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Adjustment Disorder and the Challenges of Coping with the Pandemic

A group of my friends was discussing a survey on women’s health that we have been filling out every few years for several decades. Fortunately, none of us had to answer “no” to questions on whether we could feed or dress ourselves, but we all fretted over the questions about whether we experienced depression during the past year. 

We’ve All Been Depressed

“Who hasn’t?” asked one. “Hands up if you haven’t.” No one responded. 

“Of course, we’ve all been depressed,” said another, and then, looking at each of us, she named stressful situations caused by the pandemic’s imposition of isolation.

One friend’s husband had a serious neurological disease, and she put herself into a strict quarantine for fear of bringing the virus into the house. Another had not seen two young grandchildren for months after her mother died, a third was unable to be with a who lived in Europe, and a fourth had a full house when her married son, wife, and baby came for a visit and stayed for almost a year. No one escaped the stress, anxiety, indeed, the hopelessness and helplessness of this past year. Even now, fear of another surge, of the new variants, of contact with crowds of maskless people made some of us fearful of venturing too far from our neighborhood. 

Situational Depression

But were we correct when we responded positively to the question about being depressed for two weeks or longer? If we had been able to see a therapist, should we have? Should we have gone on antidepressants? Or was our depression a predictable consequence of the lives we have all been living these past several months? 

“I think we all suffered from something called situational depression,” said one who had been looking up variants of depression on her smartphone. She read us the definition: “Situational depression is known medically as ‘adjustment disorder with depressed mood.’” She read out the symptoms: “Sadness, hopelessness, lack of enjoyment in normal activities, regular crying, constant worrying, feeling anxious, sleep difficulty, trouble focusing, feeling overwhelmed, not paying bills or taking care of important matters.” We all nodded. 

The only symptom not all of us shared was a disinterest in food: some of us did a lot of baking and a lot of eating in efforts to cope with pandemic stress.

But all of us shared the symptom “avoiding social situations and being isolated.”

Adjustment Disorder

Our discussion highlighted the difficulty of distinguishing a pathological mood state from one that seemed normal in the pandemic environment. Indeed, the modified definition of situational depression, “Adjustment Disorder,” seemed to reflect even more our responses to the pandemic because it describes an inability to adapt to the stress of a significant life change or to a serious physical illness.

In adults, this disorder is often seen among people diagnosed with potentially fatal diseases and often associated with other disorders, such as anxiety, depression, and alcohol abuse. Interestingly, the emotional changes in association with bereavement are not considered an adjustment disorder. 

Coping and Resilience

Although not everyone responds to potentially negative life changes with an inability to cope and with depression, those who do may be offered supportive psychotherapy and/or antidepressants. The goal is to enhance someone’s ability to cope with his or her current situation and find ways of preventing further depression if or when the situation worsens.

Life during the pandemic required (and still requires) this sort of coping and resilience. We were asked to cope with novel and, at the very least, difficult circumstances, and like someone with the diagnosis of advanced cancer, we knew that things could get much worse. Thus we were in the position of having to adjust to a moving target. Surges in cases of COVID-19, sometimes predictable, sometimes not, made it difficult to know how safe it was to venture outside, go to a store, or take a walk. The pandemic did not remove both the joys and tragedies of life, like births, deaths, sickness, and milestone achievements, but we could not participate, except through our computer or phone screens. 

Talking to Someone 

Many of us may have realized that our resilience, our ability to cope, was not keeping up with the demands thrust upon us. But what could we do about it? If you already had a therapist, then he or she might have been available online for a therapeutic session. But most of us did not have a professional psychological care provider in our phone contact list, and establishing a new and virtual patient-provider relationship was difficult, if not impossible.  

Talk therapy thus came from more traditional sources: by phone from a caring friend and/or relative. Many of us offered and received emotional support from those we knew. A group of us made sure to call a friend daily; her spouse was gravely ill, and except for a caretaker who came into the home daily, she often had no one to talk to, sometimes for an entire weekend. Our conversations, sometimes just relating bad jokes, eased her isolation and perhaps made coping a little easier.  

Getting to the Other Side of Adjustment Disorder 

In retrospect, should my friends and I have checked “yes” to “have self-diagnosed ourselves as depressed” during this past year when asked this by the health survey? We may have met some of the criteria for situational depression, i.e., adjustment disorder, and yet despite the depression, the anxiety, the isolation, and the social withdrawal we experienced, we are continuing to find ways to adjust. 

So maybe we were wrong in checking “yes.” Or maybe the definition of situational depression should come with a footnote: “May not apply during a pandemic.”

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