Soon after the coronavirus pandemic started, we saw a sharp increase in reports linking survivors of COVID-19 with the development of mental health problems. But until now, nothing had fully proved how bad the situation was. Finally, we have some numbers to back those claims.

A new study published in The Lancet Psychiatry has found that almost one in five people who have had COVID-19 have also later on been diagnosed with a mental illness within three months of testing positive. How were these calculations made and what does it mean for the double-edged sword that is coronavirus?

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For months now, we have been warned of an oncoming ‘tsunami of mental health problems’ due to the pandemic. Professor Til Wykes, Vice Dean for Psychology and Systems Sciences at King’s College London’s Institute of Psychiatry, Psychology and Neuroscience, who was not involved in this research, told the MIT Technology Review that “We know from previous pandemics that mental health difficulties usually follow in survivors, and this study shows the same pattern after COVID-19, so it is not unexpected.”

To calculate the exact consequences of testing positive for coronavirus and coming out of it alive, researchers from Oxford University and NIHR Oxford Health Biomedical Research Centre gathered the electronic health records of 70 million patients in the US, including 62,354 who had been diagnosed with COVID-19 from 20 January to 1 April 2020, but did not need to be hospitalised.

They found that 18 per cent of patients were diagnosed with a mental health issue in the 14 to 90 days after a diagnosis. Then, to differentiate how COVID-19 patients reacted compared to those suffering from other diseases, the team of researchers compared data with six other conditions (including flu and fractures) over the same time period.

Data showed that the likelihood of a COVID-19 patient being diagnosed with a mental health issue for the first time was twice that of those with other conditions. Anxiety disorders, insomnia, and dementia were the most common diagnoses.

On top of that, people with a pre-existing mental health condition—in particular, attention deficit hyperactivity disorder, bipolar disorder, depression, or schizophrenia—were 65 per cent more likely to be diagnosed with COVID-19.

Vaccines coming shortly or not, this study highlights how urgent the need for more mental health support is as more well-being problems appear across society in the coming months and even years. This collective trauma we’re going through will not heal itself without the necessary support. The loss of control over some major aspects of our lives and the lack of a clear endpoint to the situation led many of us to spiral into a diagnosable mental health problem, without even being diagnosed with coronavirus.

Obviously, we’re not all going through the same thing and coping during the COVID-19 pandemic can mean different things to different people. For example, healthcare workers as well as coronavirus patients are at an increased risk of such issues. The stress they have been under (and still are) could take months to be processed, which means we won’t know the pandemic’s full impact for a while.

Until then, putting a support system in place becomes our only hope at overcoming what has been one of the hardest years of the century.

Depression has many faces, and high functioning depression is one of them, which can have serious consequences if not addressed and treated. While many mental illnesses are severe enough to impair a person’s ability to function. In some cases, a mental illness may be less severe, and although a person experiences symptoms, they are still able to function normally (or almost normally) most of the time.

The signs and symptoms of high functioning depression are similar to those caused by major depression but are less noticeable, which is why you should be looking out for them. Here are some clear signs and symptoms that can indicate whether you’re suffering from high functioning depression or not.

Depression affects all personalities and can look very different in various people. High functioning depression, officially called persistent depressive disorder (PDD), is the real deal, however it can be difficult to detect in oneself, and even more so in others.

To the outside world, a person with PDD seems completely fine but internally, that person is struggling. This can lead some to think that high functioning depression is not as ‘serious’ as major depression, but it should be diagnosed and treated, just like any other mental illness.

High functioning is not the same as fully functioning—with this type of depression there is still some impairment. When someone is able to function but still experiences significant symptoms of depression, that’s what is called PDD. Previously, this mental illness was called ‘dysthymia’ and is sometimes still referred to by that term.

High functioning depression is a recognised mental health condition that should be diagnosed by a psychiatrist or other mental health professional. There are certain criteria that describe the symptoms and that need to be met for a precise diagnosis to be made. Many of the symptoms are similar to those used to diagnose major depression.

An individual suffering from PDD experiences a depressed mood most days and for most of the day, for a minimum period of two years. The depressed mood must include two or more of these symptoms: lack of energy and fatigue, insomnia or oversleeping, decreased appetite or overeating, difficulty concentrating and making decisions, lowered self-esteem, and feeling sad and hopeless.

In addition to these symptoms that cause a depressed mood most of the time, there are a few other criteria that have to be met to make a diagnosis of PDD. The symptoms mentioned above must be felt on most days for at least two years without any relief from depression for longer than two months during that period, otherwise, you might just be having a rough few months.

If the individual has been through a period of mania or hypomania, an unusually euphoric and energetic mood, then this might not be PDD. You should also be careful whether these symptoms of depression aren’t better explained by a different mental illness, a medical condition, or by substance abuse.

Finally, the symptoms and depressed mood mentioned previously must cause some impairment in one or more areas of normal functioning and significant distress in the individual. Only after ‘meeting those criteria’ will you be able to confirm whether you’re suffering from high functioning depression. And even then, you may also meet criteria for major depression.

You’re feeling down most of the time, and no matter how many times your friends and family refer to you as grumpy or gloomy, you simply can’t shake it off. When you do feel happy, it doesn’t last long. You feel tired all the time, whether you’ve slept enough or not. You’re not lazy, but people might assume so just because you can’t summon the energy needed to function normally. You manage to do everything you’re supposed to do, like go to work, keep your flat clean and force yourself to interact with others just enough, but it always seems like a monumental effort.

You feel bad about yourself, and judge the way you look or the way you behave. You gain or lose weight without meaning to, because you either have no appetite or overeat without thinking about it. You may cry without an obvious reason sometimes. At work, you do your best but focusing on a task is a real challenge. PDD can result in substance abuse, chronic pain, relationship difficulties, and problems at work or school.

Trust me, it can. While PDD may not be as severe or debilitating as major depression, no one should have to live with a constant low mood when effective treatments are available. First things first, you’ll need to get a diagnosis before even thinking about medication. As easy as that sounds, realising that your symptoms are actually clear signs of a mental illness is the hardest part. PDD hides behind your ability to function. That’s exactly when loved ones need to guide and support you, they could have the highest chance in recognising that something is wrong.

Once diagnosed, high functioning depression can be treated with a combination of therapy and medications. Antidepressants can help but they can take several weeks to work, and beware of their side effects. This means that you might have to try a few different types to find a medication that works best for you.

Therapy is also a major help when treating PDD. By teaching you ways to recognise negative patterns in your thoughts and actively change them, therapy can be the first step towards ‘recovery’ in many cases.

Getting help is essential, because treatment (both through therapy and sometimes medication) can make your life more enjoyable, improve your mood and your functioning. It can bring you a better quality of life. Battling with a mental health condition is often done internally, but that doesn’t mean you shouldn’t reach out for external help, it’s there for you.