Concentra-affiliated Clinical Psychologist Explains Employee Mental Health Fragility in Months Ahead

Michelle Hopkins

Pandemic damage assessment and time to heal

The pandemic pummeled workforces, assaulting employees’ mental health and leaving fear, anxiety, isolation, loneliness, and deep wounds of loss (human and financial) that remain open and raw. However, with the pandemic also came changes in organizational behavior that may aid in recovery from the pandemic’s mental and emotional impact – in time. Apart from changes like telework and more flexible hours, the pandemic gave rise to managers and employees compassionately uniting against a mutual unknown, managers sharing more information with teams and showing more trust, and beneficent displays of organizational concern for employees and their families – in short, more appreciation of each other as people in the face of what so many information sources daily and relentlessly said was a threat to survival.1

As an occupational health provider, Concentra® goes beyond the norm, and that includes answers to questions about pandemic behavioral health effects (mental, emotional, and substance use). Concentra gives employers context into why pandemic-driven mental health fragility could last many months longer.

Norma Yacoub, PsyD, QME, a southern California clinical psychologist affiliated with Concentra, provides answers to questions you may have wondered about but not seen answered elsewhere.

Question 1: As a trauma to Americans, how does the pandemic compare to the World Trade Center attack on September 11, 2001 that killed almost 3,000 people?

Dr. Yacoub: “Trauma, especially mass trauma, activates a chronic threat response or basically, a hyperarousal of our ‘fight or flight’ response system. Depending on how the trauma develops and how long it lasts, our hyperactivated response to it may last for a long time. This explains some of the difference between 9/11 and the pandemic.

“9/11 was one major significantly traumatic event that had lasting consequences. Initially, the media covered it extensively. But gradually, other news was covered, too. Also, the media gave positive stories about survival sooner. People came together to share in the grief and mourn with one another. Finally, while the attack was made visual for all of us, through television, the geography of the direct impact was limited.

“The pandemic, on the other hand, was widespread with no boundaries. Everyone shared in the risk but could not come together to comfort each other or share in the grief. The societal environment was different, too. The media portrayed the pandemic as doom and gloom and instilled fears about contracting it. Death seemed imminent and, due to the political climate, there were constant battles.

“The pandemic was a severely isolating event. People were afraid of one another. There were two fears common with people I have been treating. First, was the fear of experiencing the pandemic and even COVID-19 alone. The second was the fear of giving the virus to loved ones. One of my patients who was hospitalized with COVID-19 had just gotten married. He found out his wife was pregnant. While in the hospital, unable to breathe or to communicate with his wife or anyone, he kept worrying about his wife and baby. He felt guilty for exposing her to it, even though he had been unaware then that he had it. He contracted the virus at work. He was an essential worker and like many people during the pandemic, he had to go to work. He later explained the residual emotional pain he experienced during the recovery process. He continues to harbor feelings of resentment, as well as guilt, about exposure to the virus. He is challenged and often reminded of how much he had to endure alone and, similarly, his wife had to experience the loss of their child alone, as well. The grief is shared but he is having difficulty letting go of the guilt.”

Question 2: Let’s look at another event. How did the Great Recession, from December 2007 to June 2009, compare to the pandemic in its impact on mental health and substance use?

Dr. Yacoub: “This recession and the pandemic shared similar and significant effects on mental and behavioral health. First, domestic violence increased because people with abusive partners were spending more time at home and experiencing financial stressors, including unemployment. Shelters shut their doors. Police were, perhaps, making fewer arrests. The threat of abuse compounded the stress, fear, and anxiety individuals were already experiencing from the traumatic event – either the recession or the pandemic.

“Next, in both events, people sought comfort and to reduce stress through excess consumption of food and alcohol. A survey by the American Psychological Association found that 42 percent of Americans gained “more weight than they intended” during the pandemic.2,3 Weight gain can be associated with low self-esteem and further burden people who may already have difficulty making fast and accurate decisions.

“Alcohol consumption also increased in the Great Recession and during the pandemic. 4,5,6  Boredom, lack of social contacts, loss of daily structure and reward after a hard-working day due to unemployment, and loneliness were all found to be factors in increased consumption of alcohol, as well as tobacco and cannabis.7

“Alcohol can have a major impact on mental health. Because alcohol is a depressant, it slows the body down and changes the chemical makeup in the brain as well as how it responds to situations. This has many effects, altering mood, energy levels, sleeping patterns, concentration, memory and more. Alcohol also reduces inhibitions and impacts decision making. It increases risky behavior, aggression, self-harm, and suicide in people who may already be going through a tough time. People experiencing a mental health difficulty may use alcohol to manage hard times or lift their mood. This can be helpful in the short term but make things harder to handle in the long run.”

Question 3: Were there any mental health effects of the pandemic that employers may find surprising?

Dr. Yacoub: “That’s difficult to say since there are relatively few studies that have been done. Some findings about loneliness during the pandemic may be different than what many people would have expected. First, we know that the pandemic and all the social isolation it caused increased loneliness significantly. In April 2020, 25 percent more adults said they were lonely than in 2018.8 But increased loneliness hasn’t been true for everyone, and it went down for some groups as the pandemic went on9, so that may surprise some people. Another surprise may be the impact on adults under 30; one study found that two-thirds of this group had high levels of loneliness and 37 percent felt they had low support from family.10  A British study investigated predictors of loneliness and concluded that a higher risk of being lonely existed for young adults, women, people with lower education or income, the economically inactive, people living alone, and urban residents.”11

Question 4: What can employers do to, first, recognize the signs of a possible mental health issue with an employee and, second, be supportive and offer effective assistance?

Dr. Yacoub: “Some signs of serious anxiety or depression include:

  • Decreased productivity
  • Increased conflict among coworkers
  • Near hits, incidents, and injuries
  • Decreased problem-solving ability
  • Increased tardiness and absenteeism

“There are several actions employers can take in the workplace to support employee mental health generally. First, educate managers and leaders about mental health and set reasonable expectations for them to have of their employees. Every person who becomes educated about mental health brings us one step closer to quashing the stigma that can attach to a mental health concern and keep employees from facing their inner demons. Next, research mental health outreach programs and make these resources readily available to employees.”

Question 5: In all your experience, have you ever been truly amazed at an employee’s recovery from a serious mental health crisis?

Dr. Yacoub: “Yes, an experience with a veteran firefighter is quite memorable because it illustrates how important it is for the manager or direct supervisor to be involved, personally and compassionately. The fire chief put himself on call for whatever the firefighter needed. He listened. He made sure the firefighter had support. I also worked with the firefighter to provide needed support as well as helped him learn new ways to manage his frustrations and his expectations of himself and others. Ultimately, there was a great benefit in reminding him about his passion for the job, like rekindling an old relationship. Over time, he transformed from someone who was ready to quit to someone who was ready and empowered to go back to a job he loved.

“Overall, the pandemic increased everyone’s awareness that mental health is important in the workplace, just as it is important in our homes. If there is a silver lining in terms of an important lesson we learned, it is in recognizing that mental health contributes to a healthy work environment and, ultimately, to increased productivity and job satisfaction.”


  1. How the Coronavirus Pandemic Will Change the Way We Work.” Society for Human Resource Management. May 29, 2020.
  2. One year on: Unhealthy weight gains, increased drinking reported by Americans coping with pandemic stress.” American Psychological Association. March 11, 2021.
  3. Margerison-Zilko C, Goldman-Mellor S, Falconi A, Downing J. Health Impacts of the Great Recession: A Critical Review. Current Epidemiological Reports. March 2016; 3(1): 81-91.
  4. I bid.
  5. Pollard MS, Tucker JS, Green HD. Changes in Adult Alcohol Use During the COVID-19 Pandemic in the US. JAMA Network Open. September 2020; 3(9): e2022942.
  6. Barbosa C, Cowell AJ, Dowd, WN. Alcohol Consumption in Response to the COVID-19 Pandemic in the United States. Journal of Addiction Medicine. October 23, 2020. PMID: 33105169.
  7. Vanderbruggen N, Matthys F, Van Laere SV, Zeeuws D, Santermans L, Van Den Ameele S, Crunelle CL. Self-Reported Alcohol, Tobacco, and Cannabis Use during COVID-19 Lockdown Measures: Results from a Web-Based Survey. European Addiction Research. 2020; 26(6): 309-315.
  8. McGinty EE, Presskreischer R, Han H. Psychological Distress and Loneliness Reported in US Adults in 2018 and April 2020. JAMA Research Letter. June 3, 2020.
  9. Loneliness Hasn’t Increased Despite Pandemic, Research Finds. What Helped?” National Public Radio. July 15, 2020.
  10. Liu CH, Zhang E, Fong GTF, Hyun S, Hahn HC. Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic. Clinical implications for U.S> young adult mental health. Psychiatric Research. August 2020; 290.
  11. Bu F, Steptoe A, Fancourt D. Who is lonely in lockdown? Cross-cohort analyses of predictors of loneliness before and during the COVID-19 pandemic. Public Health. September 2020; 186:31-34.