fatigue/sleep disturbances

-Paranoia and fear

-Irritability and moodiness

-High/low job performance

-General worry and apprehension

-Thinking about the worst

Mental health numbers and websites

Burrell Behavioral Health

1-800-494-7355 24-hour crisis line

(417) 761-5000 Schedule an appointment

National Suicide Prevention Hotline: 1-800-273-8255, text 741741, or visit

NAMI Southwest Missouri Warm Line: 877-535-4357

Touchstone Counseling

Freedom’s Rest 24-hour crisis hotline (417) 299-2494

Freedom’s Rest family violence shelter office (417) 582-0344 or

Missouri Coalition Against Domestic and Sexual Violence (573) 634-4161 or

National Domestic Violence Hotline 1-800-799-7233

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